Did You Prescribe Oral Contraceptives? Medical Documentation Required to Waive Copays
Monday, July 31, 2023
Last year, TRICARE changed its contraceptive care coverage to allow women to receive medical contraceptive services without cost-shares or copayments when seeing network providers as part of the preventive care benefit. While claims for some medical contraceptive services (see below) can easily be identified, this is not the case for office visits where contraceptives were prescribed. For these office visits to process under TRICARE’s well-woman preventive care benefit, we need medical documentation that shows evidence of contraceptive care.
How to submit medical records to show contraceptive care services were rendered:
Online: Log in on our website and choose the “Upload Documents” option from the “Secure Tools” box.
Fax: 1-844-869-2812
Mail: Health Net Federal Services, LLC
c/o PGBA, LLC/TRICARE
P.O. Box 202100
Florence, SC 29502-2102
As a reminder, TRICARE’s contraceptive benefit changes were rolled out in two phases and allow for the following services to be covered without cost-shares or copayments:
- Effective July 28, 2022, long-acting reversible contraceptive consultations and services such as placing and removing intrauterine devices (IUD) and subdermal contraceptive rods, administering contraceptive shots and measuring/fitting and training on use of diaphragms
- Effective Jan. 1, 2023, female permanent contraception (tubal ligation)
Pharmacy copayments for prescribed contraceptives still apply and vary based on member and plan type and where the prescription is filled.
Visit our Benefits A-Z “Birth Control” page and www.tricare.mil/birthcontrol for more information on TRICARE’s birth control coverage.
