Medically necessary laser hair removal or electrolysis may be covered when primarily performed to correct or improve a bodily function whether or not there are also impacts to physical appearance. Devices used for laser surgery must be FDA-approved. An approval from Health Net Federal Services, LLC is not required; however, a benefit review is recommended. To expedite the review process, please include supporting medical documentation with the authorization request. Beneficiary cost-shares or copayments for laser surgery are the same as those for conventional surgery and vary based on place of service.
Hearing Aids and Hearing Aid Services
Hearing aids and related services are only covered for active duty family members with profound hearing loss. More >>
Hearing screenings are covered for newborns as defined by the American Academy of Pediatrics and Joint Committee on Infant Hearing, and should be performed before the newborn is discharged from the hospital or within the first three months. Evaluative hearing tests may be performed at other ages during preventive exams.
Portable heart monitors, such as Holter Monitors, are covered when prescribed by a physician as a diagnostic tool for a suspected medical condition. These are generally rented for a few days but may be required for a longer period of time depending on the medical need. TRICARE-covered monitors do not require a separate approval from HNFS. For TRICARE Prime beneficiaries, medically necessary monitoring services are covered under the referral approved to the specialist. Personal heart rate monitors used by a beneficiary to track/monitor their own heart activity are not a covered benefit.
Home Health Care
Home health care is covered for skilled nursing care and physical, speech and occupational therapy. More >>
Home Infusion Therapy
Home infusion therapy is a limited benefit. More >>
Hormone Replacement Therapy
Hormone replacement therapy may be a covered benefit when used to treat hormone deficiencies (for example, hypothyroidism). Hormone replacement therapy for menopause is a covered benefit for women when used to treat menopausal symptoms or to prevent osteoporosis or other conditions associated with menopause. Most medications are available through Express Scripts. Providers should contact Express Scripts to determine approval and availability. Providers who plan to administer injectable specialty drugs not available through Express Scripts may order specialty drugs through a specialty pharmacy/drug supplier, which may require prior authorization if administered in the home. Hormone injections for the treatment of organic impotency are a covered benefit when the medication is approved by the U.S. Food and Drug Administration (FDA) and used for an FDA-approved indication. Growth hormone is a limited benefit. Subcutaneous implantable estradiol pellets for women are not a covered benefit. See also gender dysphoria treatment for additional information.
Hospice care is a covered benefit and provides palliative care for beneficiaries with a prognoses of less than six months to live if the terminal illness runs its normal course. Beneficiaries who elect to receive care under hospice cannot receive curative treatment related to the terminal illness unless the hospice care has been revoked. Beneficiaries under the age of 21 are exempt from this requirement and are eligible to receive hospice services concurrently with curative care. This allows continued coverage of medically necessary curative treatment, even after hospice services have been elected for beneficiaries under the age of 21.
An approval is required for hospice care for all beneficiaries (excluding those with other health insurance). Approval requirements for curative care for beneficiaries under the age of 21 who have elected hospice vary by TRICARE plan type. Providers are required to submit a service and activity log for continued coverage of curative treatment. HNFS offers its Concurrent Hospice and Curative Care Monthly Service and Activity Log for your use.
There may be separate charges for durable medical equipment, prosthetics, and specific drugs with applicable copayments and cost shares. Room and board is not covered under hospice care unless the patient is receiving authorized inpatient or respite level of care. Learn more about hospice care within our Case Management program.
Providers can use our Request for Reimbursement of TRICARE Hospice Cap Amount when submitting claims.
Hospitalization for Medical and Surgical Care
Inpatient hospitalization is a covered benefit. More >>
Hospitalization for Mental Health
Hospitalization for mental health is covered, regardless of length of stay, as long as care is considered medically or psychologically necessary and appropriate. All non-emergency admissions require prior authorization for all beneficiaries (except those with other health insurance). An approval from Health Net Federal Services, LLC is not required for emergency admissions. However, notification of admission and discharge dates must be submitted by the next business day following the admission and discharge. Providers can submit this information online or by using an Inpatient TRICARE Service Request/Notification Form withclinical justification for admission. HNFS conducts continued stay reviews for all mental health care.
Human Papillomavirus (HPV) Deoxyribonucleic Acid (DNA) Testing
HPV DNA testing is a covered benefit for females age 30 and older as a cervical cancer screening when performed with a Pap smear, also known as a Pap test.
Human Papillomavirus (HPV) Vaccine
The human papillomavirus (HPV) vaccine is a limited benefit and may be covered when the beneficiary has not been previously vaccinated or completed the vaccine series. More>>
A hysterectomy is a limited benefit and only covered when medically necessary. More >>