TRICARE Vision Benefits

TRICARE vision benefits vary depending on beneficiary status (i.e., active duty service member, active duty Family member, retired service member or retired Family member) and enrollment in TRICARE Prime.

Basic Vision Benefit for Active Duty Family Members:

Active duty Family members are eligible for one comprehensive ophthalmological eye examination per calendar year. The services are provided by TRICARE-authorized optometrists or ophthalmologists, and the deductibles and cost shares/copayments are based on whether the beneficiary is enrolled in TRICARE Prime or opts to use TRICARE Extra or TRICARE Standard.

TRICARE Prime Clinical Preventive Services:

TRICARE Prime enrollees age three and older are authorized comprehensive eye examinations once every two years. TRICARE Prime enrollees may receive the services from any TRICARE network provider without a referral or authorization from the primary care manager (PCM), health care finder (HCF) or any other authority. If the eye examination is not available from a network provider, enrollees may only receive services from a non-network provider if they have a referral from the PCM and authorization from the HCF. If authorized services are received from a non-network provider a point-of-service fees will NOT apply. If a beneficiary receives services from a non-network provider that has NOT been authorized; the beneficiary will be responsible for the ENTIRE amount of the bill.

Pediatric vision screening is available at birth and approximately six months of age.

Diabetic patients, at any age, are allowed annual comprehensive eye examinations.

TRICARE Extra and Standard Clinical Preventive Services:

Vision screening is excluded from the TRICARE Extra and TRICARE Standard plans except for one comprehensive ophthalmological routine eye examination per calendar year for active duty Family members and vision screening under the well-child benefit. The well-child benefit is available from birth to age six and includes eye and vision screening by a PCM during a routine examination at birth and at approximately six months of age. Comprehensive eye examinations are authorized once every two years between ages three and six.

Retirees and their Family members who use TRICARE Standard, TRICARE Extra and TRICARE For Life are not eligible for routine eye examinations.

Lenses (lenses implanted within the eye or contacts) and Eye Glasses:

Except for active duty members, lenses or eye glasses are only cost shared for treatment of the following conditions:

• Infantile glaucoma
• Keratoconus
• Dry eyes
• Irregularities in the shape of the eye
• Loss of human lens function resulting from eye surgery or congenital absence

Benefits are limited to only one set of implantable lenses required to restore vision. A set may include a combination of both implantable lenses and eyeglasses when the combination is necessary to restore vision. If there is a prescription change related to the qualifying eye condition, a new set may be cost shared.

Replacement lenses for those that are lost, have deteriorated, or have become unusable due to physical growth are not covered. Adjustments, cleaning and repairs of eyeglasses are also not covered.

For more information about TRICARE vision benefits, beneficiaries may contact their local beneficiary counseling and assistance coordinator (BCAC) or health benefits adviser (HBA). Special programs may exist at local military treatment facilities (MTFs). Please contact your local MTF for more specific information.

Source: TRICARE Fact Sheets: TRICARE Vision Benefits