Clinical preventive care is not diagnostic, but is intended to maintain and promote good health. Clinical preventive services are not related directly to specific illnesses, injuries, symptoms, or obstetrical care; they are performed as periodic health screenings, health assessments, or health maintenance visits. Services may be provided during acute and chronic care visits or during preventive care visits for asymptomatic patients.

Coverage may vary according to beneficiary type, age, and program option. TRICARE Prime enrollees do not need referrals or prior authorizations for clinical preventive services from MTF or network providers.* TRICARE Prime enrollees must have referrals and/or authorizations to visit non-network providers.   

If a clinical preventive service is not available from a network provider (e.g., a network provider is not available in the enrollee’s prime service area), a TRICARE Prime enrollee may receive the service from a non-network provider if they obtain a referral from their PCM and authorization from Humana Military. If a TRICARE Prime enrollee uses a non-network provider without first obtaining a referral from their PCM and authorization from Humana Military, payment will be made under the POS option only for services that are otherwise covered under TRICARE Standard.

Note: TRICARE Standard and TRICARE Extra beneficiaries may seek clinical preventive care from TRICARE-authorized network and non-network providers, and cost-shares and deductibles may apply.

For more information about covered clinical preventive services, refer to the TRICARE Policy Manual, Chapter 7, Sections 2.1–2.2 at TRICARE Manuals Online.