Well-Child Visits Now Covered under Tricare Policy

Well-child visits for Tricare users over age six, as well as physicals required for school admissions, will now be covered due to newly updated rules.

The policy change, issued this week, seeks to bring the healthcare system's rules closer in line with the pediatric care standards known as "Bright Futures," included in the Affordable Care Act. Those rules, laid out by the American Academy of Pediatrics, are considered the blueprint for preventive child healthcare. Tricare is exempt by law from the Affordable Care Act.

Under previous rules, Tricare coverage for well-child exams, which are often conducted in conjunction with doctor visits for vaccinations, stopped at age six. The new policy, however, extends those visits through age 21.

"Health Promotion and Disease Prevention annual examinations for those beneficiaries age 6-21 include those services recommended by the American Academy of Pediatrics and Bright Futures guidelines," the policy states. "This includes developmental observation, physical examination, screening, immunizations and anticipatory guidance."

The change to Tricare policy has long been advocated by a coalition of childhood health watchdogs known as Tricare for Kids. Those efforts resulted in proposed language in the not-yet passed 2017 National Defense Authorization Act ordering a report on a plan for implementing the change, among other tasks.

Tricare for Kids members said they are pleased with the update.

"Tricare for Kids is thrilled to see Tricare bring coverage into alignment with Bright Futures -- something we have been advocating for military kids for years -- and applaud additional preventive measure alignments for maternal and child health issues," said Kara Tollett Oakley, a consultant with the Children's Hospital Association on military child health issues and founder of the Tricare for Kids Coalition.

The policy update also altered other rules, including genetic testing for breast cancer for some high-risk patients, and the age at which women may receive cancer-screening pap smears. The entire policy document is available on Tricare's website.

--Amy Bushatz can be reached at amy.bushatz@military.com.

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