08 September 2009

TRICARE Standard Pays to be Preventive

Obtaining clinical preventive services helps prevent illness before major health problems occur. Section 711 of the National Defense Authorization Act of 2009 encourages eligible TRICARE Standard beneficiaries to use preventive health services by waiving all cost shares for certain types of these services starting Sept. 1. These services include screenings for colorectal cancer, breast cancer, cervical cancer and prostate cancer; immunizations; and well-child visits for children under 6 years of age.

Also, for all beneficiaries over age 6, when a visit to a health care provider includes one or more of the benefits listed above, the cost share for the visit is waived. However, other services provided during the same visit are subject to cost shares and deductibles.

“Early disease detection and chronic condition management programs result in the prevention of long term health conditions and add savings for beneficiaries and the government in the long term,” said Navy Rear Adm. Christine S. Hunter, deputy director of the TRICARE Management Activity. “It’s a great new benefit under TRICARE Standard.”

The cost share waiver applies to non-Medicare eligible, TRICARE Standard or Extra beneficiaries; even if the beneficiary hasn’t met the annual deductible. Beneficiaries enrolled in TRICARE Prime are unaffected, since they do not have copayments for preventive services.

Medicare-eligible beneficiaries are covered by TRICARE For Life (TFL), which generally pays the remainder of any costs not paid under Medicare, including amounts for the listed preventive services. However, preventive services and all immunizations not covered by Medicare require TRICARE Standard cost shares and deductibles for TFL beneficiaries.

Criteria such as age, frequency of care and family history have to be met in order to waive cost shares for the six clinical preventive services. All other preventive services not included in the services listed in Section 711 are subject to cost shares and deductibles. This benefit can be applied to any services received on or after Oct. 14, 2008. Beneficiaries can request reimbursement for services received after Oct. 14, 2008, and before the implementation date of Sept. 1, 2009.

Reimbursement requests can be made by phone or in writing to the region where the beneficiary lives.
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