TRICARE Prime covers required back-to-school physicals for children ages 5-11 as a clinical preventive service. TRICARE® coverage is limited to school physicals for enrollment, not for sports physicals. Sports physicals are not a TRICARE covered benefit.
Note: There may be the rare occurrence where you will need to perform a school physical on a child older than 11 years of age in order for the child to meet the enrollment requirements of a new school due to a permanent change of station move. In these cases, check with TriWest for more information on TRICARE coverage and how to handle claims and reimbursement.
The school physical is important not only because it ensures children are healthy for school, but it also might be the only time throughout the year when you see some of these young patients. The American Academy of Pediatrics (AAP) suggests that primary care managers (PCMs) use the school physical visit as an opportunity to build and add to a child’s complete medical history. This can help you be aware of a child’s progress and development over time and detect emerging problems.
School physicals usually include checking to ensure a student’s immunizations are up to date. TRICARE covers age-appropriate vaccines per Centers for Disease Control and Prevention (CDC) guidelines to immunize children against common childhood diseases. Note: The CDC’s recommended vaccination schedule may be found at www.cdc.gov/vaccines.
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