2.5.2 Benefit Coverage Comparable
To The Extended Care Health Option (ECHO) For Seriously Ill Or Injured
Service Members
2.5.2.1 Under 10 USC 1074(c)(4)(A) and
(B), seriously ill/injured Service members shall receive
services extended
benefits comparable to those provided to dependents
of Service members under 10 USC 1079(d) and (e), the TRICARE ECHO
Program
, to reduce the disabling effects of their qualifying conditions.
2.5.2.1.1 Statutory authority for these retiree 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).
2.5.2.1.2 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.
2.5.2.2 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).
2.5.2.3 The following categories of
care listed under 10 USC 1079(e) are authorized
(see
10 USC 1079(e)(1-7):
2.5.2.3.1 Diagnosis.
2.5.2.3.2 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.
2.5.2.3.3 Training, rehabilitation, special
education, and assistive technology devices.
2.5.2.3.4 Institutional care in private
nonprofit, public, and state institutions and facilities and, if appropriate,
transportation to and from such institutions and facilities.
2.5.2.3.5 Home health services, including
custodial care in conjunction with authorized home health services.
2.5.2.3.6 Seriously ill or injured Service
members are defined as Category II or III per
Department of
Defense Instruction (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.
2.5.2.4 Documentation and Designation
of Comparable to ECHO Benefits2.5.2.4.1 The Service member’s primary
care provider or primary specialty care provider shall document
and provide the Service member’s category
status description
(II/III) on a referral as well as documentation of a
referral to
an a Medical
Evaluations Board (MEB
), as applicable. 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. If the
documentation supports the category designation of Category II/III,
the Service member is eligible for benefits comparable to ECHO,
to assist in reducing the disabling effects of their qualifying
condition.2.5.2.4.1.1 The contractor shall
use the Government furnished web-based enrollment application to
apply the ECHO Health Care Delivery Plan (HCDP) code of 400 to the
Service member.
2.5.2.4.1.2 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.
2.5.2.4.1.3 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 and severely ill or injured
Service members.
2.5.2.4.2 Preauthorization is
required for these benefits.
2.5.2.5 The contractor shall collaborate
with all DVA/VHA case managers along with the
Service member’s health care team and
case managers (to include DVA/VHA case managers) to
ensure continuity of care and transition to DVA/VHA care and management
upon retirement or separation or upon changing geographical
location.
2.5.2.6 As much as practical, these benefits
should mirror the ECHO Program and be coordinated between the contractor
and the Service member’s health care team. Benefits Eligibility
for these extended benefits for these
Service members arises 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 the
Service member’s serious or severe injury or illness. These benefits
are provided to assist in reducing the disabling effects of the
Service member’s qualifying condition. Benefits include
services for rehabilitative, habitative habilitative 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.
2.5.2.7 Provision Of Respite Care
2.5.2.7.2 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).
2.5.2.7.3 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)).
2.5.2.7.4 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 CHAMPUS Maximum Allowable
Charges (CMACs)/Diagnosis Related Groups (DRGs) when applicable.
2.5.2.7.5 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.
2.5.2.7.6 Respite care services and requirements
are as follows:
2.5.2.7.6.2 Respite care is available if
a Service member’s plan of care includes frequent interventions
by the primary caregiver(s).
2.5.2.7.6.3 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.
2.5.2.7.6.4 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.
2.5.2.7.6.5 Authorized respite care does
not cover care for other dependents or others who may reside in
or be visiting the Service member’s residence.
2.5.2.7.6.6 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.
2.5.2.7.6.7 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).
2.5.2.7.7 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.
2.5.2.8 Customized Hand Crank Bikes
2.5.2.8.1 There is a cap of $5,500.
2.5.2.8.2 Bike must be custom fitted
for the Service member’s unique injury.
2.5.2.8.3 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.
2.5.2.9 Custodial Care
2.5.2.9.1 Limited to 30 days if Service
member has not been referred to an MEB.
2.5.2.9.2 At the MTF/eMSM case manager’s
request, the appropriate regional Medical Director, Clinical Operations
Division (COD), TRICARE Health Plans Programs may
extend an additional 30 days if Service member is due to return
to duty at the end of the additional 30 days.
2.5.2.9.3 Any additional extensions must
be with a waiver from the Director, DHA for those Service members
that have not been referred to a MEB.
2.5.2.9.4 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.
2.5.2.9.5 May be provided in the home
or authorized provider/facility. Use of an unauthorized provider/facility
would require a waiver.
2.5.2.9.6 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.
2.5.2.9.7 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.
2.5.2.9.8 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.
2.5.2.9.9 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 Cancer2.4.2.11.1.1 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
Retrieval2.4.2.11.1.4.1 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 Retrieval2.4.2.11.1.5.1 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 Cryopreservation2.4.2.11.1.6.1 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 EmbryosNote: 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
DispositionIssues 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 Cancer2.4.2.11.3.1 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: 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 Trauma2.4.2.11.5.1 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 Procedures2.4.2.11.6.1 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 Program2.4.2.11.7.1 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 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.
2.5.2.10 Assisted Reproductive
Technology (ART) Services2.5.2.10.1 Scope2.5.2.10.1.1 ART services, including
sperm retrieval, oocyte retrieval, IVF, intrauterine insemination (IUI),
and blastocyst implantation, as well as cryopreservation and storage
of oocytes, sperm, and embryos, are available for seriously or severely
ill or injured Service members (Category II or III) to assist in
reducing the disabling effects of the Service member’s qualifying
condition.
2.5.2.10.1.2 The policy applies to
all Service members, regardless of gender or marital status, who sustained
a serious or severe illness or injury (Category II or III) while
on active duty that led to the inability of those members to procreate
without the use of ART; hereafter, these Service members are referred
to as a “qualifying Service member”. This includes, but is not limited
to, those suffering neurological, physiological, and/or anatomical
injuries, and those who will, or have, undergone gonadotoxic therapy
likely to impact fertility.
2.5.2.10.1.3 Qualifying Service members
must be on a period of active duty greater than 30 days and scheduled
to remain on active duty for the duration of the covered ART process.
2.5.2.10.1.4 The use of the SHCP
is authorized as this extended benefit is offered based on the condition
of the qualifying Service member and provided exclusively for the
benefit of that Service member.2.5.2.10.1.4.1 This benefit is provided
through the authorization of the expenditure of SHCP funds for delivery
of the needed services in either MTFs that offer ART or in private
sector care. For qualifying Service members, the TOP contractor
shall follow existing processes regarding where care is received
for authorized ART services.
2.5.2.10.1.4.2 Although private sector
care is available for this benefit, the use of MTFs that offer ART
services shall be encouraged, with qualifying Service members given
priority for care at MTFs if there is a waiting list.2.5.2.10.1.4.2.1 If the qualifying Service
member receives care or medications in the private sector, participating
network providers shall be used, if available.
2.5.2.10.1.4.2.2 Membership in the American
Society for Reproductive Medicine (ASRM), with associated certification(s),
is highly recommended for network providers in the 50 U.S. and District
of Columbia.
2.5.2.10.1.4.2.3 Reporting outcomes consistent
with Fertility Clinic Success Rate and Certification Act of 1992
(Public Law 102-493) is mandatory for providers in the 50 U.S. and
District of Columbia.
2.5.2.10.1.4.2.4 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).
See also Chapter 8, Section 5.
2.5.2.10.1.4.2.5 Private sector entities
who collaborate with MTF Reproductive Endocrinology and Infertility
(REI) programs are considered TRICARE-authorized providers for the
purpose of this benefit and will be reimbursed no more than the
amount applicable to all other TRICARE beneficiaries who receive
ART services through participation in the MTF program. Services
rendered by direct care providers are provided free of charge and
not included within any applicable fee schedule for participation
in the program. When a qualifying Service member and/or TRICARE-enrolled
designee is referred to one of these MTF REI programs, the contractor
shall reach out to these private sector entities and make specific
arrangements for billing and payments as required to achieve coverage
of this extended benefit.
Note: MTF REI programs that
offer ART services do so through an arrangement with private sector entities
that provide a portion of the services, including embryologist services.
Private sector entities who deliver ancillary services, regardless
of location of the services or the involvement of direct care providers,
may be reimbursed even if the provider is not TRICARE authorized
due to their DOD affiliation. Through arrangements with the MTF
REI program, these private sector entities are prohibited from billing
for the services of any direct care providers.
2.5.2.10.1.4.3 Medications shall be
obtained through the TRICARE Mail Order Pharmacy (MOP), a TRICARE
retail network pharmacy, or MTF, if available and doing so provides
a cost-savings to the Government. Alternatively, medications may
be included within the negotiated rate for ART services, if determined
to be more cost-effective.
2.5.2.10.1.4.4 The Managed Care Support
contractor and Pharmacy contractor shall provide reports on TRICARE
ART services through the SHCP program. Details for reporting are
identified in DD Form 1423, Contract Data Requirements List (CDRL),
located in Section J of the applicable contract.
2.5.2.10.1.5 The DHA Form 407, Assisted
Reproductive Services For The Benefit Of Seriously Or Severely Ill/Injured
(Category II Or III) Active Duty Service Members Qualifying Service
Member Information and Attestation, is required for use as part
of the referral and authorization process for all ART services.
2.5.2.10.1.6 Benefits may be authorized
for the qualifying Service member’s TRICARE-enrolled lawful spouse,
TRICARE-enrolled unmarried partner, or TRICARE-enrolled third-party
gestational carrier (collectively, hereafter “TRICARE-enrolled designee(s)”),
as applicable, under this policy so long as those services are for
the benefit of the qualifying Service member. A gestational carrier
is defined by the ASRM as a person who carries a pregnancy resulting
from the transfer of a preimplantation embryo created by one or
more genetic parents or gamete donors. The medical care for a TRICARE-enrolled designee
serving as a gestational carrier is covered, but compensation beyond
the provision of medical care is not permitted.
2.5.2.10.1.7 This policy does not
authorize provision of any additional care to TRICARE-enrolled designees
with conditions impacting their own fertility that is not otherwise
covered under the TRICARE Basic (i.e., medical) benefit.
2.5.2.10.1.8 Use of donor gametes
or donor embryos are permitted when procured at the qualifying Service
member’s expense.2.5.2.10.1.8.1 The qualifying Service
member is responsible for the arrangements and cost of donor gamete
and donor embryo acquisition (e.g., procedures or associated fees
for extraction, storage, or transportation of donor gametes or embryos)
regardless of the use of non-identified donation or directed (i.e.,
identified) donation.
2.5.2.10.1.8.2 Donors are defined by
the ASRM and U.S. Food and Drug Administration (FDA) as individuals
who provide oocytes, sperm, or embryos but are not sexually intimate
partners of the recipients.
2.5.2.10.1.8.3 All donor gametes and
embryos must meet applicable FDA screening and testing requirements.
2.5.2.10.1.8.4 FDA screening and testing
requirements are only required for services rendered in the 50 U.S.
and District of Columbia.
2.5.2.10.2 Guidelines For Retrieval/Collection
and Storage Of Gametes (Oocytes and Sperm)2.5.2.10.2.1 Gamete (Oocyte/Sperm)
Retrieval/Collection2.5.2.10.2.1.1 Gamete retrieval/collection
is authorized for:2.5.2.10.2.1.1.1 Qualifying Service members
who are diagnosed with a condition (cancerous or non-cancerous)
requiring gonadotoxic treatments or therapies; or
2.5.2.10.2.1.1.2 Qualifying Service members
and their TRICARE-enrolled designees, when such gametes will be
used in other ART services (i.e., IUI or IVF) in the furtherance
of the qualifying Service member becoming a parent.
2.5.2.10.2.1.2 Coverage for gamete
retrieval/collection is not authorized for third-party donations,
regardless of whether the donor gametes are directed (i.e., identified,
known) or non-identified (i.e., anonymous).
2.5.2.10.2.1.3 A separate referral
and authorization are required for each oocyte retrieval cycle, sperm
aspiration attempt, or simple specimen collection. See paragraph 2.5.2.10.6.
Request may be provided by primary care provider or other provider
significantly involved in the care of the qualifying condition(s)
or the impact of those condition(s) on the qualifying Service member’s
fertility.
2.5.2.10.2.1.4 Qualifying Service members
and their TRICARE-enrolled designee(s) must have capacity to provide
informed consent (i.e., third party consent is not authorized).
Informed consent for any care received under this extended benefit
is obtained by the provider.
Note: Prior male and/or female
surgical sterilization does not disqualify a Service member or their TRICARE-enrolled
designees from participation, Sterilization reversal is not covered.
2.5.2.10.2.1.5 Services and supplies
covered for gamete retrieval/collection include the following:2.5.2.10.2.1.5.1 Consultation and subsequent
office visits, as indicated;
2.5.2.10.2.1.5.2 Laboratory tests, ultrasound
imaging, and semen analysis, as indicated;
2.5.2.10.2.1.5.3 Provider-prescribed
medications as indicated for gamete retrieval;
2.5.2.10.2.1.5.4 Self-administered medications
as indicated for gamete retrieval as covered under Chapter
23;
2.5.2.10.2.1.5.5 Medically necessary
services and supplies associated with complications; and
2.5.2.10.2.1.5.6 Anesthesia or conscious
sedation will be provided for the oocyte retrieval and sperm aspiration
in accordance with the TPM, Chapter 3, Sections 1.1 and 1.2.
2.5.2.10.2.1.6 Coverage specific
to oocyte retrieval includes the following:2.5.2.10.2.1.6.1 The benefit is limited
to the retrieval of 20 oocytes or three completed cycles, whichever
occurs first. There may be up to six attempts (i.e., ovarian stimulation
with gonadotropins, and any associated services in preparation of
oocyte retrieval) to accomplish three completed retrieval cycles.
These limitations are based upon the total lifetime retrievals and
cycles used by the qualifying Service member, not by the TRICARE-enrolled
designee. See paragraph 2.5.2.10.6.2.3.
2.5.2.10.2.1.6.2 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.
2.5.2.10.2.1.6.3 If following oocyte
retrieval, the oocyte is cryopreserved or the oocyte is fertilized to
create an embryo and the embryo is cryopreserved, this should only
be counted as an oocyte retrieval for the purposes of the benefit
limitations.
2.5.2.10.2.1.6.4 If following oocyte
retrieval, the oocyte is fertilized to create an embryo and the embryo
is transferred rather than cryopreserved, then this should be counted
as both an oocyte retrieval and an embryo transfer for the purposes
of the benefit limitations.
2.5.2.10.2.1.6.5 Surgical retrieval is
covered.
2.5.2.10.2.1.7 Coverage specific
to sperm collection and retrieval includes the following:2.5.2.10.2.1.7.1 If indicated, invasive
procedures for sperm retrieval beyond simple collection of semen
(or urine for retrograde ejaculation) must be specified in the referral.
2.5.2.10.2.1.7.2 Invasive procedures
for sperm retrieval (e.g., electro-ejaculation, epididymal aspiration)
likely to produce viable sperm are covered for the qualifying Service
member only, and are not covered for TRICARE-enrolled designees
that require the use of invasive procedures due to their own fertility
issues. Sperm aspiration through Microsurgical Epididymal Sperm
Aspiration (MESA), Percutaneous Epididymal Sperm Aspiration (PESA),
or non-surgical fine needle aspiration may be accomplished. Vibratory
stimulation or electro-ejaculation may be used if appropriate.
2.5.2.10.2.1.7.3 A reasonable number
of simple specimen collections for use in intrauterine insemination
or for use in IVF at the time of oocyte retrieval is provided under
this benefit. However, simple sperm collection for cryopreservation
is limited to two collections. The benefit is limited to either
two simple specimen collections or one invasive procedure for sperm
retrieval.
2.5.2.10.2.1.8 Age RequirementsAge requirements at
time of retrieval of gametes for immediate use or cryopreservation
are as follows:
2.5.2.10.2.1.8.1 Oocyte retrievals may
be accomplished for individuals aged 49 or under;
2.5.2.10.2.1.8.2 Sperm retrievals may
be accomplished for individuals aged 61 or under.
2.5.2.10.2.2 Cryopreservation and
Storage of Retrieved/Collected Gametes (Oocytes/Sperm)2.5.2.10.2.2.1 Services and supplies
associated with cryopreservation and storage of gametes is covered
for gametes retrieved from:2.5.2.10.2.2.1.1 Qualifying Service members
who are diagnosed with a condition requiring gonadotoxic treatments
or therapies; or
2.5.2.10.2.2.1.2 Qualifying Service members
and their TRICARE-enrolled lawful spouse or TRICARE-enrolled unmarried
partner, when such gametes will be used in other ART services (i.e.,
IUI or IVF) in the furtherance of the qualifying Service member
becoming a parent.
2.5.2.10.2.2.2 Cryopreservation and
storage of donor gametes is not covered.
2.5.2.10.2.2.3 The contractor shall
ensure gametes and embryos are stored at facilities listed and registered
in accordance with 21 CFR 1271.
2.5.2.10.2.2.4 The contractor shall
cover storage of all non-donor gametes from the date of first retrieval
as long as the qualifying Service member remains on active duty.
2.5.2.10.2.2.5 The qualifying Service
member is responsible for all storage costs incurred after separation/retirement.
2.5.2.10.3 Creation, Cryopreservation
and Storage of Embryos2.5.2.10.3.1 Intracytoplasmic sperm
injection will be covered for those who desire to cryopreserve embryos
rather than gametes when determined by the IVF clinic to be beneficial
for fertilization.
2.5.2.10.3.2 Healthy embryos that
progress to an appropriate stage in excess of those used for a fresh
embryo transfer, as assessed by the embryologist, may also be cryopreserved.
2.5.2.10.3.3 Any combination of the
qualifying Service member’s own gametes, their TRICARE-enrolled
designee’s gametes, or independently acquired donor gametes (i.e.,
donor sperm and/or donor oocytes) may be used for the creation of
embryos. The cryopreservation and storage of these embryos are covered
when done for the benefit of a qualifying Service member.
2.5.2.10.3.4 The contractor shall
cover storage of embryos while the qualifying Service member remains
on active duty.
2.5.2.10.3.5 The qualifying Service
member is responsible for all storage costs incurred after separation/retirement.
2.5.2.10.4 Ownership and Disposition
of Gametes and Embryos2.5.2.10.4.1 Ownership of cryopreserved
gametes and embryos will be the responsibility of the qualifying
Service member and their TRICARE-enrolled designee, as applicable,
and documented in accordance with clinic policies.
2.5.2.10.4.2 Issues regarding ownership,
future use, donation, and/or destruction of cryopreserved gametes
and embryos shall be governed by applicable state law, and shall
be the responsibility of the Service member and their TRICARE-enrolled
designee, as applicable, and the facility responsible for storage.
2.5.2.10.4.3 DoD’s role is limited
to paying for this benefit when requested by the consenting qualifying
Service member.
2.5.2.10.4.4 DoD will not have ownership
or custody of cryopreserved gametes or embryos and will not be involved
in the ultimate disposition of excess cryopreserved gametes or embryos.
2.5.2.10.4.5 Ultimate disposition
or destruction of excess cryopreserved gametes or embryos is not separately
reimbursed.
2.5.2.10.4.6 Arrangements for disposition
are the responsibility of Service members and are subject to state
regulation on disposal and abandonment.
2.5.2.10.4.7 There is no transferal
of the benefit upon the death of the qualified Service member.
2.5.2.10.5 Guidelines For IUI and
IVF/Embryo Transfers2.5.2.10.5.1 General Coverage2.5.2.10.5.1.1 Preauthorization for
every IUI and IVF cycle is required.
2.5.2.10.5.1.2 IUI and IVF services
may be rendered to a qualifying Service member or their TRICARE-enrolled
designee(s), for the benefit of the qualifying Service member.
2.5.2.10.5.1.3 Transportation, and
shipping and handling costs of the qualified Service member’s cryopreserved
gametes (sperm, oocytes) or embryos shall be covered when relocating
the specimen from a local cryobank to a local fertility clinic;
or relocating the specimen from a distant cryobank to a fertility
clinic closer to where the qualifying Service member currently resides.
The DoD is not liable for any loss or damages during transport.
2.5.2.10.5.1.4 Transportation, and
shipping and handling costs for donor gametes and donor embryos
are not covered.
2.5.2.10.5.2 Procedures2.5.2.10.5.2.1 Up to six cycles of
IUI to achieve pregnancy are permitted, but not required, as a prerequisite
to the receipt of IVF services. The decision on use of IUI versus
IVF will be left to the determination of the treating provider in
discussion with the qualifying Service member and their TRICARE-enrolled
designee, as applicable, as to the most appropriate treatment.
2.5.2.10.5.2.2 Eligible individuals
(e.g., qualifying Service members or their TRICARE-enrolled designee)
with an appropriate likelihood of success of achieving pregnancy
through IVF, 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.
2.5.2.10.5.2.3 If a TRICARE-enrolled
gestational carrier (i.e., TRICARE-enrolled designee who is not a
lawful spouse or unmarried partner) is utilized, screening is required
in accordance with the U.S. Centers for Disease Control and Prevention
(CDC), FDA, and American Association of Tissue Banks (AATB). This
screening will not be covered beyond those components which are
permitted under the TRICARE basic benefit. See paragraphs 2.5.2.10.1.6 and 2.5.2.10.7.2.
2.5.2.10.5.2.4 No more than three embryo
transfers total, whether fresh or frozen, shall be covered for the
benefit of the qualifying Service member, regardless of whether
or not the embryo transfer results in pregnancy and/or live birth,
and regardless of whether these embryos are donor or autologous.
2.5.2.10.5.2.5 If a fresh embryo transfer
is planned, the retrieval policies for gametes apply as provided
at paragraph 2.5.2.10.2.1.
The limitations set upon oocyte retrieval are independent of the limitations
on embryo transfer.
2.5.2.10.5.2.6 Anesthesia or conscious
sedation will be covered for embryo transfer in accordance with
the TPM, Chapter 3, Sections 1.1 and 1.2.
2.5.2.10.5.2.7 Intracytoplasmic sperm
injection will be covered for fresh embryo transfers when determined
by the IVF clinic to be beneficial for fertilization.
2.5.2.10.5.2.8 Embryo transfer in accordance
with guidelines provided by the ASRM shall be accomplished in accordance
with accepted clinic practices.
2.5.2.10.5.2.9 Healthy embryos that
progress to an appropriate stage, as assessed by the embryologist,
in excess of those used for a fresh embryo transfer, may be cryopreserved.
See paragraph 2.5.2.10.3 for
embryo cryopreservation and storage.
2.5.2.10.6 Documentation and Management
Required For Receiving ART Services2.5.2.10.6.1 Referrals2.5.2.10.6.1.1 For all ART services
authorized under this section, a referral is required from the qualifying
Service member’s PCM or other provider significantly involved in
the care of the qualifying condition(s) or the impact of those condition(s)
on the qualifying Service member’s fertility.
2.5.2.10.6.1.2 Each referral submitted
to the contractor shall contain the following information:2.5.2.10.6.1.2.1 Name of provider of
reproductive services requested to be used, if known;
2.5.2.10.6.1.2.2 Requested facility name
and address, if applicable;
2.5.2.10.6.1.2.3 Confirmation of the
requested ART services to be provided to the qualifying Service member
or the TRICARE-enrolled designee (i.e., gamete retrieval, cryopreservation,
IUI, IVF) with the associated DoD Benefits number (DBN); and,
2.5.2.10.6.1.2.4 Confirmation that the
qualifying Service member and referring physician have appropriately
completed DHA Form 407, including Section IV with provider attestation,
and uploaded it into the electronic health record.
2.5.2.10.6.1.3 Each referral submitted
to the contractor shall also contain the following information on
DHA Form 407:2.5.2.10.6.1.3.1 For all ART services,
with the exception of gamete retrieval and cryopreservation for qualifying
Service members prior to initiation of gonadotoxic treatment, confirmation
the qualifying Service member attested the ART services provided
under this policy are exclusively for the purpose and intent of
enabling the qualifying Service member to become a parent and the
qualifying Service member intends to assume a parental relationship
with any child born as a result of the ART services covered under
this policy;
2.5.2.10.6.1.3.2 Identification of the
TRICARE-enrolled designee (name and DBN), if applicable;
2.5.2.10.6.1.3.3 Confirmation of qualifying
Service member’s category II or III status;
2.5.2.10.6.1.3.4 Service member’s qualifying
diagnosis(es); and,
2.5.2.10.6.1.3.5 Summary of relevant
medical information supporting category designation.
Note: If coverage is dependent
upon the administration of gonadotoxic therapy, summary must include
Service member’s planned or administered gonadotoxic therapy.
2.5.2.10.6.1.4 If applicable, a referral
must also be submitted for the TRICARE-enrolled designee receiving
ART services for the benefit of the qualifying Service member. The
referral is required from the TRICARE-enrolled designee’s PCM (or
referral by primary care provider for TPR enrollees), a provider significantly
involved in the care of the qualifying condition(s) of the qualifying
Service member, or a specialist with appropriate knowledge of the
impact of those condition(s) on the qualifying Service member’s
fertility. The referral must include the following:2.5.2.10.6.1.4.1 Qualifying Service member’s
name and DBN;
2.5.2.10.6.1.4.2 Confirmation the DHA
Form 407 was completed appropriately and uploaded for Referral Management
to upload into the electronic health record of the qualifying Service
member and TRICARE-enrolled designee(s).
2.5.2.10.6.2 PreauthorizationAll oocyte retrieval
cycles, sperm retrievals, IUI cycles and IVF/embryo transfer cycles
must be preauthorized.
2.5.2.10.6.2.1 Upon electronic receipt
of a referral, the contractor shall confirm the qualifying Service
member’s eligibility for this benefit, including the number of specific
gamete retrieval cycles previously initiated and completed, number
of IUI cycles previously completed, and/or number of embryo transfer
cycles completed, as applicable.
2.5.2.10.6.2.2 The contractor shall
annotate the number of available cycles or retrievals remaining on
the authorization letter.
2.5.2.10.6.2.3 The number of available
cycles or retrievals is dependent on the qualifying Service member’s
lifetime coverage limitation, regardless of any change of TRICARE-enrolled
designee. In other words, updating DHA Form 407 to designate a new
TRICARE-enrolled designee does not negate applying prior services
received towards the lifetime coverage limit.
2.5.2.10.6.3 Management2.5.2.10.6.3.1 The contractor shall
follow best business practices in the use of case management for
beneficiaries of ART services.
2.5.2.10.6.3.2 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.
2.5.2.10.6.3.3 If the beneficiary changes
their region of enrollment, the losing contractor shall forward
approved referrals, authorization letters, and DHA Form 407 to the
gaining contractor when requested (by phone or in writing) by the
beneficiary or gaining contractor. The information forwarded shall
include, but is not limited to, the number of authorized visits
and approved diagnostic/treatment codes. See paragraph 2.5.2.5.
2.5.2.10.6.3.4 The contractor shall
accept and process or reprocess qualifying ART services documentation
(DHA Form 407, referrals, claims) for services received on or after
March 8, 2024 upon request. See paragraph 1.1.1 and paragraph 9.8.
2.5.2.10.6.3.5 All SHCP requirements
and provisions of Chapter
16 and Chapter
17 apply to this benefit unless
changed or modified by this paragraph. The appropriate chapter for
the status of the Service member shall apply.
2.5.2.10.7 Exclusions
2.5.2.10.7.1 No portion of this
benefit will be used to pay for services or associated fees for
the extraction, storage, or transportation of donor gametes or donor
embryos, gestational carrier contracts, legal/court fees, and birth
orders. Third party donations
or surrogacy cannot
be cost-shared. See paragraph 2.5.2.10.1.8 regarding
use of donor gametes/embryos.
2.5.2.10.7.2 Paid arrangements cannot
be cost-shared. Compensation of any kind to a partner or third-party
gestational carrier for involvement in supporting the effort to
overcome the qualifying Service member’s loss of their ability to
procreate without the use of ART is prohibited. See paragraphs 2.5.2.10.1.6 and 2.5.2.10.5.2.3.
2.5.2.10.7.3 Care that is not for
the benefit of the qualifying Service member cannot be cost-shared, including
situations where the qualifying Service member does not intend to
be a parent to the resulting child.
2.5.2.10.7.4 This benefit is not
available if the qualifying Service member is unable to provide informed
consent.
2.5.2.10.7.5 This benefit is not
available to individuals who are not TRICARE-eligible and enrolled.
2.5.2.10.7.6 Cryopreservation of gametes in
anticipation of deployment is excluded.
2.5.2.10.7.7 Services related to gender selection will
NOT cannot be cost-shared.
2.5.2.11 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.