Clarification on Telehealth Copayments

Thursday, June 30, 2022

Telehealth, also referred to as telemedicine, continues to be a convenient option for beneficiaries who are not yet ready for in-person visits or prefer seeing physical and mental health care providers from the comfort of home. In response to the coronavirus disease (COVID-19) outbreak, the Department of Defense (DoD) implemented temporary changes to the TRICARE benefit, including the waiver of copayments and cost-shares for covered telemedicine rendered by network providers. Health Net Federal Services, LLC is aware of the DoD Final Rule published on June 1, 2022, that references terminating this waiver. We would like to remind our network providers who offer telehealth services that as a TRICARE contractor, we cannot implement rules published in the Federal Register without formal direction from the Defense Health Agency (DHA). This direction generally comes in the form of a TRICARE manual change, which will include specific effective and implementation dates.

Upon DHA direction, we will inform you if and when beneficiary out-of-pocket costs for network telemedicine visits should change.  

Please review the following excerpt from our May 2020 education titled, “Temporary Expansion of Telemedicine Benefit”:

Telemedicine copays waived
TRICARE is waiving copayments and cost-shares for covered audio-only or audio/video telemedicine rendered by network providers on or after May 12, 2020. Beneficiaries who seek telehealth from non-network providers are liable for their regular copayments or cost-shares. TRICARE Prime beneficiaries who seek care from specialists without an approved referral when required are subject to Point of Service fees.  

You can find current benefit and cost details at www.tricare-west.com and www.tricare.mil/telemedicine.