Effective September 1, 2009 and in accordance with the National Defense Authorization Act, TRICARE will waive the out of pocket cost shares for the following clinical preventive services provided to TRICARE non-Prime beneficiaries (not eligible for Medicare). The clinical services include:

• Covered screening exams, such as colorectal cancer screening, breast cancer screening, cervical cancer screening, and prostate cancer screening
• Immunizations
• Well-child visits

Any combination of the above services performed during a visit for the non-Prime TRICARE beneficiary on or after dates of service September 1, 2009 will no longer expect or calculate a Standard or Extra cost share as part of patient responsibility on the claim. Other clinical services performed during the same visit are subject to the appropriate cost share and deductibles.

HMHS advises the provider offices to submit the claim without estimating or collecting the cost share whenever there are “preventive services” performed to ensure the “patient responsibility” is determined accurately by the claims processor, PGBA. This will prevent the provider office from the administrative work of refunding collected cost shares to the beneficiaries.

(Claims processed prior to September 1, 2009 and as far back as October 14, 2008 will be handled between the beneficiary and the claims processor, PGBA for any out of pocket refunds).