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Medical Affairs Branch - Information on Infertility and Specialty Care |
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The Medical Affairs Branch (MAB), Office of Commissioned Corps Support Services, Program Support Center, is providing the following
guidance regarding infertility and specialty care. If you have any questions or need additional information, please contact LCDR
Cynthia McArdle at 301-594-6749 or 1-800-368-2777. |
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Infertility |
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Invitro Fertilization (IVF) has become a viable alternative for those persons seeking to have children. The medical care entitlement
available to the Active-Duty Service Member (ADSM) is comprehensive, but not all-inclusive, and is designed to keep them fit-for-duty.
Since infertility studies and treatment for infertility is not related to fitness-for-duty, this care is not a covered benefit. MAB has
made it a practice to correct the physical problems that ADSMs may have. An extra benefit of this may result in the ability to produce
children, but is not the reason for providing the care. If you live within the catchment area of a large Military Treatment Facility
(MTF), any service that is offered through that facility is authorized. There may be MTFs that provide IVF service via a civilian
contract and can involve cost to the ADSM. Before embarking on this quest to be parents, make sure the treatment you require is a
covered benefit. See the references below for more information. |
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Some examples are below, but this list is not all-inclusive. For more information, contact TRICARE or MAB. |
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TRICARE covers: |
Infertility diagnosis; and
Tests to find out if you are pregnant (not OTC self-tests). |
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TRICARE does not cover: |
Artificial insemination—including sperm banks/donors, IVF, and other artificial means of conception or the medications
used to support artificial insemination. |
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Specialty Care |
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With our healthcare now being overseen by TRICARE, there is some confusion regarding specialty care. Specialty care for you, the ADSM,
is care that cannot be provided by your Primary Care Provider (PCP). |
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Your Primary Care Manager (PCM) needs to submit a referral request for care through the appropriate TRICARE region (North, South, or West).
The specialist must be within the TRICARE network of providers. If the situation is urgent, the PCP should mark this on the request.
While it doesn’t usually take this long, an authorization for routine specialty care can take as long as 30 days. |
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When the referral is approved, an authorization number will be issued. If you wish to check on the status of a referral, check with your
PCP first. The PCP that requests the care will receive authorization or denial from TRICARE. If you keep an appointment before the
referral is approved, you will be liable for any expenses incurred. |
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Individual ADSMs cannot manage their own care; requests must come from the PCP. |
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When calling TRICARE for advice or information, be sure to identify yourself as the active-duty person. The rules are different for
dependents. ADSMs need to receive preauthorization for ALL specialty care. |