TRICARE to Expand Preventive Service Coverage
TRICARE has always had excellent coverage of important preventive services and
we are making it better. TRICARE is adding new services and screenings to
ensure our preventive services are aligned with recommendations of the United
States Preventive Services Task Force (USPSTF), and the Health Resources and
Services Administration's (HRSA) guidelines.
Effective Jan.1, 2017, TRICARE will cover annual preventive office visits for
all Prime beneficiaries 6 years of age and older. Children under 6 are already
covered by existing well-child coverage. This will ensure children in developing
stages receive observation, physical examination, screening, immunizations, and
various counseling services. TRICARE Standard beneficiaries can receive
preventive services with no cost-share or copayment through Health Promotion and
Disease Prevention (HP&DP) examinations (i.e. in connection with a covered
immunization or cancer screening).
Additionally, the annual well-woman exam will continue to be covered for all
Prime and Standard beneficiaries under age 65 with no cost-share or copayment.
The new covered services include free genetic counseling by a TRICARE-authorized
provider before BRCA1 or BRCA2 gene testing for women who are identified as high
risk for breast cancer by their primary care providers as well as the BRCA1 or
BRCA2 gene testing for women who meet the coverage guidelines under the existing
laboratory developed test (LDT) demonstration project.
NOTE: An authorized provider is any individual, institution/organization, or
supplier that is licensed by a state, accredited by national organization, or
meets other standards of the medical community, and is certified to provide
benefits under TRICARE. There are two types of TRICARE-authorized providers:
Network and Non-Network.
TRICARE will also cover stool DNA testing (e.g., CologuardT) once every 3 years
starting at age 50 for those who have an average risk of colon cancer. The
effective date of Cologuard coverage is June 21, 2016.
If you have recently received any of these services, please be sure to save your
receipts and file a claim. The regional contractors will be ready to process
claims for the new preventive benefits on Nov. 14, 2016, the implementation date
of this change. The implementation date is the date the contractor must be
ready to communicate and process claims for this benefit.
More Information is available at the following TRICARE website links:
TRICARE Well-Child Coverage
TRICARE Medical Claims http://www.tricare.mil/Resources/Claims
TRICARE Covered Services http://www.tricare.mil/HealthWellness/Preventive
SOURCE: TRICARE News Release at
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