The TRICARE Policy Manual defines preventive care as care that is “not directly related to specific illness, injury, a definitive set of symptoms or obstetrical care.”

TRICARE covers clinical preventive services differently, depending on the service and the TRICARE option beneficiaries choose. Health promotion and disease prevention examinations include immunizations, school physicals and screenings for breast cancer, cancer of the female reproductive organs, prostate cancer and colorectal cancer.

TRICARE also covers disease prevention exams for testicular, thyroid, oral cavity and pharyngeal cancers, and tuberculosis and rubella screenings.

All active duty family members, regardless of enrollment status, are eligible for one comprehensive eye exam by an ophthalmologist per year.

         
TRICARE Prime Coverage

In addition to these covered clinical preventive services, all TRICARE Prime beneficiaries, including retired services members and their families, are eligible for one comprehensive eye exam by an ophthalmologist or optometrist every two years.

TRICARE Prime beneficiaries (including TRICARE Prime Remote and TRICARE Prime Remote for Active Duty Family Members) do not require a referral or prior authorization for clinical preventive services received from network providers.* There is no copayment for clinical preventive services when care is received from TRICARE network providers (or, when approved, non-network providers).

*Active duty service members (ADSMs) must have a referral and prior authorization before receiving clinical preventive services from a civilian provider. TRICARE Prime Remote ADSMs can receive these services from their assigned civilian primary care manager without a referral or prior authorization.

The clinical preventive services covered for TRICARE Standard and TRICARE Extra beneficiaries are very similar to those covered for TRICARE Prime beneficiaries. However, except for vision services covered for infants and children up to age 6 under the well-child benefit, preventive eye exams are not covered for non-active duty (retirees and their family members) TRICARE Standard or TRICARE Extra beneficiaries.

TRICARE Standard beneficiaries may have clinical preventive services performed by a network or TRICARE-authorized non-network provider and are required to pay the applicable cost-share and deductible for the care provided.

  
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Consult reports are required to be returned to the primary care manager or initiating provider within 10 working days of the patient encounter. For routine specialty referrals for initial office visits and all outpatient and inpatient services, you must provide complete and legible documentation for these reports to be accurate and useful.

Returning consult reports, operative reports and discharge summaries to the initiating provider is important for timely follow up and continuity of care. Please be responsive to the request when asked to return a consult report for TRICARE beneficiaries.

Providers who treat TRICARE beneficiaries coming from the local military treatment facility may receive a faxed reminder or a call to return a consult report for a recent visit and service. Your office should return the consult report, operative report or discharge summary as requested.

Please use the fax reminder as the cover sheet and dial the fax number listed on the reminder page.

  
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Created: March 19, 2007