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Stay Healthy with TRICARE’s Clinical Preventive Services

One of the best and easiest ways for you to maintain a healthy lifestyle is to take advantage of the clinical preventive services offered through TRICARE Prime.

As a TRICARE Prime beneficiary, you can receive a wide array of clinical preventive services from any network provider without a referral from your primary care manager (PCM). There is no copayment for clinical preventive services when the care is received from TRICARE network providers (or, when approved, from non-network providers).

If your PCM does not offer these services, you can receive them from any network provider without a referral. If you live in an area where there is no network provider for a specific service, you will need a referral from your PCM.

If you receive clinical preventive services from a non-network provider without a referral, this will result in higher out-of-pocket costs for you under the point of service option.

“You may think you need a referral for clinical preventive services, but you don’t,” said Brenda Kissinger, regional manager, Population Health/Case Management for Humana Military Healthcare Services. “We want beneficiaries to be more in control of their health care and know what’s available to them.” Some laboratory or radiology tests may require a script or order from the PCM or network provider to access care, but no referral is required.

The following are some of the services that are available as part of TRICARE’s clinical preventive services:
      

• Eye exams—TRICARE Prime beneficiaries, including retired service members and their families, are eligible for one comprehensive eye exam by an ophthalmologist or optometrist every two years. Active duty family members, whether enrolled in TRICARE Prime or not, are eligible for one eye exam in any calendar year. Diabetics at any age should have a comprehensive eye exam at least once a year.
  
  
• Immunizations for age-appropriate doses of vaccines, as recommended by the Centers for Disease Control and Prevention, are covered.
  
  
• School physicals are covered for children, ages 5-11, if required in connection with school enrollment.
  Well-child services are covered for beneficiaries from birth to age 6; including visits, immunizations and vision screening.
  
  
• Cancer screening examinations and services for breast cancer, cancer of the female reproductive organs, colorectal cancer and prostate cancer are covered.

You can make an appointment to receive all of the services listed above without a referral from your PCM. Additionally, during these visits you may also receive other health promotion and disease prevention services. Some of these services include screenings for: testicular, skin, oral cavity and thyroid cancer; infectious diseases including tuberculosis and rubella; and cardiovascular disease.

For more information about clinical preventive services, including recommended time frames, talk to your PCM or refer to the “Covered Benefits, Limitations, and Exclusions” section of your TRICARE Prime Handbook.

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Last Update:  March 3, 2008