TRICARE Manuals - Display Chap 7 Sect 2.3 (Change 102, Sep 16, 2022)

Medicine

Chapter 7

Section 2.3

Family Planning

Issue Date: August 26, 1985

Revision: C-102, September 16, 2022

1.0 POLICY

1.1 Medical contraceptives listed in Sections 2.1 and 2.2, as well as tubal ligation (see note below), are covered as the clinical preventive services benefit.

1.2 In addition to the medical contraceptives listed in Section 2.1, the family planning procedures listed below may be also cost-shared:

1.2.1 Prescription contraceptives, including diaphragms received in the pharmacy setting, and prescription contraceptives used as emergency contraceptives.

Note: Implantable prescription contraceptives are covered if the U.S. Food and Drug Administration (FDA) approved and used for the labeled indication.

1.2.2 Surgical sterilization.

Note: Tubal ligation procedures are covered with no-cost sharing when performed by an in-network provider for TRICARE Prime and TRICARE Select beneficiaries, effective January 1, 2023. However, cost-sharing may apply when performed by an out-of-network provider or when provided to non-Prime or Select beneficiaries (i.e., TRICARE for Life beneficiaries). See Section 2.2.

2.0 EXCLUSIONS

2.1 Prophylactics (condoms).

2.2 Spermicidal foams, jellies, and sprays not requiring a prescription.

2.3 Services and supplies related to noncoital reproductive technologies, including but not limited to artificial insemination (including cost related to donors and semen banks), In Vitro Fertilization (IVF) and Gamete Intrafallopian Transfer (GIFT).

2.4 Male and female reversal of a surgical sterilization procedure, except medically necessary reversal of surgical sterilization for the treatment of a disease or injury (see Chapter 4, Sections 15.1 and 17.1).

2.5 For routine screening Papanicolaou (PAP) smear tests, routine gynelogic examinations, and related laboratory testing, see the Preventive Services policy.

2.6 The family planning benefit does not include screening PAP smear tests, routine gynelogic examinations, including related laboratory testing. However, family planning benefits may be allowed during an office visit for a screening PAP test.

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