In focus: TRICARE vision care benefits

Vision care is a TRICARE-covered benefit. Here’s how the benefit varies by your plan and age:

Active Duty

Active duty service members and family members (ADFM) enrolled in TRICARE Prime are allowed a comprehensive eye exam every year with no co-pay. TRICARE Standard and Extra ADFM beneficiaries older than 6 years have coverage for one routine eye exam yearly. After the deductible is met, cost-shares will apply for those using TRICARE Standard and Extra plans.

Retirees

TRICARE Prime retirees and family members are eligible for one comprehensive eye exam every two years with a network optometrist or ophthalmologist. They may have a $12 co-pay if seen outside the base clinic. Retired beneficiaries with TRICARE Standard only have vision benefits when diagnosed with a medical condition such as glaucoma, cataracts or diabetes. Normal deductible and cost shares apply.

Children

All TRICARE-eligible children, regardless of plan, are covered for eye and vision screenings at birth and for a routine exam at 6 months old by their primary or pediatric provider. All family members between the ages of 3 and 6 years are authorized to receive two comprehensive eye exams — including screening for developmental disorders — annually. After age 6, they can receive one exam per year by an ophthalmologist or optometrist depending on their TRICARE plan.

Comprehensive Exams

Eye doctors use a wide variety of tests and procedures to examine your eyes during a comprehensive exam. These tests range from simple ones, like reading an eye chart, to more complex tests.

Beneficiaries should receive comprehensive exams through an optometrist or ophthalmologist and do not usually need a referral. TRICARE Prime beneficiaries will need a referral for routine eye exams received outside the provider network. Active duty service members must get a referral through their primary care manager (PCM).

In addition to preventive exams, TRICARE covers most medically necessary eye exams. Diabetic beneficiaries are covered for an eye exam each year with no co-payment, regardless of their sponsor’s military status, although they may pay cost shares. TRICARE Prime beneficiaries need referrals for medically necessary visits if they are outside of a military treatment facility (MTF).

Beneficiaries can find a list of TRICARE network vision care providers in TriWest’s online Provider Directory at http://www.triwest.com. Searches can be conducted by location and specialty (for eye care, choose ophthalmology or optometry).

Beneficiaries who receive care at an MTF should check to see if that clinic offers special programs for vision care.

Glasses and contacts

For active duty service members, eyeglasses are available at military treatment facilities for free. All other TRICARE beneficiaries have coverage for contact lens or eyeglasses only if they are diagnosed with:

• Infantile glaucoma

• Keratoconus

• Dry eyes

• Irregularities in the eye’s shape

• Loss of human lens function from eye surgery or congenital absence.

Replacement lenses, or adjustments, cleaning and repairs of eyeglasses are not covered. Contact screenings and fittings are also not a TRICARE-covered benefit unless you have one of the medical conditions listed above.

For more information about your vision benefits, visit http://www.tricare.mil>mybenefit>home>Visionmybenefit>home>Visionhome>VisionVision