Focus on TRICARE vision benefits Published Dec. 6, 2007 By Brian P. Smith TriWest Healthcare Alliance TRIWEST -- TRICARE takes care of you, from head to toe. Along with enjoying benefits for medical care, dental and pharmacy services, TRICARE beneficiaries also have vision benefits. Active duty family members TRICARE beneficiaries are eligible for one routine eye exam annually. Active duty family members with TRICARE Prime coverage have coverage for a comprehensive eye exam every two years with no co-pay. TRICARE Standard and Extra ADFM beneficiaries (over the age of six) have coverage for one routine eye exam each year--cost-shares will apply. Retirees Beneficiaries over age six with TRICARE Prime Retiree coverage are eligible for one comprehensive eye examination every two years; retiree beneficiaries with TRICARE Standard will only have vision benefits when diagnosed with glaucoma, cataracts or diabetes. Children Children who are TRICARE-eligible are covered (under TRICARE's Well-child benefit) for eye and vision screenings at birth and during a routine exam at six months of age. All dependents between the ages of three and six are authorized to receive a comprehensive eye exam--including screening for developmental disorders such as amblyopia and strabismus--every two years. Comprehensive Exams Comprehensive eye exams include screening for visual acuity, ocular alignment and red reflux along with an examination for any external ocular abnormalities. Beneficiaries should receive comprehensive exams through an optometrist or ophthalmologist and do not usually need a referral. TRICARE Prime beneficiaries will still need a referral to cover annual routine eye exams received from a non-network provider. Active duty servicemembers always require a referral for eye exams. In addition to preventive exams, TRICARE covers most medically necessary eye exams. Diabetic beneficiaries are covered for an eye exam each year, regardless of their sponsor's military status with no co-payment, although there may be cost-shares due. TRICARE Prime beneficiaries need referrals for medically necessary visits if they are not performed at a military treatment facility. Glasses and Contacts For active duty servicemembers, eyeglasses are available at military treatment facilities at no cost. All other TRICARE beneficiaries have contact lens or eyeglass coverage only for: - Treatment of infantile glaucoma - Treatment of keratoconus - Scleral lenses to retain moisture when normal tearing is not present or is inadequate - Corneal or scleral lenses used to reduce corneal irregularities (other than astigmatism) - Loss of human lens function resulting from intraocular surgery, ocular injury, or congenital absence - "Pinhole" glasses prescribed for use after surgery for detached retina Find a Provider TRICARE Prime (and TRICARE Prime Remote) beneficiaries do not need a referral from a primary care manager if they visit a network provider for vision care. Those visiting a non-network provider must get a referral or pay through the point of service option. Active duty servicemembers must receive all vision care through the military treatment facility. ADSM enrolled in TRICARE Prime Remote can receive care from a civilian provider but must have an authorization from TriWest Healthcare Alliance for all specialty care. TRICARE Standard and Extra beneficiaries visiting a network provider for care will pay a lower cost-share than if they received care from a non-network provider. Cost-shares and the annual deductible will apply to all covered vision services. Beneficiaries can find a list of TRICARE network vision care providers in TriWest's online provider directory, found at www.triwest.com. Searches can be conducted by location and specialty (for eye care, choose ophthalmology or optometry). Beneficiaries who receive care at a military treatment facility should check to see if that facility offers special programs for vision care.