With the long, lazy days of summer coming to a close, parents across the country are getting their children ready for another school year. And, at the top of most to-do lists, is a visit to you for the child’s annual school physical.
TRICARE Prime covers required back-to-school physicals for children ages 5–11 as a clinical preventive service. TRICARE coverage is only for school physicals for enrollment, not for sports physicals. Sports physicals are not a TRICARE-covered benefit. Note: There may be the rare occurrence where you will need to perform a school physical on a child older than 11 years of age in order for the child to meet the enrollment requirements of a new school due to a permanent change of station move. In these cases, check with Humana Military Healthcare Services, Inc. for more information on TRICARE coverage and how to handle claims and reimbursement.
The school physical is important not only because it ensures children are healthy for school, but it also might be the only time throughout the year when you see some of these young patients. The American Academy of Pediatrics (AAP) suggests that primary care managers (PCMs) use the school physical visit as an opportunity to build and add to a child’s complete medical history. This can help you, and other health care providers, be aware of a child’s progress and development over time and, if necessary, detect emerging problems.
School physicals usually require a check to ensure a student’s immunizations are up to date. TRICARE coversage-appropriate vaccines per Centers for Disease Control and Prevention (CDC) guidelines to immunize children against common childhood diseases. Note: The CDC’s recommended vaccination schedule may be found on our
Immunizations page.
For school physicals, immunizations and other clinical preventive services, TRICARE Prime and TRICARE Prime Remote for Active Duty Family Members (TPRADFM) beneficiaries can see any network provider without a referral or prior authorization from their PCM. No copayment is required. TRICARE Standard (or TRICARE Extra) beneficiaries do not need a referral for school physicals; however, cost-shares and deductibles will apply.
If the parent and child are requesting a “sports physical” only, you should have the parent complete a Non-Covered Services Waiver form (or equivalent) in order to inform the parent that he or she will be paying for the non-covered service. The Non-Covered Services Waiver form may be found in the
TRICARE Provider Handbook.
For more information about TRICARE-covered school physicals, well-child care and immunizations, refer to the TRICARE Policy Manual, Chapter 7, Sections 2.2 and 2.5.
