Below you will find a list of medical, surgical, and behavioral health care services generally not covered under TRICARE. The items here are not intended to be all-inclusive. For more information call Humana Military's Service Line at 1-800-444-5445.
Services or Procedures with Significant Limitations
Abortions—Abortions are only covered when the mother’s life is in danger. The attending physician must certify in writing that the abortion was performed because a life threatening condition existed. Medical documentation must be provided.
Cardiac and Pulmonary Rehabilitation—Both are covered only for certain indications. Phase III cardiac rehabilitation for lifetime maintenance performed at home or in medically unsupervised settings is excluded.
Chiropractic Care—Coverage is limited to active duty service members and is only available at specific military treatment facilities under the Chiropractic Care Program.
Cosmetic, Plastic, or Reconstructive Surgery—Only covered when used to restore function, correct a serious birth defect, restore body form after a serious injury, improve appearance of a severe disfigurement, or after a medically necessary mastectomy.
Cranial Orthotic Device or Molding Helmet— Cranial orthotic devices are excluded for treatment of nonsynostic positional plagiocephaly.
Dental Care and Dental X-Rays—Both are covered only for adjunctive dental care.
Dental Anesthesia and Facility Charges— Covered only to safeguard a patient’s life.
Education and Training—Education and training may be covered under the Program for Persons with Disabilities when it is not otherwise excluded in policy and is specifically designed to accommodate the disabling effects of a qualifying condition (e.g., Braille for a blind person). Outpatient diabetic self-management and training programs are covered when the services are provided by a TRICARE-authorized individual provider who also meets national standards for diabetes self-management education programs recognized by the American Diabetes Association (ADA). The provider’s “Certificate of Recognition” from the ADA must accompany the claim for reimbursement.
Eyeglasses or Contact Lenses—Both are covered under limited circumstances such as corneal lens removal.
Food, Food Substitutes or Supplements, or Vitamins—Not covered outside of a hospital setting.
Gastric Bypass—To be covered, you must be 100 pounds over ideal body weight and have a co-morbidity or 200 percent of ideal body weight with no co-morbidity.
Genetic Testing—Genetic testing is only covered under certain conditions.
Hearing Aids—Hearing aids are covered under the PFPWD.
Intelligence Testing—Only covered when medically necessary for the diagnosis or treatment planning of covered psychiatric disorders.
Marital Therapy and/or Couples Counseling—Beneficiaries for whom this treatment is authorized must have a covered DSM-IV primary diagnosis, and the marital or couples therapy must be medically necessary.
Private Hospital Rooms—Not covered unless ordered for medical reasons, or a semiprivate room is not available. Hospitals that are subject to the TRICARE diagnosis-related group (DRG) payment system may provide the patient with a private room, but will only receive the standard DRG amount. The hospital may bill the patient for the extra charges if the patient requests a private room.
Smoking Cessation—Not a covered service except for certain TRICARE Prime Remote active duty service members who meet specific criteria.
Weight Reduction—Only covered when psychiatric or psychological evaluations are conducted to assess appropriateness for covered surgical gastric procedures.
