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Immunization Details
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TRICARE Prime
Active Duty Family Members
Immunizations For Children
Human Papillomavirus (HPV)
Back to School
Where to Obtain a Vaccine
Filing a Claim
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TRICARE PRIME |
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Under TRICARE Prime, immunizations are covered under clinical preventive services. Immunizations for children from birth to age 6 are covered under well-child services, a sub category of clinical preventive services. As part of TRICARE Prime’s enhanced benefit, you can go to any network provider without a referral for clinical preventive services and well-child services and pay nothing out of pocket. |
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Active Duty Family Members |
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Immunizations for active duty family members whose sponsors have permanent change of station orders to overseas locations also are covered. If these immunizations for overseas travel are received in the MTF they are at no cost to the beneficiary. ADFMs that need to go outside the MTF for an immunization and are TRICARE Prime have no co-payment. ADFMs who are not TRICARE Prime may either go to a network provider for their immunization and pay 15% of the contracted reimbursement rate or go to a provider that is not in the TRICARE network and pay 20% of the maximum allowable charge. |
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Immunizations for Children |
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TRICARE knows immunizations are important for your child’s health and will provide all age-appropriate vaccines recommended by the Center for Disease Control and Prevention’s Advisory Committee on Immunizations Practices. Recommended vaccines are available at military treatment facilities as well as TRICARE network and non-network providers.
Children are particularly vulnerable to infection, and immunizations are important for their health and well-being. By staying up-to-date on recommended vaccines, you can protect your children from these diseases: chicken pox, polio, tetanus, measles, mumps, rubella (German measles), diphtheria, pertussis (whooping cough), Haemophilus Influenzae type B (a bacterial microorganism that causes several serious, often life-threatening illnesses), meningococcal disease, pneumococcal disease, influenza and hepatitis B. Immunizations also contribute to the well-being of everyone by reducing the chance for diseases to spread.
Your doctor can also suggest the best time for other recommended immunizations. Recommendations may vary for children in different age groups or for children with certain medical conditions who require additional immunizations.
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Human Papillomavirus (HPV) |
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Following a Centers for Disease Control and Prevention (CDC) recommendation, TRICARE recently made Gardisil® available to its beneficiaries. It is the vaccine that may help to prevent the Human Papillomavirus (HPV) and ultimately cervical cancer. The three-dose vaccine (given over a period of six months) is for girls ages 11-12, and it can be safely given to those as young as 9 years old.
Currently, there is no federal law mandating that girls be vaccinated against HPV before beginning school; however, some states are considering making it a requirement for 11- and 12-year-old girls.
HPV vaccine Questions and Answers
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Back to School |
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Once again, it’s time to get the kids ready for school. Will your child be ready?
You remembered the new clothes, shoes, lunch box and school supplies, but did you remember to schedule your child’s physical? In most cases, he or she won’t be able to start school without one.
If your child is between the ages of 5-11 and is TRICARE-eligible, call your primary care manager and schedule an appointment today! Your child’s annual school physical is covered by TRICARE; however, sports physicals are not. Be sure to take any required state or local forms with you to the appointment.
TRICARE Health Matters Newsletter - Issue 4:2007
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Where to Obtain a Vaccine |
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If you live near a post or base, check with the Military Treatment Facility (MTF) to see if they offer immunizations and vaccines. If immunizations and vaccines are not available at the nearest MTF or you do not live near the post or base, please contact your primary care doctor for preventive immunizations and vaccines. |
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Filing A Claim |
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For TRICARE Prime and Extra beneficiaries, your provider will submit claims on your behalf. If you are using the TRICARE Standard option, you may be required to submit your own health care claims.
To file a claim, obtain and fill out a Claim Form Patient’s Request for Medical Payment.
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- When filing a claim, attach a readable copy of the provider’s bill to the claim form, making sure it contains the following:
- Sponsor’s Social Security number (SSN) (Eligible former spouses should use their social security number.)
- Provider’s name and address (If more than one provider’s name is on the bill, circle the name of the person who treated you.)
- Date and place of service
- Description of the service
- Charge for the service
- Diagnosis (If the diagnosis is not on the bill, be sure to complete block 8a on the form. For Immmunizations, "preventive service" can be entered).
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Be sure to complete all 12 blocks of the form correctly and sign it.
You may be required to pay up front for services if you see a non-network TRICARE-authorized provider who chooses not to participate on the claim. In this case, TRICARE will reimburse you directly for the TRICARE allowable charge minus any applicable deductible and cost-share. Remember that nonparticipating providers may charge you up to 15 percent above the inpatient TRICARE allowable charge for services in addition to your cost-share and/or deductible.
Send your claims to the claims processor for the region in which you live. If you live in the South Region send your claims to:
TRICARE South Region
Claims Department
P.O. Box 7031
Camden, SC 29020-7031
Be sure to keep a copy of the paperwork for your records. If you live in the South region and have a question regarding claims processing, you may call Humana Military's claims processor, PGBA, at 1-800-403-3950. Check the status of your claim at the PGBA Web site or at Online Beneficiary Services.
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