Provider Handbook
   

Previous Page           Table of Contents          Next Page

   


TRICARE Prime Clinical Preventive Eye Examinations
Clinical preventive eye examinations are an enhanced benefit under TRICARE Prime (see Figure 5.3). A preventive eye examination is a comprehensive screening for determination of vision or visual acuity, ocular alignment, and red reflex, along with external examination for ocular abnormalities.
 
TRICARE Prime Vision Care Coverage

Fig. 5.3
Beneficiary Coverage Provider
Infants One eye and vision screening at birth and 6 months Assigned primary care manager
Children (ages 3-6) One comprehensive eye exam every two years Optometrist or ophthalmologist
Adults and children over age 6 enrolled in TRICARE Prime One comprehensive eye exam per calendar year Optometrist or ophthalmologist

Eyeglasses or Contact Lenses

 ADSMs are covered for eyeglasses at MTFs at no cost.  To obtain eyeglasses or contact lenses outside of the MTF, prior authorization is required through the MTF or MMSO.

For all other TRICARE beneficiaries, contact lenses or eyeglasses are only cost-shared with prior authorization for treatment of infantile glaucoma, keratoconus, dry eyes when normal tearing is inadequate or absent, corneal irregularities other than astigmatism, or loss of human lens function resulting from eye surgery or congenital absence.

Benefits are limited to only one set of implantable lenses required to restore vision. A set may include a combination of both implantable lenses and eyeglasses when the combination is necessary to restore vision. If there is a prescription change related to the qualifying eye condition, a new set may be cost-shared.

Replacement lenses for those that are lost, have deteriorated, or have become unusable due to physical growth are not covered. Adjustments, cleaning, and repairs of eyeglasses are also not covered.

Other

Medically necessary eye exams are covered for all categories of TRICARE beneficiaries. TRICARE Prime beneficiaries need prior authorization for medically necessary visits if they are not performed at an MTF.

Diabetic beneficiaries enrolled in TRICARE Prime are covered for an eye exam each year, regardless of their sponsor’s military status. There is no copayment for these exams.

For more information about TRICARE’s vision coverage, access Chapter 7, Section 2.1–2.2 of the TRICARE Policy Manual.


Back to Top
Last Update: July, 2007