2.4.2 Benefit
Coverage Comparable To The Extended Care Health Option (ECHO) For Seriously
Ill Or Injured Service Members
2.4.2.1 Under 10 USC 1074(c)(4)(A)
and (B), seriously ill/injured Service members shall receive services
comparable to those provided to dependents of Service members under
10 USC 1079(d) and (e), the TRICARE ECHO Program. Statutory authority
for these benefits for retirees ended December 31, 2012. Former
Service members that utilized this benefit will continue to be covered
by this provision for benefits received before December 31, 2012
(e.g., anti-rejection medication for a limb transplant). The contractors
shall ensure all TED requirements outlined in the TRICARE Systems
Manual (TSM),
Chapter 2 are
met including appropriate use of SPC
PF to identify
TED records for care rendered under the ECHO benefit for seriously
ill or injured Service members.
2.4.2.2 There are no cost-shares, copayments,
or financial caps for any of these ECHO-like benefits when these
services are authorized. There is no requirement to register in
the Exceptional Family Member Program (EFMP). There is no time limit
with disability/illness requirement. These benefits shall be preauthorized,
to include documentation of Category II/III designation per Department
of Defense Instruction (DoDI) 1300.24; and, documentation that the
Service member has been referred to a Medical Evaluations Board
(MEB).
2.4.2.3 The following categories of
care listed under 10 USC 1079(e) are authorized (see 10 USC 1079(e)(1-7):
2.4.2.3.1 Diagnosis.
2.4.2.3.2 Inpatient, outpatient, and
comprehensive Home Health Care (HHC) supplies and services which
may include cost effective and medically appropriate services other
than part-time or intermittent services, as these terms are currently
used under the TRICARE ECHO Program.
2.4.2.3.3 Training, rehabilitation, special
education, and assistive technology devices.
2.4.2.3.4 Institutional care in private
nonprofit, public, and state institutions and facilities and, if appropriate,
transportation to and from such institutions and facilities.
2.4.2.3.5 Home health services, including
custodial care in conjunction with authorized home health services.
2.4.2.3.6 Seriously ill or injured Service
members are defined as Category II or III per DoDI 1300.24.
2.4.2.3.6.1 Category II:
• Has a serious injury or illness.
• Is unlikely to return to duty
within a time specified by his or her military department.
• May be medically separated
from the military.
2.4.2.3.6.2 Category III:
• Has a severe or catastrophic
injury or illness.
• Is highly unlikely to return
to duty.
• Will most likely be medically
separated from the military.
2.4.2.4 The Service member’s primary
care provider or primary specialty care provider shall document
and provide the Service member’s category status on a referral as
well as documentation of a referral to an MEB. Preauthorization
is required. If the documentation supports the category designation
of Category II/III, the Service member is eligible for benefits
comparable to ECHO. Using the Government furnished web-based enrollment
application, the contractor shall apply the ECHO Health Care Delivery
Plan (HCDP) code of 400 to the Service member. The provider’s documentation
of Category II/III status is the authorizing document allowing the
contractor to apply the ECHO HCDP code to the Service member. The
contractor shall ensure all TED requirements outlined in the TSM,
Chapter
2 are met, including appropriate use of SPC
PF to
identify TED records for care rendered under the ECHO benefit for
seriously ill or injured Service members.
2.4.2.5 The contractor shall collaborate
with all DVA/VHA case managers along with the Service member’s healthcare
team to ensure continuity of care and transition to DVA/VHA care
and management upon retirement or separation.
2.4.2.6 As much as practical, these
benefits should mirror the ECHO Program and be coordinated between
the contractor and the health care team. Benefits for these Service
members arise from any physiological disorder or condition or anatomical
loss affecting one or more body system and which precludes the person
with the disorder, condition, or anatomical loss from unaided performance
of at least one of the following major life activities: breathing,
cognition, hearing, seeing, and ability to bathe, dress, eat, groom,
speak, stair use, toilet use, transferring, and walking. Benefits
include services for rehabilitative, habitative care as well as
Durable Equipment (DE) and DME.
2.4.2.7 Designation of comparable to
ECHO benefits for Service members.
2.4.2.7.1 Requests for benefits under
the comparable to ECHO will come from the Service member’s PCM or
specialty provider with documentation of the category description
(II/III) along with documentation to support that category description.
2.4.2.7.2 Documentation of a referral
to an MEB must be provided.
2.4.2.8 Provision Of Respite Care
2.4.2.8.1 The eligibility rules and exclusions
contained in
32 CFR 199.5(b)(3) and
(5) do not apply to the provision of respite
benefits for a Service member. See
Appendix A for
definitions, terms, and limitations applicable to the respite care
benefit.
2.4.2.8.2 Seriously ill or injured Service
members shall qualify for respite care benefits regardless of their
enrollment status. Service members in the 50 U.S. and the District
of Columbia shall qualify if they are enrolled in TRICARE Prime,
TPR, or not enrolled and receiving services in accordance with the non-enrolled/non-referred
provisions for the use of SHCP funds. Service members outside the
50 U.S. and the District of Columbia shall qualify if they are enrolled
to TOP Prime (with enrollment to an MTF/eMSM), TOP Prime Remote,
or not enrolled and receiving services in accordance with the non-enrolled/non-referred
provisions for Service member care overseas (see TPM,
Chapter 12, Section 1.1).
Note: Respite care benefits must
be performed by a TRICARE-authorized Home Health Agency (HHA), regardless
of the Service member’s location (see
32 CFR 199.6(b)(4)(xv) for HHA definition).
2.4.2.8.3 There are no cost-shares or
copays for Service member respite benefits when those services are
approved by the Service member’s Direct Care System (DCS) case manager
or other appropriate DCS authority (i.e., SAS, the enrolled or referring
MTF/eMSM, TRICARE Area Office (TAO), or Community Care Units (CCUs)).
2.4.2.8.4 All SHCP requirements and provisions
of
Chapters 16 and
17 apply
to this benefit unless changed or modified by this paragraph. The
appropriate chapter for the status of the Service member shall apply.
Contractors shall follow the requirements and provisions of these
chapters, to include:
• MTF/eMSM or SAS referrals and
authorizations;
• Receipt and control of claims;
• Authorization, verification,
reimbursement and payment mechanisms to providers;
• Reimbursement specifying no
cost-share, copay, or deductible to be paid by the Service member
or their lawful spouse; and
• Use of CHAMPUS Maximum Allowable
Charges (CMACs)/Diagnosis Related Groups (DRGs) when applicable.
2.4.2.8.5 The contractor shall follow
the provisions of the TSM,
Chapter 2, Sections 2.8 and
6.4 regarding the TED SPC for the Service
member respite benefit. Claims should indicate an appropriate procedure
code for respite care (CPT 99600 or HCPCS S9122-S9124) and shall
be reimbursed based upon the allowable charge or the negotiated
rate.
2.4.2.8.6 Respite care services and requirements
are as follows:
2.4.2.8.6.1 Respite care is authorized
for a Service member of the Uniformed Services on active duty and
has a qualifying condition as defined in
Appendix A.
2.4.2.8.6.2 Respite care is available if
a Service member’s plan of care includes frequent interventions
by the primary caregiver(s).
2.4.2.8.6.3 Service members receiving respite
care are eligible to receive a maximum of 40 respite hours in a
calendar week, no more than five days per calendar week and no more
than eight hours per calendar day. No additional benefit caps apply.
2.4.2.8.6.4 Respite benefits shall be provided
by a TRICARE-authorized HHA and are intended to mirror the benefits
under the TRICARE ECHO Home Health Care (EHHC) program described
in the TPM,
Chapter 9, Section 15.1.
Note: Contractors are not required
to enroll Service members in the ECHO program (or a comparable program)
for this respite benefit.
2.4.2.8.6.5 Authorized respite care does
not cover care for other dependents or others who may reside in
or be visiting the Service member’s residence.
2.4.2.8.6.6 In addition, consistent with
the requirement that respite care services shall be provided by
a TRICARE-authorized HHA, services or items provided or prescribed
by a member of the patient’s family or a person living in the same
household are excluded from respite care benefit coverage.
2.4.2.8.6.7 The contractor shall follow
the reimbursement methodology for the similar respite care benefit
found in the TPM,
Chapter 9,
as modified by Service member SHCP reimbursement methodology contained
in
Chapters 16 and
17 (for
Service members located in the 50 U.S. and the District of Columbia)
or TOP reimbursement methodology contained in the TPM,
Chapter
12 (for Service members located outside the 50 U.S. and
the District of Columbia).
2.4.2.8.7 Should other services or supplies
not outlined above, or those otherwise available under the TRICARE
program, be considered necessary for the care or treatment of a
Service member, a request shall be submitted to the SAS, MTF/eMSM,
or TAO for authorization of payment. When preauthorization is possible
it shall be done.
2.4.2.9 Customized Hand Crank Bikes
2.4.2.9.1 There is a cap of $5,500.
2.4.2.9.2 Bike must be custom fitted
for the Service member’s unique injury.
2.4.2.9.3 Must be preauthorized and evidence
of a Category II/III illness or injury must accompany the request.
No request should be for more than the $5,500 cap.
2.4.2.10 Custodial
Care
2.4.2.10.1 Limited to 30 days if Service
member has not been referred to an MEB.
2.4.2.10.2 At the MTF/eMSM case manager’s
request, the appropriate regional Medical Director, Clinical Operations
Division (COD), TRICARE Health Plans may extend an additional 30
days if Service member is due to return to duty at the end of the
additional 30 days.
2.4.2.10.3 Any additional extensions must
be with a waiver from the Director, DHA for those Service members
that have not been referred to a MEB.
2.4.2.10.4 For Service members who have
been referred to an MEB, authorization is valid until Service member
retires, separates, or returns to duty. No waiver is required.
2.4.2.10.5 May be provided in the home
or authorized provider/facility. Use of an unauthorized provider/facility
would require a waiver.
2.4.2.10.6 Custodial care services may
be provided up to 24/7. The health care team will periodically review
Service member’s care plan to revise amount of custodial care required.
2.4.2.10.7 The Service member’s health
care team will determine the requirements of the Service member
for Custodial Care, including the number of hours and duration of
the service and will adjust these requirements accordingly as the
Service member’s requirements change.
2.4.2.10.8 As required the contractors
shall collaborate with DoD and DVA/VHA case managers along with
the Service member’s health care team to ensure continuity of care
and transition to DVA/VHA care and management upon retirement or
separation.
2.4.2.10.9 Care must be preauthorized
with documentation of Category II/III illness or injury and other
inclusion criteria in this section accompanying the request.
2.4.2.11 Cryopreservation
And Reproductive Services
2.4.2.11.1 Policy
Guidelines For Cyropreservation Of Sperm/Oocytes/Embryos For Service Members
With A Diagnosis Of Cancer
2.4.2.11.1.1 Service member must be either
Category II or III as a result of their cancer at the time of retrieval.
The Service member must be scheduled to undergo a gonadotoxic treatment
for their cancer.
2.4.2.11.1.1.1 For females cyropreservation
of eggs at age 49 or under at the time of retrieval.
2.4.2.11.1.1.2 For males cyropreservation
of sperm at 61 or under at time of retrieval.
2.4.2.11.1.2 Are on a period of active duty
greater than 30 days and are scheduled to remain on active duty
for the duration of the retrieval and freezing process.
2.4.2.11.1.3 Have capacity to provide informed
consent (i.e., third party consent is not authorized).
Note: Prior surgical sterilization
does not disqualify a Service member from participating.
2.4.2.11.1.4 Mature Oocyte Retrieval
2.4.2.11.1.4.1 Referral by PCM (or referral
by primary care provider for TPR enrollees) or specialist involved
in a Service member’s cancer care is required for each cycle. No
more than three completed retrieval cycles are covered. Services
and supplies covered for mature oocyte retrieval include the following.
2.4.2.11.1.4.1.1 Consultation and subsequent
office visits as indicated.
2.4.2.11.1.4.1.2 Laboratory tests and ultrasound
imaging as indicated.
2.4.2.11.1.4.1.3 Provider-administered medications
as indicated for oocyte retrieval.
2.4.2.11.1.4.1.4 Self-administered medications
as indicated for oocyte retrieval are covered under
Chapter
23.
2.4.2.11.1.4.1.5 Surgical retrieval and anesthesia.
2.4.2.11.1.4.1.6 Medically necessary services
and supplies associated with complications.
2.4.2.11.1.4.2 The benefit is limited to the
retrieval of 20 oocytes or three completed cycles, whichever occurs
first. There may be a total of four attempts to accomplish three
completed cycles.
2.4.2.11.1.4.3 Additional retrieval beyond
one cycle shall be authorized by the contractor only if the cumulative
number of oocytes retrieved of all previous cycles is less than
20. For instance, if 12 oocytes are retrieved in the first cycle,
the contractor may approve a second cycle. If 11 more oocytes are
retrieved in the second cycle, the contractor shall not approve
a third cycle.
2.4.2.11.1.5 Sperm Collection And Retrieval
2.4.2.11.1.5.1 Referral by PCM (or referral
by primary care provider for TPR enrollees) or specialist involved
in a Service member’s cancer care is required. If indicated, invasive
procedures for sperm retrieval beyond simple collection of semen
(or urine for retrograde ejaculation) must be specified in the referral.
Services and supplies covered for sperm collection and retrieval
includes the following.
2.4.2.11.1.5.1.1 Consultation and subsequent
office visits as indicated.
2.4.2.11.1.5.1.2 Laboratory tests as indicated
including semen analysis.
2.4.2.11.1.5.1.3 Provider-administered medications
as indicated for sperm retrieval.
2.4.2.11.1.5.1.4 Self-administered medications
indicated for sperm retrieval are covered under
Chapter
23.
2.4.2.11.1.5.1.5 Invasive procedures for sperm
retrieval (e.g., electro-ejaculation, epididymal aspiration) likely
to produce viable sperm.
2.4.2.11.1.5.1.6 Medically necessary services
and supplies associated with complications.
2.4.2.11.1.5.2 The benefit is limited to either
two simple specimen collections or one invasive procedure for sperm
retrieval.
2.4.2.11.1.6 Cryopreservation
2.4.2.11.1.6.1 Services and supplies associated
with cryopreservation of all mature oocytes and sperm retrieved,
and embryos.
2.4.2.11.1.6.2 Storage Of Retrieved/Collected
Oocyte/Sperm And Embryos
Note: The 36 month limitations in
paragraphs 2.4.2.11.1.6.2.1 and
2.4.2.11.1.6.2.2 are temporarily waived for
qualified ADSMs whose coverage ended or will end between the date
of the declaration of the COVID-19 national emergency on March 1,
2020, until 90 days following the declared end of the national emergency
by the President of the United States. All other coverage criteria
still apply.
2.4.2.11.1.6.2.1 Storage is covered for 36 months
from date of first retrieval of all mature oocytes and sperm. The
cost of storage is incurred on the first day of the initial period
of storage and the first day of any subsequent year of storage.
2.4.2.11.1.6.2.2 The Service member is responsible
for all costs incurred after 36 months or when the Service member
separates/retires (whichever comes first). Arrangements for disposition
are the responsibility of Service members subject to state regulation
on disposal and abandonment of frozen specimens.
2.4.2.11.1.6.2.3 The contractor shall ensure
that oocytes, sperm, and embryos shall be stored at facilities listed
and registered in accordance with 21 CFR 1271.
2.4.2.11.1.6.3 Ownership And Disposition
Issues regarding ownership,
future use, donation, and/or destruction shall be governed by applicable state
law and shall be the responsibility of the Service member and their
lawful spouse and the facility storing the cryopreserved oocytes/sperm/embryos.
DoD’s role is limited to paying for this benefit when requested
by the consenting Service member. DoD will not have ownership or
custody of cryopreserved oocytes/sperm/embryos. DoD will not be
involved in the ultimate disposition of excess cryopreserved oocytes/sperm/embryos.
Ultimate disposition or destruction of excess cryopreserved oocytes/sperm/embryos
is not separately reimbursed.
2.4.2.11.2 Policy Guidelines For Assisted
Reproductive Technology (ART)
2.4.2.11.2.1 The policy provides for the
provision of ART which includes embryo cryopreservation and storage,
to assist in the reduction of the disabling effects of the Service
member’s qualifying condition. The authority for this policy for
care outside of the basic medical benefit is derived from Section
1633 of the 2008 National Defense Authorization Act (NDAA). This
section allows the Service member to receive services that are outside
the definition of “medical care.” This benefit is provided through
the authorization of the expenditure of SHCP funds and delivery
of the needed services in either MTFs/eMSMs that offer assisted
reproductive technologies or in the purchased care sector that are
outside the medical benefit. Although purchased care is available
for this benefit depending on the Service member’s circumstances
not allowing him or her to travel, the use of MTFs/eMSMs shall be encouraged,
with Service members eligible for this benefit given priority for
care at MTFs/eMSMs if there is a waiting list. If the Service member
receives care or medications in the civilian sector, participating
network providers shall be used if available. Preauthorization for
every IVF cycle is required.
2.4.2.11.2.2 Assisted reproductive services,
including sperm retrieval, oocyte retrieval, IVF, artificial insemination,
and blastocyst implantation is offered based on the condition of
the seriously or severely ill/injured Service member not the spouse;
therefore, the use of the SHCP is authorized.
2.4.2.11.2.3 The benefit is limited to permitting
a qualified Service member to procreate with their lawful spouse,
as defined in federal statute and regulation.
2.4.2.11.2.4 Consent must be able to be
given by the Service member and his or her lawful spouse. Third
party consent is not authorized under this policy.
2.4.2.11.2.5 Third party donations and surrogacy
are not covered benefits. The benefit is designed to allow the Service
member and their spouse to become biological parents through reproductive technologies.
2.4.2.11.3 Cancer
2.4.2.11.3.1 The policy applies to Service
members, regardless of gender, who are seriously or severely ill
(Category II, III) as a result of their cancer and will or have
undergone cancer therapy that may have effected their fertility.
The Service member will use their cryopreserved sperm/oocytes or embryos
for the ART services such as IVF.
Note: The 36 month limitations in
paragraphs 2.4.2.11.3.2 and
2.4.2.11.3.3 are temporarily waived for qualified
ADSMs whose coverage ended or will end between the date of the declaration
of the COVID-19 national emergency on March 1, 2020, until 90 days
following the declared end of the national emergency by the President
of the United States. All other coverage criteria still apply.
2.4.2.11.3.2 The ART benefit will be available
for 36 months from the date of sperm or oocyte retrieval.
2.4.2.11.3.3 If the Service member proceeds
with embryo cryopreservation and storage during this 36 month period,
these services will be covered only during the 36 month period.
2.4.2.11.4 Transportation, shipping and
handling costs of oncocryopreserved sperm and oocytes shall be covered
when:
2.4.2.11.4.1 Relocating the specimen from
a local cryobank to a local fertility clinic; or
2.4.2.11.4.2 Relocating the specimen from
a cryobank to a distant fertility clinic closer to where the Service
member currently resides.
2.4.2.11.5 Urogenital Trauma
2.4.2.11.5.1 The policy applies to Service
members, regardless of gender, who have sustained a serious or severe
illness/injury while on active duty that led to the loss of their
natural procreative ability. It is the intent of this policy to
provide ART services, including embryo cryopreservation and storage
without limitation while on active duty, only to consenting male
Service members whose illness or injury to their urogenital system
prevents the successful delivery of their sperm to their spouse’s
egg and to consenting female Service members whose illness or injury
to their urogenital system prevents their egg from being successfully
fertilized by their spouse’s sperm, but who maintain ovarian function
and have a patent uterine cavity. This includes, but is not limited
to, those suffering neurological, physiological, and/or anatomical
injuries.
2.4.2.11.5.2 Male Service members must be
able to produce sperm, but need alternative sperm collection technologies
as they can no longer ejaculate in a way that allows for egg fertilization.
Ill/injured female Service members require ovarian function and
a patent uterine cavity that would allow them to successfully carry
a fetus even if unable to conceive naturally (e.g., thorough damage
to their fallopian tubes).
2.4.2.11.5.3 Embryo cryopreservation and
storage will be covered as long as the Service member remains on
active duty.
2.4.2.11.5.4 The Service member is responsible
for all storage costs when the Service member separates/retires.
Arrangements for disposition are the responsibility of Service members
subject to state regulation on disposal and abandonment of frozen
specimens.
2.4.2.11.6 Procedures
2.4.2.11.6.1 Prediction of fertility potential
(Ovarian Reserve) shall be conducted in accordance with the provider
clinic’s practice guidelines. (This may include a Clomiphene Citrate
Challenge Test (CCCT) and evaluation of the uterine cavity.) Beneficiaries
with a likelihood of success, based on the specific clinic’s guidelines,
shall be provided IVF cycles under this benefit. Infertility testing
and treatment, including correction of the physical cause of infertility,
are covered in accordance with the TPM,
Chapter 4, Section 17.1.
2.4.2.11.6.2 Three completed IVF cycles
shall be provided for the seriously or severely ill/injured female
Service member or lawful spouse of the seriously or severely ill/injured
male Service member. No more than six IVF cycles shall be initiated
for the seriously or severely ill/injured female Service member
or legal spouse of the seriously or severely ill/injured male Service
member. There may be a total of six attempts to accomplish three
completed IVF cycles. If the ill/ injured Service member has used
initiated IVF cycles, subsequently remarries and desires this benefit
with the new spouse, the number of cycles available is dependent
on prior cycles used.
2.4.2.11.6.3 Assisted reproductive service
centers with capability to provide full services including alternative
methods of sperm aspiration will be invited to participate and accept
payment at the network discount rate. (Membership in the American
Society for Reproductive Medicine (ASRM), with associated certification(s),
is highly recommended for network providers. Reporting outcomes
to the Centers for Disease Control and Prevention (CDC) is mandatory.)
When a network provider is not available, the benefits provided
under this policy may be provided by any TRICARE-authorized provider,
including those authorized pursuant to
32 CFR 199.6(e).
2.4.2.11.6.4 IVF cycles shall be accomplished
in accordance with the practice guideline for the provider clinic
using gonadotropins which are concentrated mixtures of Follicle
Stimulating Hormone (FSH) or FSH and Luteinizing Hormone (LH) given
as an injection to stimulate the ovary to produce multiple oocytes
in preparation for egg retrieval. These medications shall be purchased
through the TPharm contract (to include home delivery, non-network
retail pharmacy, and network retail pharmacy options) or MTF/eMSM.
2.4.2.11.6.5 Anesthesia or conscious sedation
will be provided for the oocyte retrieval and sperm aspiration in
accordance with the TPM,
Chapter 3, Section 1.1 and
1.2. For males, sperm aspiration through Microsurgical
Epididymal Sperm Aspiration (MESA), Percutaneous Epididymal Sperm Aspiration
(PESA), or non-surgical fine needle aspiration will be accomplished
in conjunction with egg retrieval. Vibratory stimulation or electro-ejaculation
may be used if appropriate for the seriously or severely ill/injured
Service member.
2.4.2.11.6.6 Intracytoplasmic sperm injection
will be accomplished for all viable oocytes.
2.4.2.11.6.7 Embryo transfer in accordance
with guidelines provided by the ASRM shall be accomplished in accordance
with specific clinic practices at either cleavage stage or blastocyst
stage of the embryo.
2.4.2.11.6.8 Healthy embryos that progress
to an appropriate stage, as assessed by the embryologist, in excess
of those used for the fresh embryo transfer may be cryopreserved.
2.4.2.11.6.9 In the event that frozen embryos
are available for transfer, TRICARE will authorize frozen embryo
transfer cycles to facilitate the utilization of these embryos.
Frozen embryo transfers may be accomplished in fresh ovulatory cycles
or in medicated transfer cycles in order to provide the optimal uterine
environment for embryo implantation.
2.4.2.11.7 Process For Participating In
Assisted Reproductive Services Program
2.4.2.11.7.1 For a Service member to be
eligible, there must be documentation of Category II or III illness
or injury designation as defined in DoDI 1300.24.
2.4.2.11.7.2 The referral to the contractor
will contain the following information:
• Service member’s qualifying
diagnosis(es);
• Category (II or III);
• Summary of relevant medical
information supporting category designation;
• Name of provider of reproductive
services requested to be used;
• Number of initiated IVF cycles;
and
• Number of cancelled IVF cycles.
2.4.2.11.7.3 All TED records for this benefit
shall include Enrollment/Health Plan Code “
SR SHCP
- Referred Care” regardless of the enrollment status returned by
DEERS. The contractor shall follow all applicable TED coding requirements
in accordance with TSM,
Chapter 2.
2.4.2.11.7.4 All SHCP requirements and provisions
of
Chapters 16 and
17 apply
to this benefit unless changed or modified by this paragraph. The
appropriate chapter for the status of the Service member shall apply.
Contractors shall follow the requirements and provisions of these
chapters, to include MTF/eMSM or SAS referrals and authorizations,
receipt and control of claims, authorization verification, reimbursement
and payment mechanisms to providers, reimbursement specifying no cost-share,
copay, or deductible to be paid by the Service member or their lawful
spouse, and use of CMACs/DRGs when applicable.
2.4.2.11.8 Exclusions
2.4.2.11.8.1 Third party donations or surrogacy
cannot be cost-shared.
2.4.2.11.8.2 Cryopreservation of gametes
in anticipation of deployment.
2.4.2.11.8.3 Services related to gender
selection will NOT be cost-shared.
2.4.2.12 Incontinence Supplies
Personal incontinence supplies
(i.e., diapers) that support skin integrity and prevent deterioration
of skin due to incontinence are covered. Also covered are other
types of incontinence supplies such as diaper creams, bed pads,
etc. that are necessary for skin protection.