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It is VERY IMPORTANT that you understand how newborn coverage works and the steps you must take to ensure continuous coverage for your new baby from the day of their birth on.
Please read the following information carefully and call a Martin’s Point US Family Health Plan representative at 1-866-659-0210 if you have any questions.
If at least one other member of the newborn’s immediate family is already enrolled in the Martin’s Point US Family Health Plan at the time of your baby’s birth, your baby can be conditionally enrolled in the US Family Health Plan for the first 90 days of their life.
The US Family Health Plan will pay claims for covered services your newborn receives from Day 1 through Day 90 under this Conditional Enrollment.
Birth is considered a Qualifying Life Event (QLE) which allows a family to enroll any other eligible member of the family within 90 days of the newborn's date of birth. Once the other family member is enrolled, we will be able to conditionally enroll the newborn at the same time.
Anyone enrolling while using this QLE options will have coverage begin on the newborn's date of birth.
For newly adopted child's coverage, see below.
Call the Martin’s Point US Family Health Plan as soon as possible after the baby’s birth to notify us of their birth. This will ensure that your child will be conditionally enrolled so we can smoothly process any claims for services your baby receives in the first 90 days.
The easiest way to complete the application is by phone with one of our Customer Service representatives at 1-888-241-4556. You may also print, fill out, and mail or fax in the enrollment form yourself (found on the right side of this page).
When calling to complete the application over the phone, please be sure to have your newborn’s primary care provider's (PCP) full name, address, and the name of their supervising provider, if they have one.
IMPORTANT NOTE: Newborns cannot be conditionally enrolled via the Beneficiary Web Enrollment “BWE” system. The system can only be used if the newborn is already registered in DEERS. We do not recommend enrolling your newborn via the BWE system because it enrolls the newborn with a coverage start date of the date you complete the action in the BWE system and does not give you the ability to request coverage back to date of birth.
In order to complete the newborn's enrollment and ensure coverage beyond the first 90- day conditional period, you must register the baby in the DEERS database within 90 days of the newborn's date of birth.
Parents and legal guardians must enroll their newborn child in DEERS as soon as possible after birth. To establish a newborn’s TRICARE eligibility in DEERS, you must do the following things:
IMPORTANT NOTE: Any changes that impact family status must be reported to DEERS. Family status changes include marriage, divorce, or new child. Because DEERS enrollment is directly tied to TRICARE eligibility, care may be denied if the sponsor and family members are not enrolled in DEERS.
To enroll a newly adopted child, you will need to register them in DEERS first, then contact us to enroll them in the US Family Health Plan within 90 days of the date of the adoption.
Their date of enrollment will be backdated to the date of adoption.
Talk to one of our health plan benefit specialists today.