TRICARE Vision Benefits Fact Sheet

TRICARE ® Vision BenefitsCoverage varies by beneficiary type, program option, and ageGeneral vision coverage for TRICARE beneficiaries mayinclude an eye examination and other specialized servicesto diagnose or treat a medical condition of the eye. Theseservices are covered when provided in connection with themedical or surgical treatment of a covered illness or injury.ROUTINE EYE EXAMINATIONSMedically necessary eye-examination coverage variesaccording to beneficiary type, program option, and age.Referrals and prior authorizations may be required.Active duty family members (ADFMs) are entitled to oneannual routine eye examination. ADFMs covered by TRICAREPrime may receive their annual routine eye examinations fromany network providers without referrals or prior authorizations.ADFMs covered by TRICARE Standard and TRICARE Extramay receive their annual eye examinations from any TRICAREauthorizedproviders (network or non-network).Routine eye examinations are not covered for TRICAREStandard and TRICARE Extra retirees or their familymembers, except for eye examinations allowed under thewell-child benefit.Note: Medically necessary eye examinations for diabeticpatients of any age are not limited. One eye examinationper year is recommended.TRICARE Routine Eye-Examination Coverage for Beneficiaries over Age 6Beneficiary Type TRICARE Program Option Routine Eye-ExaminationCoverageProviderActive Duty ServiceMembersTRICARE PrimeAs needed to maintain fitnessfor dutyMilitary treatment facility,unless specifically referred toa civilian providerTRICARE Prime Remote (TPR)As needed to maintain fitnessfor dutyNetwork optometrist orophthalmologistActive Duty FamilyMembers or TRICAREReserve Select (TRS)MembersTRICARE Prime or TPRTRICARE Standard andTRICARE Extra or TRSOne routine eye examination percalendar yearOne routine eye examination percalendar yearNetwork optometrist orophthalmologistAny TRICARE-authorizedoptometrist or ophthalmologist(network or non-network)Retirees, TheirFamilies, and OthersTRICARE PrimeOne routine eye examination everytwo years (24 months)Network optometrist orophthalmologistTRICARE Standard andTRICARE Extra, TRICARERetired Reserve, or TRICAREFor LifeNoneNot applicableThis fact sheet is not all-inclusive. For additional information, please visit www.tricare.mil.February 2013

TRICARE Well-Child Vision Care CoverageBeneficiary Type TRICARE Program Coverage ProviderInfants (up to age 3) All programs One routine eye and visionscreening at birth and at 6 monthsActive Duty FamilyMembers (ADFMs) orTRICARE ReserveSelect (TRS) Children(ages 3–6)Non-ADFM Children(ages 3–6)TRICARE Prime orTRICARE Prime RemoteTRICARE Standard andTRICARE Extra or TRSTRICARE PrimeTRICARE Standard andTRICARE Extra, TRICARERetired Reserve, or TRICAREFor LifeOne routine eye examination percalendar yearOne routine eye examination percalendar yearOne routine eye examinationevery two years (24 months)One routine eye examinationevery two years (24 months)Primary care manager orphysicianNetwork optometrist orophthalmologistAny TRICARE-authorizedoptometrist or ophthalmologist(network or non-network)Network optometrist orophthalmologistAny TRICARE-authorizedoptometrist or ophthalmologist(network or non-network)LENSES AND EYEGLASSESExcept for active duty service members, lenses (lenses implantedwithin the eye or contacts) or eyeglasses are only cost-shared forthe following conditions:• Contact lenses for treatment of infantile glaucoma• Corneal or scleral lenses for treatment of keratoconus• Scleral lenses to retain moisture when normal tearing is notpresent or is inadequate• Corneal or scleral lenses prescribed to reduce a cornealirregularity other than astigmatism• Intraocular lenses, contact lenses, or eyeglasses to perform thefunction of the human lens, lost as the result of intraocularsurgery or ocular injury or congenital absenceBenefits are also specifically limited to one set of intraocularlenses necessary to restore vision. A set may also include acombination of both intraocular lenses and eyeglasses whena combination is necessary to restore vision. If there is aprescription change related to the qualifying eye condition, anew set may be cost-shared. However, replacement lenses forthose that are lost, have deteriorated, or have become unusabledue to physical growth are not covered. Adjustments, cleaning,and repairs of eyeglasses are also not covered.For more information about TRICARE vision benefits, contactyour regional contractor, TRICARE Overseas Program RegionalCall Center, or TRICARE Service Center. Special programsmay exist at local military treatment facilities (MTFs). Pleasecontact your local MTF for additional information.FOR INFORMATION AND ASSISTANCETRICARE North RegionHealth Net Federal Services, LLC1-877-TRICARE (1-877-874-2273)www.hnfs.comTRICARE Overseas Program (TOP)Regional Call Center—Eurasia-Africa 1+44-20-8762-8384 (overseas)1-877-678-1207 (stateside)tricarelon@internationalsos.comTRICARE South RegionHumana Military, a division ofHumana Government Business1-800-444-5445Humana-Military.comTOP Regional Call Center—Latin Americaand Canada 1+1-215-942-8393 (overseas)1-877-451-8659 (stateside)tricarephl@internationalsos.comTRICARE West RegionUnitedHealthcare Military & Veterans1-877-988-WEST (1-877-988-9378)www.uhcmilitarywest.comTOP Regional Call Centers—Pacific 1Singapore: +65-6339-2676 (overseas)1-877-678-1208 (stateside)sin.tricare@internationalsos.comSydney: +61-2-9273-2710 (overseas)1-877-678-1209 (stateside)sydtricare@internationalsos.com1. For toll-free contact information, visit www.tricare-overseas.com.An Important Note About TRICARE Program InformationAt the time of publication, this information is current. It is important to remember that TRICARE policies and benefits are governed by public law andfederal regulations. Changes to TRICARE programs are continually made as public law and/or federal regulations are amended. Military treatmentfacility guidelines and policies may be different than those outlined in this product. For the most recent information, contact your TRICARE regionalcontractor, TRICARE Service Center, or local military treatment facility.“TRICARE” is a registered trademark of the TRICARE Management Activity. All rights reserved.FS11401BET02133W