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TRICARE Prime: 
Covered Services,
Limitations and Exclusions

Covered Services

TRICARE Prime covers most care that is medically necessary and considered proven. However, there are special rules or limits on certain types of care, while other types of care are not covered at all. Coverage details on the following services can be viewed in the Prime Handbook.
  • Outpatient and inpatient services
  • Clinical preventive services
  • Behavioral health services
  • Pharmacy services
  • Maternity services
  • Dental services.

Services or Procedures with Significant Limitations

A list of services and coverage details can be found by going to the Prime Handbook.

Exclusions

In general, TRICARE excludes services and supplies that are not medically or psychologically necessary for the diagnosis or treatment of a covered illness (including a mental disorder) or injury or for the diagnosis and treatment of pregnancy or well-baby care.  All services and supplies (including inpatient institutional costs) related to a non-covered condition or treatment, or provided by an unauthorized provider, are excluded.  A list of exclusions can be viewed in the Exclusions Section of the Prime Handbook.

For more information on behavioral health exclusions, contact ValueOptions at 1-800-700-8646.
 
Last Reviewed: February 10, 2011