TRICARE beneficiary with a cold



What is the Flu?

Influenza, also called the “flu”, is a viral infection that affects the nose, throat and lungs. The flu spreads through the air when a person sneezes or coughs and can even be transmitted through touch. Flu symptoms vary from person to person but common symptoms include: high fever, headache, fatigue, cough, sore throat, runny nose, and muscle aches. Complications of flu can include pneumonia, ear infections, sinus infections, dehydration, and even death.

Flu Prevention

Practicing healthy habits, like covering your mouth when you cough and routinely washing your hands, will help prevent the spread of illnesses like the flu.  The flu vaccine is the most effective method for preventing the flu. The CDC recommends everyone 6 months and older get a flu shot. Certain people are at higher risk for serious medical problems if they get the flu, so it is especially important they get a flu shot. People at high risk include young children, persons age 65 and older, women who are pregnant, people with certain chronic conditions such as heart, lung, or kidney disease, diabetes, asthma or a weakened immune system, health care workers, and people who live in nursing homes or long term care facilities.
TRICARE covers two types of flu vaccines. The “flu shot”, containing a dead virus, is approved for use in both healthy populations and those with chronic conditions, ages 6 months and older. The nasal-spray vaccine, made with a live weakened flu virus, is approved for use in all healthy people (ages 2-49) who are not pregnant.
Flu Shots and other immunizations are considered preventive services by TRICARE policy. To be covered by TRICARE, get your flu shot from a TRICARE network provider or a TRICARE participating pharmacy.
To find a participating pharmacy near you, visit the Express Scripts web site or call 1-877-363-1303. Note: laws vary from state to state. Call your local pharmacy to verify vaccination schedule, availability, and any age restrictions.

Seasonal Flu Vaccine Referral Requirements

Prime beneficiary to Non-Network provider:
  • Requires a referral
  • With a referral--beneficiary may be assessed a copay for the office visit (unless ADSM/ADFM)
  • Without a referral -- pays POS
Prime beneficiary to Network provider
  • Does NOT require a referral
  • Beneficiary NOT assessed a co-pay
Standard beneficiary to Network or Non-Network provider
  • No referral required
  • No cost share

Related Links

TRICARE Flu web portal leaving site
CDC Seasonal Flu leaving site
What You Need to Know: Flu Vaccine leaving site



Last Update: July 24, 2014