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H1N1 Referral and Authorization Waiver
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TRICARE is waiving the referral and authorization requirements for TRICARE Prime beneficiaries to receive the H1N1 vaccine from any TRICARE-authorized provider without a referral from their primary care manager. The requirement is waived from October 1, 2009 - April 30, 2010.
H1N1 Flu Vaccine Charges and Referral Requirements
Prime beneficiary to Non-network provider
- Does NOT require a referral if visit solely related to H1N1 vaccination.
- No co-pay accessed if visit solely related to H1N1 vaccination (or if beneficiary is ADSM or ADFM)
Prime beneficiary to Network provider
- Does NOT require a referral
- Beneficiary NOT accessed a co-pay
Standard beneficiary to Network or Non-Network
- No referral required
- No cost share
The referral and copay requirements listed above apply to visits that only include the receipt of TRICARE-defined clinical preventive services.
Target Groups for H1N1 Vaccines
The target groups for the general population recommended by the ACIP (Advisory Committee on Immunization Practices) are:
- pregnant women
- people who live with or care for children younger than 6 months of age
- healthcare and emergency medical services personnel
- persons between the ages of 6 months through 24 years
- people ages 25 through 64 who are at higher risk for Novel Influenza A (H1N1) 2009 because of chronic health disorders or compromised immune systems
1 Definition of Pandemic: having widespread effect: existing in the form of a widespread epidemic that affects people in many different countries or very widespread disease: a disease or condition that is found in a large part of a population.
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