Beneficiary Standard Handbook

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Inpatient Services
Clinical Preventive Services
         
Inpatient Services

Figure 3.2 provides coverage details for covered inpatient services. Note: This chart is not intended to be all-inclusive.

Inpatient Services:  Coverage Details


Figure 3.2
Service Description
Hospitalization Semiprivate room (and when medically necessary, special care units), general nursing, and hospital service. Includes inpatient physical and surgical services; meals (including special diets); drugs and medications while an inpatient; operating and recovery room; anesthesia; laboratory tests; X-rays and other radiology services; necessary medical supplies and appliances; and blood and blood products.
Skilled Nursing Facility Care Semiprivate room; regular nursing services; meals, including special diets; physical, occupational, and speech therapy; drugs furnished by the facility; and necessary medical supplies and appliances. Unlike Medicare, unlimited number of days as medically necessary.

   
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Clinical Preventive Services

Figure 3.3 provides coverage details for covered clinical preventive services. Note: This chart is not intended to be all-inclusive.

Clinical Preventive Services: Coverage Details


Figure 3.3
Service Description
Health Promotion and Disease Prevention Examinations

Office visits may be covered for the following services (subject to age and other criteria):

  • Cancer screening examinations and services (breast cancer, cancer of female reproductive organs, colorectal cancer, and prostate cancer)
     
  • Infectious diseases (Hepatitis B screening, human immunodeficiency virus [HIV] testing,) and preventive therapy when at-risk (tetanus, animal bite, Rh immune globulin, and exposure to certain infectious diseases, including tuberculosis)
     
  • Genetic testing and counseling for certain clinical indications during pregnancy
     
  • Other: routine chest X-rays and electrocardiograms required for admission when a patient is scheduled to receive general anesthesia on an inpatient or outpatient basis
Immunizations Covered for age-appropriate dose of vaccines as recommended by the Centers for Disease Control and Prevention. Immunizations for active duty family members whose sponsors have permanent change of station orders to overseas locations also are covered.
Other Health Promotion and Disease Prevention Services

The following services may be covered if provided in connection with a visit for immunizations, Pap smears, mammograms, or examinations for colon and prostate cancer:

  • Cancer screening (testicular, skin, oral cavity, pharyngeal, and thyroid)
     
  • Infectious disease (tuberculosis screening, Rubella antibodies)
    Cardiovascular disease (cholesterol screening, blood pressure screening)
     
  • Body measurements (height and weight)
     
  • Vision screening (only allowed under well-child services)
     
  • Audiology screening (only allowed under well-child services)
     
  • Counseling services expected of good clinical practice that are included with the appropriate office visit at no additional charge (dietary assessment and nutrition; physical activity and exercise; cancer surveillance; safe sexual practices; tobacco, alcohol, and substance abuse; promoting dental health; accident and injury prevention; and stress, bereavement, and suicide risk assessment)
School Physicals Covered for children ages 5-11 if required in connection with school enrollment. Note: Annual sports physicals are not a covered benefit.
Well-child Services

Covered from birth to age 6; includes visits, immunizations, and vision screening.

      
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Last Reviewed: February 15, 2008