Items Included Under TRICARE Health Care Programs

07 Jul Items Included Under TRICARE Health Care Programs

TRICARE health care programs offer numerous benefits. Some examples of these benefits which are included in the health care include basic diagnostic and medical treatment.

TRICARE health care programs offer numerous benefits. Some examples of these benefits which are included in the health care include basic diagnostic and medical treatment. However, these programs also encompass a number of other health related benefits under the TRICARE coverage plans. It is suggested that you contact a Health Benefits Advisor prior to receiving these health care benefits to know complete details about any restrictions or limitations so that you can make the best informed decision about which TRICARE plan to choose.

For Anthrax Immunizations

Visit the webpage of https://www.vaccines.mil/Anthrax to find out more details regarding the Anthrax Vaccine Immunization Program for military personnel.

Purchasing Durable, Long-Lasting Medical Equipment

The TRICARE Standard program can help cover some costs for medical equipment. Under the program, there are cost-shares for the monetary amount spent on purchasing necessary medical equipment and items such as hospital beds, wheelchairs, oxygen tanks, etc. This medical equipment can be either purchased directly or you also have the option to rent or lease it. rented For covreage assistance, you must send a claim stating the reasons why you require the equipment and for the duration that it is required as well as other documented information. This should be sent along with the doctor’s prescription for the item(s) needed.

Annual Eye Exams for the Family Members of those in Active Service Duty

One eye examination per year is avaiable to members who are in active military duty as well as each of their family members. The eye examination will be performed to check thoroughly both the interior and exterior of the eyes and diagnose any problems with vision if there are any.

Treatment and Diagnosis for Family Planning

Under TRICARE, there is available assistance for family planning for birth control methods such as diaphragms, IUDS (intrauterine devices), birth control pills, shot injections, contraceptive implant systems, tubal litigations, pregnancy tests, vasectomies, etc.  The treatment and diagnosis for infertility is also covered by TRICARE health programs.

TRICARE Standard Coverage for Genetic Testing for your Unborn Child

The TRICARE Standard plan provides coverage for genetic testing for an unborn child in order to search for any possible defects. TRICARE does not cover to test to find out the gender of the child or nor does it cover paternity testing. The TRICARE Standard plan offers coverage only when you are more than 35 years of age and pregnant; you suffered from rubella during the first trimester of your pregnancy; or if either parent or a previous biological child has suffered from congenital defects, etc.

Complete Home Health Care Services by TRICARE

The home health care program offered by TRICARE provides complete care and home health aid services for patients. This includes receiving the services of well-trained nursing staff, necessary care, as well as speech, physical, and occupational therapies, etc. The duration that is covered by TRICARE is for about 28 hours per week for part-time health services or occasionally, at least 35 hours of aid per week. The home health agency will provide all of these home health care services and should be set up with a health care advisor.

Long-Term Health Insurance Coverage

Health care insurance for a long-term period can be purchased by active duty military members and retired personnel, as well as for members of their families. To obtain more details about long-term health insurance coverage, visit  www.opm.gov/insure/ltc.

Hospice Care Services for Terminally Ill Patients

The TRICARE program also provides hospice care as an alternative choice for those patients who are terminally ill and whose life expectancy is less than 6 months. A Medicare-approved service provides the hospice care which comprises of nursing care, physician services, counseling to the patients, medications, medical supplies, inpatient respite care, acute patient short-term care, services for home health aid, etc. Most hospice care services for patients are covered by the TRICARE Standard program and does not require meeting deductibles though it may require some cost-sharing for prescription medications.  Room and board at facilities is not covered during this time unless it is for inpatient or respite care.  There is additional information available about hospice care.

Coverage for Surgical Implants

TRICARE also provides coverage for surgical implants that are approved by the FDA. Some of these surgical implants are the intraocular lenses implanted following a cataract surgery in the eye, cochlear implants that aid in hearing, penile implants, breast implants, implants to correct any birth malformations, correction of the reproductive organs, correction of the organic impotence, etc. However, these procedures also may have some restrictions and limitations in the coverage offered through TRICARE for surgical implants.

Pap Smears and Mammograms

As a measure of preventive and diagnostic health care services, Pap smears tests and mammograms, etc. for women are also covered under TRICARE.

Behavioral/Mental Health Care Services

Psychological and mental health care services are also offered through TRICARE programs. Coverage varies based on the different types of behavioral or mental health care the patient requires.

Psychotherapy services forboth inpatient and outpatient treatments, care and treatment for substance abuse issues, care and treatment for adolescents and children up to 21 years old in authorized treatment centers (for a maximum of 150 days), etc. are all scenarios which are covered under the TRICARE program.

To learn more details about coverage, visit http://www.tricare.mil/CoveredServices/Mental/Treatments.aspx.

Types of Health Care Services NOT Covered by TRICARE

The TRICARE health care option doesn’t cover some types of health services. You can contact your Health Benefits Advisor, Beneficiary Counselor, or a TRICARE service center to know the complete list of services that TRICARE does not cover and considers them as exclusions. These include:

• Acupuncture
• Abortions or Pregnancy TerminationMethods
• Anabolic Steroids
• Post-Mortem or Autopsy Examinations
• Artificial Insemination
• Cosmetic Drugs
• Transplantation of Bone Marrow for Ovarian Cancer Treatment
• Plastic Surgery or Elective Cosmetic Surgery
• LASIK Surgery
• Experimental or Unproven Procedures
• Chronic Fatigue Syndrome
• Hearing Aids
• Podiatry Care
• Patient Counseling Services
• Vision Treatment
• Naturopathy Treatment
• Rest Cure in Private Hospital Rooms
• Health and Vitamin Supplements purchased Outside of a VA Facility
• Self-Help Courses
• Sex Changes
• Elective Psychotherapy or Mind Expansion
• Orthopedic Shoes and Other Supports
• Homes of Retirement
• OTC Drugs
• Psychiatric Therapy
• Speech and Occupational Therapy
• Products for Cessation of Smoking
• Treatment for Impotency or Sexual Dysfunction
• Management and Control of Weight
• Reversal Procedures of Surgical Sterilization
• Care Vitamins other than Niacin and Folic acid formulations and also injections of Vitamin B12, D, and K.
• Medical compensation reviews for workers

School Physical Exams

Physical exams can be obtained by dependents of the TRICARE-eligible servicemembers in the dependent’s schools. These dependents must be more than 5 years of age and below the age of 12 years old.  The TRICARE physical exam benefit doesn’t include those physical examinations conducted by schools which are required in order to take part in sports and other events.

Military Health Care FAQs

If I live in locations like Alaska, Hawaii or the U.S. territory, is it possible to use the BWE (Beneficiary Web Enrollment) website?

The BWE website can be accessed if you happen to live in locations such as Alaska or Hawaii in addition to the lower 48 states.  However, it but cannot be accessed in the U.S. territories and in other locations overseas.

Where can my overseas claims be filed?

In order to start the process of your claim, you can send your overseas claim bill and the form through mail to:

Wisconsin Physician Services

P.O. Box number 7985

Madison, WI, 53707-7985

In case I have issues with my claim and the processor of claims is not able to resolve the issue, who should I contact regarding this?

You can contact the Beneficiary Counseling and Assistance Coordinator (BCAC) or the regional contractor in case of any issues with the claim. You can also get in touch with the local military treatment facility (MTF) regarding this problem. Also, you can contact your nearest Debt Collection Assistance Officer (DCAO) at the military treatment facility when a notice of negative credit is sent to you by a collection agency.

In case my claim hasn’t been paid and has been sent to a collections agency, who can I contact to report this issue?

The DCAO (Debt Collection Assistance Officer) at your local MTF can be contacted in situations when the collections agency sends a notice of negative credit due to a TRICARE bill.

Is it true that free health care services for two years can be received by combat veterans?

Yes, it is true that free health care is provided to combat veterans by the VA. This benefit to combat veterans has been  provided after November 11, 1998 for a five-year time period that commences from the date when the veteran parted from the service.

Is the shingles vaccine paid for by TRICARE?

Yes., the shingles vaccine is paid byTRICARE as of October 19, 2007.

Can I visit a doctor other than my PCM (Primary Care Manager)?

Yes. The benefits of the Point of Service will then be paid by TRICARE. In that case, an annual fee of $300 will be deducted and also a 50% cost-share will have to be paid by you after the annual deductible is met.

I also have other health care insurance while being enrolled in the TRICARE Prime plan. I need to know whether this will be my best choice.

In the event that TRICARE Prime is your primary health care coverage plan, you can enjoy a number of benefits from the program. However, in the case that you have other health coverage plans, TRICARE health insurance is always considered to be secondary. You can also discuss about your options with your representative at the local service center of TRICARE.

Will I get benefits from TRICARE if I had no referral prior to visiting the hospital?

Yes, you will be paid for benefits under the Point of Service option of TRICARE. However, an annual fee deductible of $300 or  $600 for a family is applicable in addition to the 50% cost-share pay after the annual deductible has been met.

Does it apply to the maximum out-of-pocket expense in case I choose the Point of Service option during my visit to the doctor?  

No. The cost sharing amounts and the Point Of Service annual deductible are not included in the maximum out-of-pocket expense in the year of enrollment, but it is credited to the fiscal year maximum.

TRICARE Coverage for Skilled Nursing Facilities

Skilled nursing facilities (SNF) are covered under the TRICARE health care plan for an unlimited period of time. These SNF services can be offered only by skilled professionals under the direction of a doctor. The TRICARE plan provides coverage for rehabilitative therapies, skilled nursing care, medical equipment and devices, drug prescriptions, lab work, etc. under the Skilled Nursing Facility benefit of TRICARE.

TRICARE Coverage for Substance Abuse

In the cases of substance abuse, coverage for detoxification is provided by TRICARE for a maximum of 7 days in a rehabilitation treatment facility. Also, a maximum of 21 days in rehabilitation is covered by the TRICARE Standard program.

Filing Appeals with TRICARE

TRICARE decisions can be appealed in respect to the payment of claims or authorization for denial of services. You can also contact your nearest TRICARE service center representative to learn more details about the appeal process. It is imperative that you remember these following tips when filing an appeal with TRICARE:

• All deadlines of the appeal must be met.
• You must file your appeal with TRICARE in written format with your signature on the appeal.
• While submitting the appeal, you must make sure that all the supporting documents are also included in it. Also, the letter must be sent before the deadline in case you don’t possess the documents.
• Make sure that you also have a copy of all documents.