TRICARE laboratory developed tests demonstration extended, certain tests now covered

The Defense Health Agency (DHA) announced the five-year extension of the  Laboratory Developed Tests  (LDT) demonstration, from July 19, 2023, through July 18, 2028. This means that if you have TRICARE, you’ll continue to have access to certain LDTs that aren’t approved by the Food and Drug Administration (FDA).

Non-covered services waiver information

It is important to understand both your responsibility as a TRICARE beneficiary, as well as your provider’s responsibility when it comes to non-covered services.

Beneficiary’s responsibility:

• Report your TRICARE benefit and Other Health Insurance (OHI) coverage to a provider.
• Know the covered benefits as well as limitations and exclusions.

Download the TRICARE non-covered services waiver

Provider’s responsibilities:

• Verify if a service is covered or non-covered before rendering services to a TRICARE beneficiary.  
• Must have the patient sign the non-covered services waiver if a network provider renders a non-covered service to a TRICARE beneficiary.  
• A non-network provider is not required to use the official TRICARE waiver; however, they must have the patient sign a waiver that is equivalent to a TRICARE non-covered services waiver.

Information about the waiver:

• This waiver confirms that the beneficiary is aware that the service is not covered and that the beneficiary is financially responsible for the rendered service.  
• If there is no signed waiver, the provider cannot hold the beneficiary financially responsible for the claim. 
• The use of this waiver protects the provider from payment misunderstandings with a patient and/or having to cover the cost of non-covered services rendered to a TRICARE patient. 
• Non-covered services list (the list is not all inclusive). 

Update to TRICARE's Childbirth and Breastfeeding Support Demonstration (CBSD)

TRICARE’s Childbirth and Breastfeeding Support Demonstration allows Certified Labor Doulas (CLD), lactation consultants or lactation counselors to provide care to eligible beneficiaries.

Effective July 25, the following telemedicine services for the CBSD are no longer included:

• Audio-only breastfeeding counseling
• Antepartum and postpartum care visits

Please note: All childbirth support services provided by a Certified Labor Doula (CLD) must be in-person.

Learn how Qualifying Life Events (QLE) work at August 10 TRICARE webinar

TRICARE beneficiaries are invited to attend a webinar called, “Moving, marriage and more: What TRICARE Qualifying Life Events (QLE) mean for you” on Thursday, August 10, from 1 to 2 PM ET. The event is free, but registration is necessary and space is limited. Sign up here.

This online presentation and Q&A will cover all aspects of QLEs:

When you or your family have a QLE, you have 90 days to make eligible changes to your TRICARE health plan. This webinar will talk about the types of changes that count as QLEs and what to do after you have one. You’ll also learn tips for navigating:

• Moving
• Getting married
• Giving birth or adopting a child
• Retiring
• Becoming eligible for Medicare

Telemedicine policy changes

At the start of the COVID-19 pandemic, the Defense Health Agency (DHA) made several temporary updates to the TRICARE benefit regarding telehealth. These temporary policy updates allowed you to get care safely during the COVID-19 pandemic. The DHA has since updated these policies. It has now been more than two years since the start of the pandemic. Some of these policy changes have recently expired. Meanwhile, others have become permanent.

Payment requirements for TRICARE beneficiaries

Every year, TRICARE costs may change based on the law, the federal cost of living adjustment, changes in the cost of health care services and prescription drugs, and other factors. Depending on your TRICARE plan, you may see changes to your costs, including enrollment fees, premiums, cost-shares and copayments next year.

Kaiser Permanente, a TRICARE Prime Option is ending for Atlanta, GA beneficiaries

The Accountable Care Organization (ACO) demonstration, Kaiser Permanente, a TRICARE Prime option, ends on Dec 31, 2022. If you have this plan, you must change your Primary Care Manager (PCM) to a new TRICARE network provider or enroll in TRICARE Select during TRICARE Open Season. For 2022, Open Season is from Nov 14 to Dec 13, 2022.

Get the latest on Respiratory Syncytial Virus (RSV)

Respiratory Syncytial Virus, or RSV, is a common respiratory virus that usually causes mild, cold-like symptoms. Most people recover in a week or two, but RSV can be serious, especially for infants and older adults. RSV is the most common cause of bronchiolitis (inflammation of the small airways in the lung) and pneumonia (infection of the lungs) in children younger than one year of age in the United States.

Monitoring by the Centers for Disease Control (CDC) has shown an increase in RSV detections and RSV-associated emergency department visits and hospitalizations in multiple US regions, with some regions nearing seasonal peak levels.