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News > Tricare Standard pays for prevention
Story at a Glance
 Standard beneficiaries can use certain preventive health services with Tricare waiving all cost shares.
 Services include screenings for colorectal cancer, breast cancer, cervical cancer and prostate cancer; immunizations; and well-child visits for children younger than 6.
 Beneficiaries who received certain clinical preventive services in the past several months may be entitled to reimbursement.
 Cost-share waiver applies to non-Medicare eligible, Tricare Standard or Extra beneficiaries.
Tricare Standard pays for prevention

Posted 9/8/2009   Updated 9/8/2009 Email story   Print story

    

9/8/2009 - FALLS CHURCH, Va. (AFRNS)  -- Obtaining clinical preventive services can help prevent illness before major health problems occur so 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 younger than 6.

Also, for all beneficiaries older than 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.

Beneficiaries who received certain clinical preventive services in the past several months may be entitled to reimbursement.

"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 has not 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 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.

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

For requests by phone:

North Region
Net Federal Services, LLC
877- 874-2273

South Region
Humana Military Healthcare Services, Inc.
800-444-5445

West Region
TriWest Healthcare Alliance
888-874-9378

Requests submitted in writing to the regional claims processor should include the sponsor's Social Security number, full names and dates of birth of all dependents and current mailing address. For written requests:

North Region
Health Net Federal Services, Inc.
c/o PGBA, LLC/TRICARE Claims Correspondence
PO Box 870141
Surfside Beach, SC 29587-9741

South Region
Humana Military Healthcare Services, Inc.
P.O. Box 740062
Louisville, KY 40201-7462

West Region
West Region Customer Service
P.O. Box 77029
Madison, WI 53707-7029

(Courtesy of Tricare)



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