1.3.1 Deductible Amount: Outpatient Care
1.3.1.1 Active Duty
Sponsor in Pay Grade E-4 or Below
1.3.1.1.1 Deductible,
Individual: Each beneficiary is liable for the first fifty dollars
($50.00) of the allowable amount on claims for care provided in
the same fiscal year.
1.3.1.1.2 Deductible,
Family: The total deductible amount for all members of a family
with the same sponsor during one fiscal year shall not exceed one
hundred dollars ($100.00).
1.3.1.2
All
TRICARE Beneficiaries Except Family Members of Active Duty Sponsors
in Pay Grade E-4 or Below
1.3.1.2.1 Deductible,
Individual: Each beneficiary is liable for the first $150.00 of
the allowable amount on claims for care provided in the same fiscal
year.
1.3.1.2.2 Deductible, Family: The total deductible
amount for all members of a family with the same sponsor during
one fiscal year shall not exceed $300.00.
1.3.1.3 TRICARE-Approved
Ambulatory Surgery Centers (ASCs), Birthing Centers, or Partial Hospitalization
Programs (PHPs)
1.3.1.3.1 TRICARE-Approved
Ambulatory Surgery Centers (ASCs), Birthing Centers, or Partial Hospitalization
Programs (PHPs). No deductible shall be applied to allowable amounts
for services or items rendered to ADFMs. For family members of active
duty members of the armed forces of NATO/PfP foreign nations who
are eligible for outpatient care under TRICARE, see
paragraph 1.1.5 for
deductible and cost-share information.
1.3.1.3.2 Allowable
Amount Does Not Exceed Deductible Amount. If fiscal year allowable amounts
for two or more beneficiary members of a family total less than
$100.00 (or $300.00 if
paragraph 1.3.1.2, applies), and no one beneficiary’s
allowable amounts exceed $50.00 (or $150.00 if
paragraph 1.3.1.2 applies),
neither the family nor the individual deductible will have been
met and no TRICARE benefits are payable.
1.3.1.3.3 In
the case of family members of an active duty member of pay grade
E-5 or above, with Persian Gulf conflict service who is, or was,
entitled to special pay for hostile fire/imminent danger authorized
by 37 USC 310, for services in the Persian Gulf area in connection
with Operation Desert Shield or Operation Desert Storm, the deductible
shall be the amount specified in
paragraph 1.3.1.2.
Note: The
provisions of
paragraph 1.3.1.3.3, also apply to family
members of Service members who were killed in the Gulf, or who died
subsequent to Gulf service; and to Service members who retired prior
to October 1, 1991, after having served in the Gulf war, and to
their family members.
1.3.1.3.4 Adjustment
of Excess. Any beneficiary identified under
paragraphs 1.3.1.3.2 and
1.3.1.3.3 who
paid any deductible in excess of the amounts stipulated is entitled
to an adjustment of any amount paid in excess against the annual
deductible required under those paragraphs.
1.3.1.3.5 The deductible
amounts identified in this section shall be deemed to have been satisfied
if the catastrophic cap amounts identified in
Section 2 have
been met for the same fiscal year in which the deductible applies.
1.3.3 Cost-Share Amount
1.3.3.1 Outpatient Care
1.3.3.1.1 The cost-share
for ADFMs for outpatient care is 20% of the allowable amount in
excess of the annual deductible amount. This includes the professional
charges of an individual professional provider for services rendered
in a non-TRICARE-approved ASC or Birthing Center. For family members of
active duty members of the armed forces of NATO/PfP foreign nations
who are eligible for outpatient care under TRICARE per DEERS, see
paragraph 1.1.5.
1.3.3.1.2 Other Beneficiary.
The cost-share applicable to outpatient care for other than active duty
and authorized NATO/PfP family member beneficiaries is 25% of the
allowable amount in excess of the annual deductible amount. This
includes: partial hospitalization for alcohol rehabilitation; professional
charges of an individual professional provider for services rendered
in a non-TRICARE-approved ASC.
1.3.3.2
Inpatient
Care
1.3.3.2.1 ADFM:
For services prior to October 3, 2016, except in the case of mental
health and Substance Use Disorder (SUD) services, ADFMs or their
sponsors are responsible for the payment of the first $25 of the
allowable institutional costs incurred with each covered inpatient
admission to a hospital or other authorized institutional provider,
or the daily charge the beneficiary or sponsor would have been charged
had the inpatient care been provided in a Uniformed Service hospital,
whichever is greater. (Please reference daily rate chart below.)
For services on or after October 3, 2016, the following applies
to all services (to include mental health and SUD services) for
ADFMs or their sponsors.
Figure 2.1-1 Uniformed
Services Hospital Daily Charge Amounts
|
Period
|
Daily Charge
|
|
Use the daily
charge (per diem rate) in effect for each day of the stay to calculate
a cost-share for a stay which spans periods.
|
|
October 1, 2015
- September 30, 2016 (for ADFMs not enrolled in Prime)
|
$18.00
|
|
October 1, 2016
- September 30, 2017 (for ADFMs not enrolled in Prime)
|
$18.20
|
|
October 1, 2017-
September 30, 2018 (for ADFMs not enrolled in Prime)
|
$18.60
|
|
October 1, 2018
- December 31, 2019 (for ADFMs not enrolled in Prime)
|
$19.05
|
|
January 1, 2020
- December 31, 2020 (for ADFMs not enrolled in Prime)
|
$19.55
|
1.3.3.2.2 Other
Beneficiaries: For services exempt from the DRG-based payment system
and the mental health per diem payment system and services provided
by institutions other than hospitals (i.e., Residential Treatment
Centers (RTCs)), the cost-share shall be 25% of the allowable charges.
1.3.3.3
Cost-Shares:
Maternity
1.3.3.3.1 Determination. Maternity care cost-share
shall be determined as follows:
1.3.3.3.1.1 Inpatient cost-share
formula applies to maternity care ending in childbirth in, or on
the way to, a hospital inpatient childbirth unit, and for maternity
care ending in a non-birth outcome not otherwise excluded.
Note: Inpatient
cost-share formula applies to prenatal and postnatal care provided
in the office of a civilian physician or certified nurse-midwife
in connection with maternity care ending in childbirth or termination
of pregnancy in, or on the way to, a Military Treatment Facility
(MTF)/Enhanced Multi-Service Market (eMSM) inpatient childbirth
unit. ADFMs pay a per diem charge (or a $25.00 minimum charge) for
an admission and there is no separate cost-share for them for separately
billed professional charges or prenatal or postnatal care.
1.3.3.3.1.2 Ambulatory surgery
cost-share formula applies to maternity care ending in childbirth in,
or on the way to, a birthing center to which the beneficiary is
admitted, and from which the beneficiary has received prenatal care,
or a hospital-based outpatient birthing room.
1.3.3.3.1.3 Outpatient cost-share
formula applies to maternity care which terminates in a planned childbirth
at home.
1.3.3.3.1.4 Otherwise
covered medical services and supplies directly related to “complications
of pregnancy”, as defined in the Regulation, shall be cost-shared
on the same basis as the related maternity care for a period not
to exceed 42 days following termination of the pregnancy and thereafter
cost-shared on the basis of the inpatient or outpatient status of
the beneficiary when medically necessary services and supplies are
received.
1.3.3.3.2 Otherwise
authorized services and supplies related to maternity care, including maternity
related prescription drugs, shall be cost-shared on the same basis
as the termination of pregnancy.
1.3.3.3.3 Claims
for pregnancy testing shall be cost-shared on an outpatient
basis when the delivery is on an inpatient basis.
1.3.3.3.4 Where
the beneficiary delivers in a professional office birthing
suite located in the office of a physician or certified nurse-midwife
(which is not otherwise a TRICARE-approved birthing center) the
delivery shall be adjudicated as an at-home birth.
1.3.3.3.5 Claims
for prescription drugs provided on an outpatient basis
during the maternity episode but not directly related to the maternity
care shall be cost-shared on an outpatient basis.
1.3.3.3.6 Newborn
cost-share. Effective for all inpatient admissions occurring on
or after October 1, 1987, separate claims must be submitted for
the mother and newborn. The cost-share for inpatient claims for
services rendered to a beneficiary newborn is determined as follows:
1.3.3.3.6.1 In a
DRG hospital:
1.3.3.3.6.1.1 Same newborn date of birth and date
of admission:
• For ADFMs,
there shall be no cost-share during the period the newborn is deemed
enrolled in Prime.
• For newborn
family members of other than active duty members, unless the newborn
is deemed enrolled in Prime, the cost-share shall be the lower of
the number of hospital days minus three multiplied by the per diem
amount, OR 25% of the total billed charges (less duplicates and
DRG non-reimbursables such as hospital-based professional charges).
1.3.3.3.6.1.2 Different newborn date of birth
and date of admission:
• For ADFMs,
there shall be no cost-share during the period the newborn is deemed
enrolled in Prime.
• For all
other beneficiaries, the cost-share shall be applied to all days
in the inpatient stay unless the newborn is deemed enrolled in Prime.
1.3.3.3.6.2 In DRG
exempt hospital:
1.3.3.3.6.2.1 Same
newborn date of birth and date of admission:
• For ADFMs, there shall be no cost-share
during the period the newborn is deemed enrolled in Prime.
• For family members of other than
active duty members, the cost-share shall be calculated based on
25% of the total allowed charges unless the newborn is deemed enrolled
in Prime.
1.3.3.3.6.2.2 Different
newborn date of birth and date of admission:
• For ADFMs, there shall be no cost-share
during the period the newborn is deemed enrolled in Prime.
• For family members of other than
active duty members, the cost-share shall be calculated based on
25% of the total allowed charges unless the newborn is deemed enrolled
in Prime.
1.3.3.3.7 Maternity
Related Care. Medically necessary treatment rendered to a pregnant
woman for a non-obstetrical medical, anatomical, or physiological
illness or condition shall be cost-shared as a part of the maternity
episode when:
• The treatment
is otherwise allowable as a benefit; and
• Delay of the treatment until after the
conclusion of the pregnancy is medically contraindicated; and
• The illness or condition is, or increases
the likelihood of, a threat to the life of the mother; or
• The illness or condition will cause,
or increase the likelihood of, a stillbirth or newborn injury or
illness; or
• The usual course
of treatment must be altered or modified to minimize a defined risk
of newborn injury or illness.
1.3.3.4
Cost-Shares:
DRG-Based Payment System
1.3.3.4.1 General
These special
cost-sharing procedures apply only to claims paid under the DRG-based payment
system.
1.3.3.4.2
TRICARE
Standard
1.3.3.4.2.1 Cost-shares
for ADFMs. ADFMs or their sponsors are responsible for the payment
of the first $25 of the allowable institutional costs incurred with
each covered inpatient admission to a hospital or other authorized
institutional provider, or the amount the beneficiary or sponsor
would have been charged had the inpatient care been provided in
a Uniformed Service hospital, whichever is greater.
1.3.3.4.2.2 Cost-shares
for beneficiaries other than ADFMs.
1.3.3.4.2.2.1 The cost-share
shall be the lesser of:
1.3.3.4.2.2.1.1 An
amount based on a single, specific per diem amount which will not
vary regardless of the DRG involved. The following is the DRG inpatient
TRICARE Standard cost-sharing per diems for beneficiaries other
than ADFMs.
1.3.3.4.2.2.1.1.1 The per diem amount will be calculated
as follows:
• Determine the
total allowable DRG-based amounts for services subject to the DRG-based
payment system and for beneficiaries other than ADFMs during the
same database period used for determining the DRG weights and rates.
• Add in the allowance for Capital and Direct
Medical Education (CAP/DME) which have been paid to hospitals during
the same database period used for determining the DRG weights and
rates.
• Divide
this amount by the total number of patient days for these beneficiaries.
This amount will be the average cost per day for these beneficiaries.
• Multiply this amount by 0.25. In this
way total cost-sharing amounts will continue to be 25% of the allowable
amount.
• Determine any
cost-sharing amounts which exceed 25% of the billed charge (see
paragraph 1.3.3.4.2.2.1.2) and divide this
amount by the total number of patient days in
paragraph 1.3.3.4.2.2.1.1).
Add this amount to the amount in
paragraph 1.3.3.4.2.2.1.1. This is the per
diem cost-share to be used for these beneficiaries.
1.3.3.4.2.2.1.1.2 The per diem amount shall be required
for each actual day of the beneficiary’s hospital stay which the
DRG-based payment covers except for the day of discharge. When the
payment ends on a specific day because eligibility ends on a short-stay
outlier day, the last day of eligibility is to be counted for determining
the per diem cost-sharing amount. For claims involving a same-day discharge
which qualify as an inpatient stay (e.g., the patient was admitted
with the expectation of a stay of several days, but died the same
day) the cost-share is to be based on a one-day stay. (The number
of hospital days must contain one day in this situation.)
1.3.3.4.2.2.1.2 Twenty-five
percent (25%) of the billed charge. The billed charge to be used includes
all inpatient institutional line items billed by the hospital minus
any duplicate charges and any charges which can be billed separately
(e.g., hospital-based professional services, outpatient services, etc.).
The net billed charges for the cost-share computation include comfort
and convenience items.
1.3.3.4.2.2.2 Under no circumstances
can the cost-share exceed the DRG-based amount.
1.3.3.4.2.2.3 Where
the dates of service span different fiscal years, the per diem cost-share amount
for each year is to be applied to the appropriate days of the stay.
1.3.3.4.3 TRICARE Extra
1.3.3.4.3.1 Cost-shares
for ADFMs. The cost-sharing provisions for ADFMs are the same as
those for TRICARE Standard.
1.3.3.4.3.2 Cost-shares
for beneficiaries other than ADFMs. The cost-sharing provisions
for beneficiaries other than ADFMs is the same as those for TRICARE
Standard, except the per diem copayment is $250.
1.3.3.4.4 TRICARE Prime
There
is no cost-share for ADFMs. For beneficiaries other than ADFMs,
the cost-sharing provision is the first $25 of the allowable institutional
costs incurred with each covered inpatient admission to a hospital
or other authorized institutional provider, or a per diem rate of
$11, whichever is greater.
1.3.3.4.5 Maternity Services
See
paragraph 1.3.3.3,
for the cost-sharing provisions for maternity services.
1.3.3.5 Cost-Shares:
Inpatient Mental Health Per Diem Payment System
1.3.3.5.1 General. These
special cost-sharing procedures apply only to claims paid under
the inpatient mental health per diem payment system. For inpatient
claims exempt from this system, the procedures in
paragraph 1.3.3.2 or
1.3.3.4 are
to be followed.
1.3.3.5.2 Cost-shares
for ADFMs. For dates of service prior to October 3, 2016, inpatient
cost-sharing for mental health services is $20 per day for each
day of the inpatient admission. This $20 per day cost-share applies
to admissions to any hospital for mental health services, any RTC,
any Substance Use Disorder Rehabilitation Facility (SUDRF), and
any PHP providing mental health or SUD rehabilitation services.
For Prime ADFMs cost-share is $0 per day. See
Addendum A for
further information.
1.3.3.5.3 For
dates of service on or after October 3, 2016, the inpatient cost-sharing
for mental health services is that described in
paragraph 1.3.3.2.1. The cost-share
applies to admissions to any hospital for mental health services,
any RTC, and any inpatient/residential SUD detoxification and rehabilitation
program. For Prime ADFMs, the cost-share is $0 per day. See
Addendum A for further information.
1.3.3.5.4 Cost-shares
for beneficiaries other than ADFMs.
1.3.3.5.4.1 Higher volume hospitals and units.
With respect to care paid for on the basis of a hospital specific
per diem, the cost-share shall be 25% of the hospital specific per
diem amount.
1.3.3.5.4.2 Lower
volume hospitals and units. For care paid for on the basis of a
regional per diem, the cost-share shall be the lower of
paragraphs 1.3.3.5.4.2.1 or
1.3.3.5.4.2.2:
1.3.3.5.4.2.1 A
fixed daily amount multiplied by the number of covered days. The
fixed daily amount shall be 25% of the per diem adjusted so that
total beneficiary cost-shares will equal 25% of total payments under
the inpatient mental health per diem payment system. This fixed
daily amount shall be updated annually and on the DHA website at
http://www.health.mil/rates.
This fixed daily amount will also be furnished to contractors by
the DHA. The following fixed daily amounts are effective for services
rendered on or after October 1 of each fiscal year.
• FY 2019 - $248
per day.
• FY 2020 - $255
per day.
• FY 2021 - $261
per day.
1.3.3.5.4.2.2 Twenty-five
percent (25%) of the hospital’s billed charges (less any duplicates).
1.3.3.5.5 Claims
which span a period in which two separate per diems exist. A claim
subject to the inpatient mental health per diem payment system which
spans a period in which two separate per diems exist shall have
the cost-share computed on the actual per diem in effect for each
day of care.
1.3.3.5.6 Cost-share whenever
leave days are involved. There is no patient cost-share for leave days
when such days are included in a hospital stay.
1.3.3.5.7 Claims
for services that are provided during an inpatient admission which
are not included in the per diem rate shall be cost-shared as an
inpatient claim if the contractor cannot determine where the service
was rendered and the status of the patient when the service was provided.
The contractor shall examine the claim for place of service and
type of service to determine if the care was rendered in the hospital
while the beneficiary was an inpatient of the hospital. This would include
non-mental health claims and mental health claims submitted by individual
professional providers rendering medically necessary services during
the inpatient admission.
1.3.3.6 Cost-Shares:
PHPs And Intensive Outpatient Program (IOPs)
1.3.3.6.1 For care rendered prior to October
3, 2016, cost-sharing for partial hospitalization is on an inpatient
basis. The inpatient cost-share also applies to the associated psychotherapy
billed separately by the individual professional provider. These
providers shall identify on the claim form that the psychotherapy
is related to a partial hospitalization stay so the proper inpatient
cost-sharing can be applied. The cost-share for ADFMs enrolled in
Prime for inpatient mental health services is $0. For retirees and
their family members, the cost-share is 25% of the allowed amount.
Since inpatient cost-sharing is being applied, no deductible shall
be taken for partial hospitalization regardless of sponsor status.
The cost-share for ADFMs shall be taken from the PHP claim.
1.3.3.6.2 For care rendered on or after October
3, 2016, cost-sharing for PHPs and IOPs is on an outpatient basis.
The outpatient cost-share also applies to the associated psychotherapy
billed separately by the individual professional provider. These
providers shall identify on the claim form that the psychotherapy
is related to PHP or IOP care so the proper outpatient cost-sharing
can be applied. Cost-shares for standard beneficiaries can be found
in
paragraph 1.3;
cost-sharing requirements for prime beneficiaries can be found in
paragraph 1.2.
1.3.3.7
Cost-Shares:
Ambulatory Surgery
1.3.3.7.1 For non-TRICARE Prime ADFMs, for
all services reimbursed as ambulatory surgery, the cost-share shall
be $25 and shall be assessed on the facility claim. No cost-share
shall be deducted from a claim for professional services related
to ambulatory surgery. This applies whether the services are provided
in a freestanding ASC, a hospital outpatient department or a hospital
emergency room. So long as at least one procedure on the claim is
reimbursed as ambulatory surgery, the claim shall be cost-shared
as ambulatory surgery as required by this section. For family members
of active duty members of the armed forces of NATO/PfP foreign nations
who are eligible for outpatient care under TRICARE per DEERS, see
paragraph 1.1.5.
1.3.3.7.2 Other
Beneficiaries. Since the cost-share for other beneficiaries is based
on a percentage rather than a set amount, the cost-share shall be
taken from all ambulatory surgery claims. For professional services,
the cost-share is 25% of the allowed amount. For the facility claim,
the cost-share is the lesser of:
1.3.3.7.2.1 Twenty-five
percent (25%) of the applicable group payment rate (see
Chapter 9, Section 1); or
1.3.3.7.2.2 Twenty-five
percent (25%) of the billed charges; or
1.3.3.7.2.3 Twenty-five
percent (25%) of the allowed amount as determined by the contractor.
1.3.3.7.2.4 The special
cost-sharing provisions for beneficiaries other than ADFMs will
ensure that these beneficiaries are not disadvantaged by these procedures.
In most cases, 25% of the group payment rate will be less, but because
there is some variation within each group, 25% of billed charges could
be less in some cases. This will ensure that the beneficiaries get
the benefit of the group payment rates when they are more advantageous,
but they will never be disadvantaged by them. If there is no group
payment rate for a procedure, the cost-share shall simply be 25%
of the allowed amount.
1.3.3.8 Cost-Shares and Deductible: Former Spouses
1.3.3.8.1 Deductible.
In accordance with the FY 1991 Appropriations and Authorization
Acts, Sections 8064 and 712 respectively, beginning April 1, 1991,
an eligible former spouse is responsible for payment of the first
one hundred and fifty dollars ($150.00) of the reasonable costs/charges
for otherwise covered outpatient services and/or supplies provided
in any one fiscal year. Although the law defines former spouses
as family members of the member or former member, there is no legal familial
relationship between the former spouse and the member or former
member. Moreover, any TRICARE-eligible children of the former spouse
will retain a legal familial relationship with the member or former
member and shall be included in the member’s or former member’s
family deductible. The former spouse cannot contribute to, nor benefit
from, any family deductible of the member or former member to whom
the former spouse was married or of that of any TRICARE-eligible
children. In other words, a former spouse must independently meet
the $150.00 deductible in any fiscal year.
1.3.3.8.2 Cost-Share.
An eligible former spouse is responsible for payment of cost-sharing amounts
identical to those required for beneficiaries other than ADFMs.
1.3.3.9 Cost-Share
Amount: Under Discounted Rate Agreements
Under
managed care, where there is a negotiated (discounted) rate agreed
to by the network provider, the cost-share shall be based on the
following:
1.3.3.9.1 For non-institutional providers
providing outpatient care, and for institution-based professional
providers rendering both inpatient and outpatient care; the cost-share
(20%) for outpatient care to ADFMs, 25% for care to all others)
shall be applied to (after duplicates and noncovered charges are
eliminated), the lowest of the billed charge, the prevailing charge,
the maximum allowable prevailing charge (the Medicare Economic Index
(MEI) adjusted prevailing), or the negotiated (discounted) charge.
1.3.3.9.2 For institutional
providers subject to the DRG-based reimbursement methodology, the cost-share
for beneficiaries other than ADFMs shall be the LOWER OF EITHER:
• The single, specific per diem supplied
by DHA after the application of the agreed upon discount rate; OR
• Twenty-five percent (25%) of the billed
charge.
1.3.3.9.3 For institutional
providers subject to the Mental Health Per Diem Payment System (high volume
hospitals and units), the cost-share for beneficiaries other than
ADFMs shall be 25% of the hospital per diem amount after it has
been adjusted by the discount.
1.3.3.9.4 For institutional
providers subject to the Mental Health per diem payment system (low volume
hospitals and units), the cost-share for beneficiaries other than
ADFMs shall be the LOWER OF EITHER:
• The fixed daily amount supplied by DHA
after the application of the agreed upon discount rate; OR
• Twenty-five percent (25%) of the billed
charge.
1.3.3.9.5 For RTCs,
the cost-share for other than ADFMs shall be 25% of the TRICARE
rate after it has been adjusted by the discount.
1.3.3.9.6 For institutions
and for institutional services being reimbursed on the basis of
the TRICARE-determined reasonable costs, the cost-share for beneficiaries
other than ADFMs shall be 25% of the allowable billed charges after
it has been adjusted by the discount.
Note: For all
inpatient care for ADFMs, the cost-share shall continue to be either
the daily charge or $25 per stay, whichever is higher. There is
no change to the requirement for the ADFM’s cost-share to be applied
to the institutional charges for inpatient services. If the contractor
learns that the participating provider has billed a beneficiary
for a greater cost-share amount, based on the provider’s usual billed
charges, the contractor shall notify the provider that such an action
is a violation of the provider’s signed agreement. (Also see
paragraph 1.3.3.4.)
For Prime ADFMs, the cost-share is $0 for care provided on or after
April 1, 2001.
1.3.3.10
Preventive
Services
1.3.3.10.1 No copayments
or authorizations are required for the following preventive services
as described in the TPM,
Chapter 7, Sections 2.1 and
2.5:
1.3.3.10.1.1 Colorectal
cancer screening.
1.3.3.10.1.2 Breast cancer
screening.
1.3.3.10.1.3 Cervical cancer
screening.
1.3.3.10.1.4 Prostate cancer
screening.
1.3.3.10.1.5 Immunizations.
1.3.3.10.1.6 Well-child visits
for children under six years of age.
1.3.3.10.2 In addition
to the services listed in
paragraph 1.3.3.10.1, effective January 1,
2017, cost-shares are eliminated for the services listed in the
TPM,
Chapter 7, Section 2.1, paragraphs 1.1.1.1.2 and
1.1.5.1 through
1.1.5.12.
Effective January 1, 2018, cost-shares are eliminated for the services
listed in the TPM,
Chapter 7, Section 2.1, paragraph 1.1.5.13.
1.3.3.10.3 A beneficiary
is not required to pay any portion of the cost of these preventive
services even if the beneficiary has not satisfied the deductible
for that year.
1.3.3.10.4 This waiver
does not apply to any TRICARE beneficiary who is a Medicare-eligible beneficiary.