Summer is still in full swing, but the first day of school will be here before you know it, and parents will be
making appointments for their children’s school physicals.
 
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.
 
A child’s school physical may be one of the only times throughout the year that you see some of your young patients. Because of this, the American Academy of Pediatrics suggests that 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 you and other health care providers monitor a child’s progress and development over time and detect emerging problems.
 
School physicals often require confirming the child’s immunizations are up-to-date. TRICARE covers ageappropriate vaccines per Centers for Disease Control and Prevention (CDC) guidelines to immunize children against common childhood diseases. Please read the CDC's recommended vaccination schedule.
 
A beneficiary using TRICARE Prime or TRICARE Prime Remote for Active Duty Family Members does not need a referral or prior authorization from his or her 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 a beneficiary uses TRICARE Standard or TRICARE Extra; however, cost-shares and deductibles will apply.
 
Remember, TRICARE coverage is only for school physicals required for enrollment, not for sports physicals. If the child’s parent requests a sports physical only, you should have the parent complete a Non-Covered Services Waiver form. By completing this form, the parent acknowledges that he or she will be paying for the non-covered service. You may also advise beneficiaries to check if their MTFs offer sports physicals, as some sites may offer this service.