The following
preventive services are covered and exempt from cost-share requirements:
1.1.2 Immunizations
1.1.2.1 Coverage is
extended for the age appropriate dose of vaccines that meet the
following requirements:
• The vaccine
has been recommended and adopted by the Advisory Committee on Immunization
Practices (ACIP) for use in the United States (U.S.); and
• The ACIP adopted recommendations have been
accepted by the Director of the Centers for Disease Control and
Prevention (CDC) and the Secretary of Health and Human Services
(HHS) and published in a CDC Morbidity and Mortality Weekly Report (MMWR).
• The effective
date of coverage for CDC recommended vaccines is the date ACIP recommendations
for the vaccine are published in a MMWR.
1.1.2.2 Refer
to the CDC’s web site (
http://www.cdc.gov)
for a current schedule of CDC recommended vaccines for use in the
U.S.
1.1.2.3 Immunizations
recommended specifically for travel outside the U.S. are NOT covered, EXCEPT
for immunizations required by dependents of active duty military
personnel who are traveling outside the U.S. as a result of an active
duty member’s duty assignment, and such travel is being performed
under orders issued by a Uniformed Service. Claims must include
a copy of the travel orders or other official documentation verifying
the official travel requirement.
1.1.5 Other
Screenings And Services
The following
services are covered when rendered during a covered HP&DP exam
or a well woman exam, as delineated in
paragraphs 1.1.3 and
1.1.4,
or when ordered/recommended during one of these exams:
1.1.5.1 Tuberculosis
(TB) Screening. Screen annually, regardless of age, for all individuals
at high risk for TB (as defined by the CDC) using Mantoux
tests.
1.1.5.2 Rubella Antibodies.
Test females once, between ages 12-18, unless a history of adequate rubella
vaccination with at least one dose of rubella vaccine on or after
the first birthday is documented.
1.1.5.3 Hepatitis
B Virus (HBV) Screening. Screen for HBV in individuals at high risk
for infection.
1.1.5.4 Hepatitis C
Virus (HCV) Screening. Screen for HCV in individuals at high
risk for infection and as a one-time screening for adults
born between 1945 and 1965.
1.1.5.5 Diabetes Mellitus
(Type II) Screening. Screen adults with a sustained blood pressure (treated
or untreated) greater than 135/80 mmHg. Screen adults aged 40-70
who are overweight or obese.
1.1.5.6 Human Immunodeficiency
Virus (HIV) Infection Screening. Screen for HIV in individuals ages
15-65. Younger adolescents and older adults who are at increased
risk should also be screened.
1.1.5.7 Syphilis
Infection Screening. Screen at risk individuals for syphilis infection.
1.1.5.8 Chlamydia
and Gonorrhea Screening. Screen sexually active women age 24 years
and younger and older women who are at increased risk for
infection.
1.1.5.9 Cholesterol
Screening. Screen children once between the ages of 9 and 11 and
again between the ages of 17 and 21. Screen men age 35 and older.
Screen men and women age 20 and older who are at increased
risk for coronary heart disease.
1.1.5.10 Blood
Pressure Screening. Blood pressure screening at least every two
years after age six.
1.1.5.11 Osteoporosis
Screening. Screen women for osteoporosis with
bone measurement testing to prevent osteoporotic fractures in women
65 years and older and in post-menopausal women younger than 65
years who are at increased risk of osteoporosis as determined by
a formal clinical assessment tool including, but not limited to,
the Simple Calculated Osteoporosis Risk Estimation (SCORE).
1.1.5.12 Intensive
Behavioral Counseling for Sexually Transmitted Infections (STIs).
Intensive behavioral counseling (counseling that lasts more than
30 minutes) for all sexually active individuals who are at increased
risk for STIs is covered when rendered by a TRICARE authorized
provider.
1.1.5.13 Intensive,
Multicomponent Behavioral Interventions for Obesity. For adults
with a Body Mass Index (BMI) of 30 kg/m2 or higher and for children/adolescents
with a BMI value greater than the 95th percentile, intensive, multicomponent
behavioral interventions to promote sustained weight loss (12 to
26 sessions in a year) are covered when rendered by a TRICARE authorized
provider. Intensive, multicomponent behavioral interventions include,
but are not limited to: behavioral management activities such as
setting weight-loss goals; diet and physical activity guidance;
addressing barriers to change; active self-monitoring; and, strategies
to maintain lifestyle changes.