Summer is still in full swing, but the first day of school will be here before you know it. If you haven’t already scheduled appointments for your children’s school physicals, now is the time to do it!
TRICARE Prime and TRICARE Standard cover required back-to-school physicals for children ages 5–11 years as a clinical preventive service. Sports physicals are not a TRICARE-covered benefit.
Your child’s school physical may be one of the only times throughout the year he or she sees a doctor. Because of this, the American Academy of Pediatrics suggests providers use a child’s yearly school physical as an opportunity to build and add to his or her complete medical history. This can help ensure your child’s progress and development over time are monitored and potential emerging problems are detected.
School physicals often require confirming your child’s immunizations are up-to-date. TRICARE covers age-appropriate vaccines per Centers for Disease Control and Prevention (CDC) guidelines to immunize children against common childhood diseases. The CDC’s recommended vaccination schedule may be found at the
CDC Web site.
If you use TRICARE Prime or TRICARE Prime Remote for Active Duty Family Members, you don’t need a referral or prior authorization from your primary care manager to see a network provider for school physicals, immunizations or other clinical preventive services. In addition, no copayment is required for these services.
Referrals for school physicals are also not necessary if you use TRICARE Standard or TRICARE Extra. Cost-shares and deductibles will apply to the school physical; however, if an immunization is required, the immunization will not be subject to cost-sharing.
Remember, TRICARE coverage is only for physicals required for school enrollment, not for sports physicals. If your child requires a sports physical only, your provider may ask you to complete a Request for Non-Covered Services form. By completing this form, you acknowledge that you will pay for the non-covered service. You may also want to check if your MTF offers sports physicals, as some sites may offer this service.
For more information about TRICARE-covered school physicals, well-child care and immunizations, visit
TRICARE's Web site.
