Health coverage changes at age 18 include HIPAA privacy protection

By Lesley AtkinsonSeptember 5, 2019

Health coverage changes at age 18 include HIPAA privacy protection
(Photo Credit: U.S. Army) VIEW ORIGINAL

FORT LEE, Va. -- Military dependents still covered by TRICARE at age 18 have greater responsibility for managing their own health care needs, and privacy of their medical information becomes law under the stipulations of the Health Insurance Portability and Accountability Act, typically referred to as HIPAA.

Nicole Miles, a medical support assistant in Kenner's Family Medicine Clinic at Fort Lee, is well-versed in the youth-to-adult transition under TRICARE because she helps patients daily with appointment scheduling, referral requests, verification of beneficiary coverage and more.

The topic of what happens when a depended turns 18 comes up often, and she professionally points out that they are now an adult with new rules and requirements associated with their health care.

"Most don't know their young adults have been moved over by Humana from Pediatrics to Family Medicine until they call to make an appointment," Miles said. "At age 18, they are now able to make their own appointments, set up their own TRICARE and Humana account, and handle their medical records.

If parents want to have access to their child's information, they must have a healthcare power of attorney, Miles emphasized. Without that, the staff can't discuss any health issues related to their adult child.

"When the young adult comes in for their first appointment, we explain the policies and procedures that now apply to them," she further explained. "We also provide them with a new Patient Packet. Then we discuss TRICARE Online and Humana. They are encouraged to establish an account in order to make appointments and track their benefits and history of referrals."

Another rule of the commonwealth most parents aren't aware of is that under Chapter 29 of Title 54.1, Code of Virginia Medicine, it is stated that a minor 14 years of age or older is physically capable of giving consent for medical services. In other words, for a parent to go back into the exam room, the adult child must give permission.

"Sometimes, the adult child doesn't want to say no when asked by the nurse in front of their parents for fear of being reprimanded," Miles said. "In those situations, they are able to speak with the MSA at the front desk and let them know they don't feel comfortable with a parent being in the examine room. It's not uncommon, actually. They want to be in a safe environment. Especially with young girls that come in and do not want their parents to know they might have an issue."

Additionally, minors over the age of 14 can consent to medical or health services for the following:

• To determine the presence of or treat venereal disease or any infectious or contagious ailment that the State Board of Health requires to be reported.

• Birth control, pregnancy or family planning except for the purposes of sexual sterilization.

• Outpatient care, treatment or rehabilitation for substance abuse.

• Outpatient care, treatment or rehabilitation for mental illness or emotional disturbance.

Another area where confusion often exists is what happens when the young adult goes off to college but remains a Kenner Army Health Clinic beneficiary. "That's where having that TRICARE Online account comes in really handy," Miles noted. "It is possible for the parent to schedule an appointment if they have a copy (front and back) of the individual's ID card. They can't use theirs even though they're the sponsor."

TRICARE states that if a dependent youth is heading to college, he or she has 90 days to update their health plan. The "student status" must be reflected in the Defense Enrollment Eligibility Reporting System, also known as DEERS. They need a letter from the school registrar's office stating they are enrolled full-time in an accredited college in pursuit of an Associate's Degree or higher. The sponsor must show he or she is providing more than half of their financial support. This information must be provided at an ID card issuing facility. Visit milConnect for further details.

Additional information on this topic is available on the TRICARE Online website. The medical support assistants in pediatrics and the family medicine clinic also can assist beneficiaries.

Related Links:

U.S. Army Medical Command