Coronavirus Frequently Asked Questions

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We will update the information below as the situation changes. 

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COVID-19 Testing

Can I just show up at any testing site to be tested for COVID-19?

No. You should not just show up at a hospital and request testing. Testing is authorized based on the clinical judgment of a provider, exposure, travel history and symptoms. You must have an in-person or virtual telephone/video visit with a provider who will arrange testing in a military treatment facility (if MTF-enrolled) or in the private sector (if enrolled to the network provider with TRICARE Prime or if you’re using TRICARE Select or TRICARE For Life).  If network, the cost of the test is covered in the cost of the visit itself.

How is testing prioritized?

Your health care provider will make that decision based on your exposure risk, symptoms, and guidance from the CDC. There is a screening process to determine who should get tested.

Where can I get tested for COVID-19?

You can get tested at a local military treatment facility if it has the ability to test for COVID-19. If it doesn’t, the MTF will send the sample to an outside laboratory. Stay informed: www.tricare.mil/coronavirus.

What does the test entail?

A simple nasal swab is all that is needed to test for COVID-19.

Did you get tested for COVID19?

Copays will be waived retroactively to March 18 for approved COVID diagnostic testing and office visits related to the testing. If you paid any copays for testing related to COVID-19 and the resulting office visits with a network or non- network provider, you may file a claim for reimbursement.

How long does it take to get results?

The time it takes to get results varies depending on where the test is performed. We’re working to expedite the testing process and more testing sites at military treatment facilities are coming online daily.

What’s the difference between testing and screening for COVID-19? Who gets what?

The screening process begins when you contact your provider or the MHS Nurse Advice Line to discuss your symptoms and it will begin with a series of questions.

The nurse or staff member decides whether your symptoms may be due to COVID-19 or another illness requiring treatment.  You might get advice on self-care since symptoms often can be treated at home.

The nurse/staff member may arrange a telephone visit between you and a health care provider or tell you to call your provider directly. The provider can talk with you about possible exposure, your symptoms, and discusses treatment.  The provider may give you self-care advice to use at home. Or, he or she may tell you to go to your primary care clinic or emergency to be tested.

It’s important to call first so we can protect you, other patients, and medical staff from unnecessary exposure to COVID-19.

How much does the test cost?

  • The COVID-19 test is free. The COVID-19 Test should only be done when your provider thinks your symptoms show likely infection.
  • Effective March 18, under the Families First Coronavirus Response Act, TRICARE is also waiving copays for doctor-ordered COVID 19 testing office visits.
    • The law doesn't waive copayments and cost-shares for the treatment due to infection. Copays and cost shares remain the same for TRICARE program and plans.
    • Under TRICARE you have fairly low out-of-pocket costs, a catastrophic cap and protection against balance billing.
  • Active duty service members and ADFMs under Prime do not have cost-shares and so are not impacted by this law.
  • Due to the claims billing process and modifications, TRICARE can't immediately waive all copayments and cost-shares. Beneficiaries may have to pay up front and file a claims for reimbursement until the contractors can modify their systems.
  • If you receive a prescription for medication, your copay still applies. By law, TRICARE can't waive pharmacy copays. Consider filling your medication through home delivery or at a retail pharmacy depending on your MTFs operating status.

If you’re located overseas: Beneficiaries overseas with a cost-shareA percentage of the total cost of a covered health care service that you pay. (retirees and their family members, active duty family members (ADFMs) under TRICARE Select, and TRICARE For Life) may be eligible for cost share waivers. This is only if the COVID-19 test with the visit meets the requirements of the law. It has to be FDA approved, cleared, or authorized. Some tests used and TRICARE-covered overseas may not meet this statutory requirement. This includes the World Health Organization test, which is not currently FDA authorized.

If I’m enrolled in TRICARE Prime Remote or TRICARE Select, what’s the policy for testing?

If you’re enrolled in TRICARE Prime Remote or are a TRICARE Select beneficiary, it’s up to your civilian provider to assess your status and determine if you need testing. They may want to first test you for other infections, flu, bacteria, and then will follow-up with the COVID-19 test if he or she feels it’s necessary. The COVID-19 Test is only being done when a provider thinks your symptoms show likely infection. The testing is free.

  • Effective March 18, under the Families First Coronavirus Response Act, TRICARE is also waiving copays for doctor-ordered COVID 19 testing office visits.
    • The law doesn't waive copayments and cost-shares for the treatment due to infection. Copays and cost shares remain the same for TRICARE program and plans.
    • Under TRICARE you have fairly low out-of-pocket costs, a catastrophic cap and protection against balance billing
  • Active duty service members and ADFMs under Prime do not have cost-shares and so are not impacted by this law.
  • Due to the claims billing process and modifications, TRICARE can't immediately waive all copayments and cost-shares. Beneficiaries may have to pay up front and file a claims for reimbursement until the contractors can modify their systems.
  • If you receive a prescription for medication, your copay still applies. By law, TRICARE can't waive pharmacy copays. Consider filling your medication through home delivery or at a retail pharmacy depending on your MTFs operating status.

If you’re located overseas: Beneficiaries overseas with a cost-share (retirees and their family members, active duty family members (ADFMs) under TRICARE Select, and TRICARE For Life) may be eligible for cost share waivers. This is only if the COVID-19 test with the visit meets the requirements of the law. It has to be FDA approved, cleared, or authorized. Some tests used and TRICARE-covered overseas may not meet this statutory requirement. This includes the World Health Organization test, which is not currently FDA authorized.

Are tests available at the Emergency RoomThe hospital department that provides emergency services to patients who need immediate medical attention. (ER)?

They are likely available in most ERs. They may be set aside for who were exposed to or in contact with someone exposed to the virus AND showing symptoms. Tests are not likely to be offered for screening purposes for all others.

Elective Surgeries and Procedures

What’s happening with other appointments and elective procedures at military treatment facilities?

 

What’s happening with elective procedures at military treatment facilities (MTFs) and dental treatment facilities (DTFs)?

The Department of Defense issued policy guidance directing that all MTFs and DTFs postpone all elective surgeries, invasive procedures, and dental procedures as of March 31, 2020 for 60 days.

There are 2 exceptions to the policy if the MTF or DTF commander or director determines there is adequate capacity to safely authorize a surgery or procedure. Specifically, there may be an exception when the:

  • Procedures are required to maintain the deployability and readiness of service members;
  • Provider determines that postponing the procedure would cause harm to the patient.

What is an “elective” surgery or procedure?

Elective surgeries and procedures are those that are not urgent and can be rescheduled for a later date. Examples include, but are not limited to:

  • Laser surgery
  • Hernia repair
  • Non-emergent back surgery
  • Colonoscopies
  • Joint replacements

MTFs and DTFs will continue to conduct surgeries and procedures to save lives and avoid further harm from underlying conditions or diseases, or where the risk of delaying the procedure outweighs all other considerations.

What do I do if I really need my medical procedure?

We encourage those who are impacted by this policy to talk to their local MTF or DTF.

Who is impacted by this policy?

This policy applies to all eligible beneficiaries who use our military medical treatment facilities or dental treatment facilities, including:

  • Active duty service members
  • Active duty family members
  • Retirees
  • Retiree family members
  • Reserve Component and National Guard service members on active duty or issued a delayed-effective date active duty orders
  • Other eligible beneficiaries

Who do I call if I have questions?

Work through your military medical treatment facility or dental treatment facility; each facility can address your concerns, and can provide guidance on rescheduling and how to proceed.

How will this impact the coronavirus outbreak?

In the executive order, the President stated: “To ensure that our healthcare system is able to surge capacity and capability to respond to the spread of COVID-19, it is critical that all health and medical resources needed to respond to the spread of COVID-19 are properly distributed to the Nation’s healthcare system and others that need them most at this time.”

Are you closing the Military Treatment Facilities?

No. Military clinics and hospitals will remain open. This is only for elective surgeries and procedures. For those who have may have COVID-19 symptoms, we encourage you to call your local treatment facility’s COVID hotline and follow the instructions on how to seek care.

What will Military Treatment Facilities (MTFs) and Dental Treatment Facilities (DTFs) continue in terms of offering services that are non-COVID related?

Non-elective procedures, particularly acute and urgent care, will continue, as well as procedures that will keep a Service member medically ready and deployable.

MTFs and DTFs will continue to provide routine appointments and exams, such as check-ups, specialty consultations, and prenatal visits at this point in time. However, individual MTFs and DTFs may further limit availability based on response demands.

What do I do if the ID-card office is closed? My card is going to expire this month, but the office is closed. My active duty son needs to add his new wife.

For information on expired ID cards and DEERS enrollment, visit https://www.cac.mil/Coronavirus/. Topics covered include:

  • Frequently Asked Questions - DoD Response to COVID-19/DoD ID Cards & Benefits
  • DEERS Enrollment and ID Card Issuance During COVID-19
  • DEERS Enrollment/ID Card Issuance Guide During COVID-19 DoD Civilian Employee CAC Retention
  • DoD Memorandum, “Common Access Card Retention for Department of Defense Civilian Personnel Transferring Between Department of Defense Components,” dated December 20, 2016
  • RAPIDS Site Locator (RSL)
  • RAPIDS Appointment Scheduler (RAS)

My Common Access Card (CAC) (active duty members/federal workers) is going to expire. What am I supposed to do?

Per Personnel and Readiness dated April 16, 2020 indicates:

  • CACs and Volunteer Logical Access Credentials (VoLACs).  Credentials that expire on or after April 16, 2020 or are going to expire within 30 days:
    • Individuals can update their certificates using “ID Card Office Online”.
    • This allows access through September 30, 2020.
    • Visit https://www.cac.mil/Coronavirus for step-by-step instructions.  Click on the links for “User Guide – Updating CAC/VoLAC Certificates”.  If not done within 30 days of the expiration date, the cardholder can’t use the online system.
  • CACs that expire on or after April 16, 2020, are authorized for use to access benefits through September 30, 2020.  The cardholders must still be eligible for benefits.
  • Existing and new Trusted Associate Sponsorship System (TASS) applications are valid for 180 days. This lets TASS-sponsored cardholders use remote options to update their certificates.

TRICARE Benefit

What, if any, copayments will be waived related to COVID-19 treatment and testing? How does this apply to active duty, reserve component, and retirees?

  • The COVID-19 test is only being done when a provider thinks your symptoms show likely infection. The testing is free.
  • The COVID-19 test is free. The COVID-19 test should only be done when your provider thinks your symptoms show likely infection.
  • Effective March 18, under the Families First Coronavirus Response Act, TRICARE is also waiving copays for doctor-ordered COVID 19 testing office visits.
    • The law doesn't waive copayments and cost-shares for the treatment due to infection. Copays and cost shares remain the same for TRICARE program and plans.
    • Under TRICARE you have fairly low out-of-pocket costs, a catastrophic cap and protection against balance billing
  • Active duty service members and ADFMs under Prime do not have cost-shares and so are not impacted by this law.
  • Due to the claims billing process and modifications, TRICARE can't immediately waive all copayments and cost-shares. Beneficiaries may have to pay up front and file a claims for reimbursement until the contractors can modify their systems.
  • If you receive a prescription for medication, your copay still applies. By law, TRICARE can't waive pharmacy copays. Consider filling your medication through home delivery or at a retail pharmacy depending on your MTFs operating status.

If you’re located overseas: Beneficiaries overseas with a cost-share (retirees and their family members, active duty family members (ADFMs) under TRICARE Select, and TRICARE For Life) may be eligible for cost share waivers. This is only if the COVID-19 test with the visit meets the requirements of the law. It has to be FDA approved, cleared, or authorized. Some tests used and TRICARE-covered overseas may not meet this statutory requirement. This includes the World Health Organization test, which is not currently FDA authorized.

Are retirees using TRICARE For Life and Medicare covered for COVID-19 testing and treatment?

  • Medicare covers the lab tests for COVID-19. You pay no out-of-pocket costs.
  • Medicare covers all medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. hospitalizations. This includes if you're diagnosed with COVID-19 and might otherwise have been discharged from the hospital after an inpatient stay, but instead you need to stay in the hospital under quarantine.
  • If you have a Medicare Advantage Plan, you have access to these same benefits. Medicare allows these plans to waive cost-sharing for COVID-19 lab tests. Check with your plan about your coverage and costs.
  • Scammers may use the coronavirus national emergency to take advantage of people while they’re distracted. As always, guard your Medicare card like a credit card, check Medicare claims summary forms for errors, and if someone calls asking for your Medicare Number, hang up! Check for guidance at Medicare.gov.
  • TRICARE acts as second payer for Medicare and TRICARE covered services, to include coronavirus testing and hospitalization.

Do you know when the Defense Health Agency (DHA) is going to hold the Applied Behavioral Analysis (ABA) and Autism Care Demonstration (ACD) Town Hall?

DHA will not be hosting an ACD specific Town Hall.

TRICARE is allowing a temporary exception to the use of telehealth capabilities for ABA services, but it is limited. Telehealth, by videoconferencing, is being allowed for an unlimited use of CPT 97156 with GT modifier. This code a temporary, timed, 15-minute session for use by the authorized ABA supervisor (or as delegated to an assistant behavior analyst) for guiding the parents/caregivers (with or without the beneficiary present) to utilize the ABA TP protocols to reinforce adaptive behaviors.

This starts March 31, 2020 and runs through May 31, 2020. Should the period of emergency extend past May 31, 2020, the Defense Health Agency will provide additional guidance on a possible extension of this exception to policy.

To view additional FAQs and a full article go to: https://www.health.mil/Military-Health-Topics/Conditions-and-Treatments/Autism-Care-Demonstration.

You can also get information at: https://tricare.mil/autism and https://tricare.mil/CoveredServices/IsItCovered/TelementalHealth.

What type of telehealth/telemedicine services does TRICARE cover?

TRICARE covers many telehealth/telemedicine services when:

  • Medically or psychologically necessary,
  • Appropriate,
  • With a military or TRICARE-authorized providerAn authorized provider is any individual, institution/organization, or supplier that is licensed by a state, accredited by national organization, or meets other standards of the medical community, and is certified to provide benefits under TRICARE. There are two types of TRICARE-authorized providers: Network and Non-Network. DS.

Services may include:

  • Primary, routine, and specialty care,
  • Behavioral health care like psychotherapy, Family guidance/training from a board certified behavior analyst under the Autism Care Demonstration, or
  • Physical therapy or occupational therapy.

Update:

The Department published an interim final rule on May 12, 2020. It makes three temporary changes to TRICARE regulation. The goal is to ensure you have access to care during the national health emergency due to the pandemic.

With the rule change:

1. TRICARE will temporarily pay for certain phone (audio-only) telehealth services. The visit must be medically or psychologically necessary. It must be appropriate.

  • For example, you may have a phone visit with your provider to evaluate and manage your care, or you may have a psychotherapy visit.
  • TRICARE won’t pay for all phone visits. Some aren’t appropriate by phone, e.g. intensive outpatient programs. In these cases, your visit must be face-to-face or through audio-video channels.
    • If your care normally requires a physical exam, an audio-only visit isn’t appropriate. (This includes a remote physical exam using a “telepresenter”- which may be a nurse with digital tools and resources.)
    • Your provider can’t bill separately for administrative services. For example, he or she can’t bill for setting up the appointment or verifying your prescriptions. These costs are part of the audio-only visit itself.
  • TRICARE billing and payment rules still apply.
  • TRICARE program and plan rules still apply. For example, if you are TRICARE Prime, you still need to get a PCM referral for specialty care.

2. TRICARE is temporarily paying providers who practice across state or country lines. This only applies when federal, state, or host nation laws allow the out-of-state or international practice. It helps in areas where there is a high-need for health care services.

  • It applies to both in-person and telemedicine services.
  • Federal, state, or host-nation licensing requirements apply.
    • Stateside: The license has to permit practice out-of-state.
    • Overseas: The provider’s host-nation has to permit inter-country practice. The provider has to be licensed in both countries.
  • Your provider can’t barred or restricted from practice in any state. He or she can’t be on the Department of Health and Human Services sanction list.

3. TRICARE is temporarily waiving copays or cost-shares for telehealth services. This includes your deductible (if applicable).

  • This is for TRICARE-covered services from in-network providers. It’s not just for your COVID-19 care.
  • It’s for both Prime and Select enrollees.

These temporary changes are in effect:

  • Starting May 12, 2020, for the United States. They will be in place until the end of the President’s declared national emergency
  • Starting March 10, 2020, overseas. They may be in place beyond the U.S. national emergency end date, based on local conditions.

You may not see these changes right away as the contractors have to make system changes.

If you have a question about a telehealth claim, reach out to your regional contractor.

 

I have TRICARE and live overseas. Many providers aren’t seeing patients in their offices. Does TRICARE cover telemedicine here due to COVID-19?

  • TRICARE may cover telemedicine services overseas. Services must be medically or psychologically necessary and appropriate.
  • Civilian TRICARE Overseas Program (TOP) network or participating providers have to:
    • Follow host nation country privacy laws 
    • Meet telemedicine credentialing requirements
    • Follow TRICARE policy requirements
  • You still have to get required referrals, pre-approvals, or authorizations for services. If you have:
    • TRICARE Overseas Program (TOP) Prime: Your primary care manager (PCM) has to submit a “Defer to Network Request (DTNR)” to the overseas contractor. The DTNR has to note the need for telemedicine services.
    • TOP Prime Remote: You must call your TOP Regional Call Center for all of your telemedicine services. This includes your first visit and follow-up visits that you may need.
  • If you self-refer for services, you must see a telemedicine credentialed provider. This would apply if you choose to self-refer for some outpatient mental health services.
    • Active duty service members must get pre-authorization for all types of mental health care that they seek. This will come from your PCM at your military hospital or clinic or from the overseas contractor.
  • Telemedicine must have both live video and audio for TRICARE to cover it. TRICARE doesn’t cover telemedicine services through:
    • Audio-only conferencing
    • Phone calls
    • Texts
  • Services that TRICARE doesn’t now cover under the TOP are not covered through telemedicine.

To learn more, contact your TOP Regional Call Center.

Does TRICARE cover telehealth services for the Intensive Outpatient Program?  IOP is often the last stop before hospitalization.

The Defense Health Agency issued guidance on the telemental health services, to include IOPs.

  • Providers may use interactive telecommunications systems for TRICARE-covered diagnostic and treatment services.  Services have to be medically or psychologically necessary, and appropriate.
  • Definitions:
    • Medically or psychologically necessary. The frequency, extent, and types of medical services or supplies represent appropriate medical care and are generally accepted by qualified professionals to be reasonable and adequate for the diagnosis and treatment of illness, injury, pregnancy, and mental disorders or that are reasonable and adequate for well-baby care.
    • Appropriate medical care.
      • (i)   Services performed in connection with the diagnosis or treatment of disease or injury, pregnancy, mental disorder, or well-baby care which are in keeping with the generally accepted norms for medical practice in the United States;
      • (ii)   The authorized individual professional provider rendering the medical care is qualified to perform such medical services by reason of his or her training and education and is licensed or certified by the state where the service is rendered or appropriate national organization or otherwise meets CHAMPUS standards; and
      • (iii)   The services are furnished economically. For purposes of this part, “economically” means that the services are furnished in the least expensive level of care or medical environment adequate to provide the required medical care regardless of whether or not that level of care is covered by CHAMPUS.
  • Partial Hospitalization Program (PHP). PHP is normally 6 hours of more per day of behavioral health services. PHP via telehealth is not a covered benefit.  The DHA is going to make a decision on possible coverage in the future. 
  • Intensive outpatient services:  TRICARE may cover these services by telehealth during the COVID-19 crisis only.  TRICARE already covers outpatient psychotherapy, crisis therapy, family therapy, and group therapy via telehealth.  It will do so after the crisis is over.
    • Intensive Outpatient Program (IOP)
      • This is normally a 2 to <6 hour outpatient program. It takes place in an organized setting, day or evening
      • Providers may carry out some IOP services via telehealth (for example, individual psychoeducation, case management, recreational therapy, etc.). Telehealth won’t cover: drug screening, group psychotherapy, and some other services. 
      • TRICARE policy requires a referral OR prior-authorization for IOP care.
      • The IOP, or PHP providing IOP services, by telehealth must be at the same intensity and level of services required by those programs per policy.  The provider has to show its offering all components of the IOP via telehealth (e.g., at least 2 hours of services). IOPs have to document all services via telehealth in the medical records and on the claim.
    • Medication Assisted Treatment (MAT) and Opioid Treatment Programs (OTP)
    • Other outpatient behavioral health telehealth services. 
      • Providers may offer TRICARE-covered services via telehealth. This may include evaluation and management, psychotherapy, medication management, and more.  A TRICARE-authorized provider may bill for professional services via telehealth if it can’t offer IOP services aren’t at the same intensity or frequency as required for those programs. Providers have to follow existing policies.

If you have questions, contact your regional contractor.

Does TRICARE cover antibody testing for COVID-19?

Many civilian providers offer COVID-19 antibody or blood tests. There’s no solid proof that all tests are accurate or useful.  Testing seems to change every day.  

  • However, TRICARE may cover an FDA-approved test if:
    • It’s ordered by a TRICARE-authorized provider, and 
    • It’s medically necessary and appropriate.
  • TRICARE won’t cover antibody blood tests:
    • To see if someone is safe to return to work,
    • As part of public health outreach, or
    • For research purposes.

As always, contact your medical provider before you get a test done.

I’m a member of the National Guard/ Reserve and have TRS coverage.  What happens to me and my family if my employer shuts due to COVID-19 and I can’t pay the monthly TRS premium?

Only through a congressional law may TRICARE waive premium payments. There currently is no such law. The Defense Health Agency (DHA) is studying COVID-19’s effects on beneficiaries who pay enrollment fees or premiums for their TRICARE health plan during the national health emergency due to the pandemic.

For TRICARE Reserve Select (TRS), DHA is reviewing TRS premium payments for those in units which suspended paid drills. It hopes to have a decision soon.  Until there’s a decision, if you miss a payment or don’t pay on time, they contractor will disenroll you from TRS. Call your contractor for reconsideration if this happens. If you can’t keep up your TRS payments, you may also find health coverage through the Health Insurance Marketplace: https://www.healthcare.gov/.

 Pharmacy

Will my military pharmacy be closing? Will I be able to get my medications from a military pharmacy?

To maintain patient and personnel safety amidst COVID-19, the Department of Defense will take actions prescribed by Health Protection Condition (HPCON) Risk Levels and health official’s guidance. Military pharmacies are to adjust their operations as needed.

Local assessments determine the status of each military pharmacy. This may result in temporary measures address a changing situation. There may be temporary, partial or full limitation of services. Military pharmacies conduct daily operation assessments.

In the case of a local outbreak or a confirmed case of COVID-19 among military pharmacy staff, Military Medical Treatment Facility (MTF) Directors are authorized to limit pharmacy services as necessary. This may include:

  • Alternative pick up options (staggered pick up times, curbside pickup, etc.).
  • Temporary transfer of non-enrolled, non-Active Duty Service Members (ADSMs) and/or non-Active Duty Family Members to home delivery or retail.
  • Temporary closure of a military pharmacy.

We don’t expect any of these limitations to be a routine practice, but rather a case-by-case determination. The Director bases it on the severity of the spread of COVID-19 at a specific location. If pharmacy services are limited, they will be assessed and reopened as soon as it is safe for personnel and beneficiaries.

How will I know if my military pharmacy is operating?

You can call your MTF pharmacy refill line to check for changes to pharmacy services, closures, and resuming services. You can look up your pharmacy’s number via http://www.tricare.mil/mtf.

What should I do if my military pharmacy is closed due to COVID-19?

There are several actions you can take:

  • Call your MTF pharmacy refill line to check for changes to service offerings, closures, and resumption of services: You can look up your pharmacy’s number via http://www.tricare.mil/mtf.
  • Switch your prescription to TRICARE Pharmacy Home Delivery by calling Express Scripts at 877-363-1303 or visiting http://www.militaryrx.express-scripts.com/home-delivery.
  • Call your retail network pharmacy and ask them to call your military pharmacy to transfer your medication or call your provider for a new prescription for fill at a retail pharmacy
  • Find a retail network pharmacy via https://militaryrx.express-scripts.com/find-pharmacy.
  • Call Express Scripts at 877-363-1303 to speak with a pharmacist 24/7.
  • If you don't have any refills, call your provider to send a new prescription to either the Express Scripts TRICARE Pharmacy Home Delivery or your network retail pharmacy.
  • MTF pharmacies have staff available to assist

Will I have to pay copayments for my prescriptions at retail pharmacies and via home delivery?

Yes. Copayments are directed by law and the Department of Defense can’t waive them.

Visit https://tricare.mil/Costs for an overview of pharmacy copayments. You can search your specific drug(s) can determine your medication coverage and copayments at http://www.express-scripts.com/tform.

I’m worried about running out of my medications. What should I do?

We encourage you to refill your drugs at the appropriate time. Standard refill policies, which allow you to refill or renew a prescription drug when 25% of your current prescription remains. This process should help you stay on track with your drug supply during this time.

We understand the desire to be prepared. Present conditions don’t call for early refills through Home Delivery or at retail. We are monitoring the situation closely and are updating our information and policies as the situation requires.

Should you have any questions or concerns about your individual situation, Express Scripts pharmacists are available 24/7 to answer questions, offer counseling and support, and assist with prescription orders. Call Express Scripts at 877-363-1303.

Can the mail order system support an increase in work load from the beneficiary population?

The home delivery network is fully operational and able to absorb a potential increase in the Department of Defense workload. In addition to home delivery, the retail network is currently not experiencing any lack of services. Many retail network pharmacies offer home delivery as well.

How will you determine who will transition to home delivery or retail?

Based on Health Protection Condition (HPCON) levels and spread of COVID-19 at the particular location, Military Medical Treatment Facility (MTF) Directors are authorized to limit pharmacy services with a step-wise approach that prioritizes the readiness posture of the United States Military. The following limitations MAY be implemented:

  • First, beneficiaries who aren’t enrolled to an MTF may be temporarily required to switch to home delivery or a retail network pharmacy due to local COVID-19 impact.
  • If a further reduction in services is required, MTF-enrolled Retirees and Family members may be temporarily required to switch to home delivery or a retail network pharmacy.
  • Finally, the temporary closure of a local military pharmacy may require all local beneficiaries to switch to home delivery or a retail network pharmacy on a temporary basis.

Will this impact me?

The best way to find out if a change in pharmacy services impacts you is to call your local military pharmacy and/or the prescription refill number to find out about the pharmacy’s operating status. The MTF will routinely update the prescription refill line with the latest information on its pharmacy’s status.

While we expect limited impact at most military pharmacies, all eligible beneficiaries may be impacted due to the spread of COVID-19.

How will you transfer my prescription if the military pharmacy is closed?

The Defense Health Agency issued guidance to military pharmacies to ensure that work-around solutions, to include remote capabilities in case of full closure. Staff will be available to assist in transferring your prescription to either mail order or a network retail pharmacy of your choice.

What if I can’t reach my military pharmacy?

Express Scripts is the DOD’s pharmacy benefit contractor and supports the DOD in delivering the pharmacy benefit to its 9.5 million beneficiaries. Express Scripts pharmacists are available 24/7 to help answer questions about your prescriptions, to include supporting prescription transfers. You can call Express Scripts anytime at 877-363-1303.

If you are unable to find a solution with your prescription after speaking with Express Scripts, you may want to call your provider directly and ask them to e-prescribe a new prescription to Express Scripts or to a network retail pharmacy of your choice.

Will pharmacy refill restrictions be waived so we can get prescriptions filled sooner?

At this time, there is no plan to waive refill restrictions to get prescriptions refilled early.

TRICARE offers beneficiaries the option to get a 90-day supply of their prescriptions at military pharmacies, via TRICARE Pharmacy Home Delivery, or at retail network pharmacies.

As a first step, beneficiaries should ensure they have refills remaining on their prescription. Each prescription bottle indicates the number of refills remaining. If there are no refills left, they will need to call their healthcare provider. If enough refills remain, beneficiaries can get a 90-day supply at military pharmacies, via TRICARE Pharmacy Home Delivery, or at retail network pharmacies.

Military pharmacies offer a 90-day supply of medications at no cost to beneficiaries. After military pharmacies, home delivery is the most affordable option. Beneficiaries can switch to home delivery to get a 90-day supply delivered right to their door. At a retail network pharmacy, beneficiaries can get up to three, 30-day supplies (three copays will apply).

Home delivery provides a convenient and affordable way to get medications without leaving the house. There are many convenient ways to switch a prescription to home delivery to include by phone, online, and via the Express Scripts mobile app.

Currently, there are no pharmacy supply chain issues/outages as a result of COVID-19 and the Defense Logistics Agency is engaged with Prime Vendors to ensure Military pharmacies get their fair share if shortages do occur.

Why is the Defense Health Agency placing Quantity Limits on albuterol and levalbuterol inhalers?

DHA is putting quality limits in place to prevent shortages. It noted a large increase in the number of inhaler prescriptions over the past month. DHA wants to support beneficiaries’ health and readiness, and still treat COVID-19.

What do you need to know about the quantity limits?

While Quantity Limits are in place, you will get 1 inhaler for each prescription fill. This limit applies at military pharmacies, retail network pharmacies, and via TRICARE Pharmacy Home Delivery. If you need another inhaler because your inhaler is running low, you can request a refill, as long as there are still refills on the prescription.

What do you need to know about getting my inhalers from TRICARE Pharmacy Home Delivery?

When quantity limits are in place, home delivery will mail you 1 inhaler for each 30-day fill. The full copaymentA fixed dollar amount you may pay for a covered health care service or drug. applies for each inhaler during this temporary period.

Copayments are mandated by law. Full copayments apply to each fill. The temporary quantity limit is 1 inhaler/30 days. Based on the type of albuterol or levalbuterol inhaler you have, you may pay:

  • $10 for one fill of a generic inhaler via home delivery,
  • $29 for one fill of a name-brand inhaler via home delivery, or
  • $60 for one fill of a non-formulary inhaler via home delivery.

Check the TRICARE Formulary Search tool at www.express-scripts.com/tform for more on the category and cost of your inhaler.

You will need to contact the TRICARE Pharmacy contractor (Express Scripts) online or by phone to ask for a refill each month. You have to have refills left on your prescription. If you don’t any refills, you need to contact your provider for a new prescription.
If you need another inhaler sooner, you can call ESI to request an early refill.

If you're using a TRICARE retail network pharmacy or TRICARE home delivery, what will your copayment be?

Copayments are mandated by law. Full copayments apply to each fill. A fill is 1 inhaler/30 days under the current, temporary quantity limit. Based on the type of albuterol or levalbuterol prescription you have, you may pay:

  • $10 (home delivery) or $13 (retail network pharmacy) for 1 generic inhaler,
  • $29 or $33 for 1 name-brand inhaler, or
  • $60 for 1 non-formulary inhaler for a 30-day period).

Check the TRICARE Formulary Search tool at www.express-scripts.com/tform for more information on the category and cost of your inhaler.

How did the Defense Health Agency (DHA) make this decision about the inhalers?

DHA based its decision on current supply and demand data and requirements. Its decision mirrors that of multiple commercial plans. DHA is following the guidance of several organizations, to include the American Medical Association, American Pharmacists Association, and American Society of Health-System Pharmacists. These organizations each identified inappropriate ordering, prescribing, and dispensing of COVID-19-related medications as urgent issues. They encourage health care teams to be stewards of health care resources during times of emergency and national disaster.

How long will these limits be in place?

The quantity limit period for albuterol/levalbuterol inhalers is only temporary. DHA expects the demand to level out or decline as states across the country flatten the curve of COVID-19 infections.

DHA is monitoring conditions daily. It will again address quantity limit restrictions at the end of April 2020.

Having to enter a military or retail pharmacy once or more a month puts me more at risk. I have major breathing problems. What will you do to protect me?

To maintain patient and personnel safety during the COVID-19 national health emergency due to the pandemic, DHA is taking actions and making changes to military pharmacy operations. Several military pharmacies are practicing social distancing with drive-through or curbside pharmacy services. Call your local military pharmacy (the refill line) to check for changes and limitations to service. Visit www.tricare.mil/mtf to look up the phone number of your military pharmacy.

Retail network pharmacies are also taking measures for safe prescription pick up. They are practicing social distancing, adjusting hours, and/or many offer delivery options or curbside pickup. You can find more information about retail pharmacy operations during COVID-19 at: https://militaryrx.express-scripts.com/notices/other/get-your-medications-while-maintaining-distance-others.

TRICARE Pharmacy Home Delivery is an affordable option that limits your exposure compared to in-person pick up. To learn more about switching to home delivery, go to https://www.tricare.mil/CoveredServices/Pharmacy.

I have lost or run out of my inhaler supply. What should I do?

In case of a life-threatening emergency, call 911. If you need another inhaler because your inhaler is running low, you can request a refill from your pharmacy or through Home Delivery. If you have no more refills, you need to contact your provider. If you are experiencing an urgent need for another inhaler, call Express Scripts at 877-363-1303 or contact your military or retail pharmacy.

I hear there is a quantity limit on prescriptions for hydroxychloroquine and chloroquine. I use one of these to treat my lupus. What is the limit?

The Pharmacy benefit program is limiting you to one 30-day supply with each fill. This limit is in place at all pharmacies – military, retail network, or home delivery. This was done so the Defense Health Agency can make sure there is enough of these drugs on hand for all users.

I use (or my dependent uses) hydroxychloroquine/chloroquine. What do I need to know?

  • If your see a provide in an office or clinic:
    • Your prescription has to be FDA-approved for your medical condition (e.g. lupus, arthritis, or malaria); not for COVID-19.
    • Your provider has to request prior authorization if your prescription starts on or after 15 March 2020. Have your doctor search for your drug at www.express-scripts.com/tform for prior authorization information.
  • If you’re hospitalized and prescribed COVID-19, your provider has to follow established guidance and be or consult with an Infectious Diseases (ID) provider.

Will the Defense Health Agency (DHA) be placing quantity limits on other drugs?

DHA is constantly monitoring drug supply and availability. It may consider placing additional temporary quantity limits on other drug as needed to make sure all beneficiaries who need them can get them.

Quarantine

What is quarantine? And why is 14 days recommended for COVID-19?

Quarantine, in general, means the separation of a person or group of people reasonably believed to have been exposed to a communicable disease but not yet symptomatic, from others who have not been so exposed, to prevent the possible spread of the communicable disease. It is recommended by the CDC to quarantine for 14 days because symptoms usually emerge 2-14 days after exposure.

Where can I go if I am placed in/on quarantine? Is it OK to go to doctor’s appointments, the grocery store, or the mall?

No. You need to stay at home and not go anywhere.

If one person in my family is placed in/on quarantine, does that mean everyone else in the house is in/on quarantine? If not, how do we protect our non-quarantined family members?

Yes. All family members should quarantine if one family member is quarantined. Please contact your health care provider if you have questions.

How is quarantine different than isolation?

Isolation is used to separate people who have already been infected with a communicable disease from those who are healthy. Isolation restricts the movement of ill persons to help stop the spread of certain diseases. For example, hospitals use isolation for patients with infectious tuberculosis.

Quarantine is used to separate and restrict the movement of people who aren’t sick who may have been exposed to a communicable disease to see if they become ill. These people may have been exposed to a disease and do not know it, or they may have the disease but do not show symptoms. Quarantine can also help limit the spread of communicable disease.

If you live with someone who may have been exposed, what should you do?

Contact your local military clinic or hospital, your local health department, or the MHS Nurse Advice Line at 1-800-874-2273, Option 1 or online: https://mhsnurseadviceline.com.

What will screening measures (as mentioned in the Force Health Protection Supplement #4) entail?

We are instituting risk assessments and if necessary, medical evaluations, for all personnel prior to departure on any military aircraft. Additionally, we are putting preventive monitoring measures in place for those who have recently traveled. Specifically, for those who recently traveled to, though, or from a CDC Travel Health Advisory Level 2 or Level 3 country, we are directing that they stay at home at 14 days, practice social distancing, and self-monitor for potential symptoms of COVID-19 including taking their temperature twice a day. For all other returning travelers, including those traveling within the United States, we are telling them to practice social distancing and be mindful in their daily self-observation for any signs or symptoms of COVID-19. For all, we are telling them that if they feel sick, they should immediately self-isolate, notify their leadership, and call the appropriate medical authorities for assistance.

Will the screening measures only be for those landing in Level 2 or 3 locations?

No, this policy applies to all personnel who travel or have recently traveled. However, the actions we expect our leaders and people to take are dependent upon their travel routes and locations. At this time, all countries other than the United States are either Level 2 or Level 3, which requires screening whether it was for travel to, from, or through.

MTF Management

Where are they putting people in hospitals who test positive for COVID-19?

All medical facilities have infectious disease protocols in place, not just for COVID-19 but for any infectious disease. Patients who test positive are isolated from the general population in designated isolation rooms.

Medical Care

Should I make an appointment to get my physical?

Military hospitals and clinics are now offering virtual telehealth visits, through audio-video conferencing or by phone.  They are doing this to limit exposure for you, other patients and the medical staff. 

If you get have a telehealth appointment, make sure you answer any of the telephone numbers the military clinic or hospital has on file for you.  Or answer your phone at the designated time of your appointment, even if it shows as a blocked or restricted number.  If you have questions or problems, please contact the clinic or send your team a secure message. 

After exposure and recovery, can you get COVID-19 again?

At this time it’s too soon to know as we are still learning about the virus.

Should we call 911 if we get sick?

If you have a true medical emergency, call 911. If you develop emergency warning signs for COVID-19 get medical attention immediately. Emergency warning signs include*:

  • Difficulty breathing or shortness of breath
  • Persistent pain or pressure in the chest
  • New confusion or inability to arouse
  • Bluish lips or face

*This list is not all inclusive. Please consult your medical provider for any other symptoms that are severe or concerning.

I have asthma, do I need to immediately go to the doctor if I get sick, show symptoms?

If you have asthma, or other underlying conditions, the COVID-19 can cause inflammation. If you feel you’re experiencing symptoms, contact your provider to be evaluated.

What’s the difference between allergies and COVID-19?

An allergy is a reaction by your immune system to something that doesn’t bother most other people (e.g. pollen, dust, mites, etc.). Allergies symptoms can include a runny nose, sneezing, itching, rashes, swelling, or asthma. COVID -19 is the disease caused by the corona virus. Symptoms include fever, coughing or sneezing, or difficulty breathing. As you can see, there are similar symptoms. If you don’t have a fever, it’s likely you may be suffering from allergies.

Is it true that NSAID’s can be dangerous with COVID-19? Other countries are suggesting acetaminophen instead of an NSAID. Why do you say NSAIDs are preferable?

Per the U.S. Food and Drug Administration (https://www.fda.gov/drugs/drug-safety-and-availability/fda-advises-patients-use-non-steroidal-anti-inflammatory-drugs-nsaids-covid-19). 

At this time, FDA is not aware of scientific evidence connecting the use of NSAIDs, like ibuprofen, with worsening COVID-19 symptoms. The agency is investigating this issue further and will communicate publicly when more information is available. However, all prescription NSAID labels warn that “the pharmacological activity of NSAIDs in reducing inflammation, and possibly fever, may diminish the utility of diagnostic signs in detecting infections.”

For those who wish to use treatment options other than NSAIDs, there are multiple over-the-counter and prescription medications approved for pain relief and fever reduction. FDA suggests speaking to your health care professional if you are concerned about taking NSAIDs and rely on these medications to treat chronic diseases.

My child needs to get her immunizations for school.  What can I do get her the shots she needs?

Here is guidance from the Defense Health Agency:   

  • Immunization of uniformed service members is of the highest priority.  The goal is to achieve and maintain readiness.
  • Military clinics:
    • Provider exams may not be necessary (e.g., well-baby check).  This is a military hospital or clinic decision.
    • Pediatric clinics:  The priority is for newborns, infants, young children, and those prone to infection (e.g., immune problems).  They are likely to get shots before older children with routine needs.
    • Adult Clinics:  The priority is for those prone to infection.  They are likely to get shots before those needing routine shots.
  • To limit COVID-19, you may experience:
    • Verbal screening for possible infection,
    • Separate appointments for immunization versus sick-patient visits, and/or
    • Separate immunization locations.
  • Immunization clinics are to inform to parents and patients.  They should tell you about how to catch up on routine immunizations after COVID-19.
  • Civilian providers and clinics may have similar guidance and processes.   Contact you provider for more specific information.

Note:  Rabies post-exposure treatment is the only immunization considered “urgent”. These shots have the highest priority for care.You may want to contact your daughter’s school.  Some school are allowing for delays in immunization dates.

What is COVID-19?

COVID-19 is a viral respiratory illness that can spread from person-to-person. It’s a novel coronavirus that was first identified during an investigation into an outbreak in China.

How does COVID-19 spread?

The virus spreads through close contact between people and by droplets from coughs or sneezes.  It also spreads when a person touches a surface with the virus on it, and then touches his or her nose, mouth or eyes.  

What are the symptoms of COVID-19?

  • People with COVID-19 have a wide range of symptoms – ranging from mild symptoms to severe illness. Symptoms may appear 2-14 days after exposure to the virus.
  • People with these symptoms or combinations of symptoms may have COVID-19:
    • Cough
    • Shortness of breath or difficulty breathing
    • Fever
    • Chills
    • Muscle pain
    • Sore throat
    • New loss of taste or smell
  • Seek emergency medical attention if you show these signs for symptoms:
    • Trouble breathing
    • Persistent pain or pressure in the chest
    • New confusion
    • Inability to wake or stay awake
    • Bluish lips or face

This list is not all possible symptoms. Please consult your medical provider for any other symptoms that are severe or concerning to you. Call 911 or call ahead to your local emergency facility: Notify the operator that you are seeking care for someone who has or may have COVID-19.

View this information on the CDC website at https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html.

Check out the “Self Checker”on that same site.

How severe is the COVID-19 illness? 

Reported illnesses range from very mild (with no reported symptoms) to severe, including some deaths.  Adults 65 years and older and anyone with severe underlying health problems, such as compromised immune systems, existing respiratory problems, diabetes, heart disease or lung disease, are at a higher risk of developing severe illness from COVID-19. 

How do I know if I could have COVID-19?

You may have COVID-19 if you:

AND

  • You now have a fever, cough and/or have difficulty breathing.

What should I do if I have been exposed or have symptoms of COVID-19?

A great place to start is the CDC Self-Checker. It walks you through an assessment and determines the best next steps. You can find it at: https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/index.html.

If you have been exposed to someone who has COVID-19, traveled to areas where infection is widespread (see the CDC country list at https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html) or have symptoms of COVID-19, please do not make an appointment or walk into your local military hospital or clinic.

Instead, please speak to a Registered Nurse or office staff member in advance. That person will assess your symptoms and advise you on what to do.  You may:

  • Call the Military Health System Nurse Advice Line (MHS NAL) at 1-800-874-2273, Option 1 or online at https://mhsnurseadviceline.com/
  • Call your military or civilian primary care clinic directly
  • Send your primary care physician a secure online message, if you can do so.
  • If you’re enrolled to a military hospital or clinic, you may also:
    • Call the appointment line; the appointment line staff can submit a telephone consult to your primary care clinic nurse if you ask for one
    • Send your primary care team a secure message in the TRICARE Online or MHS GENESIS Patient Portal.

What happens after I speak to a nurse or office staff member?

The nurse or staff member decides whether your symptoms may be due to COVID-19 or another illness requiring treatment.  You might get advice on self-care since symptoms often can be treated at home.

The nurse/staff member may arrange a telephone visit between you and a healthcare provider or tell you to call your provider directly.  The provider can talk with you about possible exposure, your symptoms, and discusses treatment.  The provider may give you self-care advice to use at home.  He or she may tell you to go to your primary care clinic or emergency room/urgent care. 

Why do I need to call before I see a provider?

This is so we can protect you, other patients, and medical staff from unnecessary exposure to COVID-19. 

Should everyone get tested for COVID-19?

No.  You only have to get tested if you show symptoms of COVID-19.  Your healthcare provider will make that decision based on your exposure risk, symptoms, and guidance from the Centers for Disease Control. There is a screening process to determine who should get tested. 

If you have a civilian provider, TRICARE will cover the costs of the test if your provider determines it's medically appropriate and the request meets the screening criteria.

When do I seek medical care?

You should only go to a clinic or hospital if you are advised to, or are having difficulty breathing or have flu-like symptoms that aren’t getting better with time.  First, call for advice.  The nurse or office staff will assess your symptoms.  They may have you speak to a healthcare provider or tell you to come directly to the office/clinic or hospital. You should:

  • Call the Military Health System Nurse Advice Line (MHS NAL) at 1-800-874-2273, Option 1 or online at https://mhsnurseadviceline.com/
  • Call your military or civilian  primary care clinic directly
  • Send your primary care physician a secure online message, if you can do so.

If you’re enrolled to a military hospital or clinic, you may:

  • Call your military clinic/hospital appointment line; the appointment line staff can submit a telephone consult to your primary care clinic nurse if you ask
  • Send your MTF primary care team a secure message in the TRICARE OnLine or MHS GENESIS Patient Portal

What can I do to protect myself and my family from COVID-19?

There are a number of things you can do (https://www.cdc.gov/coronavirus/2019-ncov/about/prevention.html?), including:

  • Practice good personal hygiene.  This includes:
    • Washing your hands (at least 20 seconds with soap and water) or use a hand sanitizer that is at least 60% alcohol
    • Disinfecting frequently touched surfaces and surfaces where you prepare food
    • Using tissues when you cough or sneeze, throwing the tissues away, and washing your hands
    • Coughing or sneezing into your upper sleeve or elbow, not your hands, if you don’t have a tissue.
    • Avoiding touching your eyes, nose, and mouth
    • Avoiding being close to others who are ill or showing symptoms.  Greet people verbally instead of shaking hands or hugging.
    • Limiting touching frequently touched services in public, e.g. opening doors, pressing elevator buttons, using hand rails, handling menus
  • Get a flu shot if you didn’t get one earlier.  The flu vaccine won’t protect you from COVID-19, but the flu currently poses a greater threat to the public than COVID-19.
  • Avoid public activities or areas visited by a large number of people.
  • Get the pneumonia vaccine if you’re eligible. It’s recommended for adults 65 and older, all children younger than 2 years, persons 2 through 64with certain health conditions, and adults 19-64 who smoke cigarettes (https://www.cdc.gov/vaccines/vpd/pneumo/index.html)  

It doesn’t protect you from COVID-19, but lowers your risk of bacterial infection.

Note:  Face masks

  • The Secretary of Defense directs that all individuals on Department of Defense property, installations, and facilities will wear cloth face coverings when they cannot maintain six feet of social distance in public areas or work centers. This guidance applies to all service members, DOD civilians, contractors, families (apart from residences on installations) and all other individuals on DOD property.
  • The Centers for Disease Control and Prevention (CDC) recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain, especially in areas of significant community-based transmission.
  • CDC also advises the use of simple cloth face coverings to slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others. Cloth face coverings fashioned from household items or made at home from common materials at low cost can be used as an additional, voluntary public health measure.
  • If you want information on face coverings and how to make them visit these CDC sites:
  • The cloth face coverings recommended are not surgical masks or N-95 respirators.  Those are critical supplies that must continue to be reserved for healthcare workers and other medical first responders, as recommended by current CDC guidance.

What if I can’t or won’t go to doctor’s office?

Speak to a Registered Nurse, office staff member, public health office first.  Someone should be able to assess your symptoms and advise you on what to do.  You may:

  • Call the Military Health System Nurse Advice Line (MHS NAL) at 1-800-874-2273, Option 1 or online at https://mhsnurseadviceline.com/
  • Call your military or civilian primary care clinic directly
    • Send your primary care physician a secure online message, if you can do so.
  • If you’re enrolled to a military hospital or clinic, you may also:
    • Call the appointment line; the appointment line staff can submit a telephone consult to your primary care clinic nurse if you ask for one
    • Send your primary care team a secure message in the TRICARE OnLine or MHS GENESISMHS GENESIS is currently available at Fairchild Air Force Base, Madigan Army Medical Center, Naval Hospital Bremerton, Naval Health Clinic Oak Harbor, Travis Air Force Base, Naval Air Station Lemoore, the Presidio of Monterey, and the Mountain Home Air Force Base. Patient Portal

If your military or TRICARE-authorized civilian provider has the ability to provide telehealth/telemedicine services (securely and in accordance with their license), certain services are covered.  You may have copays or cost shares. Telehealth must be HIPPA-compliant and protect your privacy. Audio-only (i.e., telephone) visits are not covered. See the article at https://tricare.mil/CoveredServices/BenefitUpdates/Archives/03_24_2020_TRICARE_covers_certain_telemedicine_services.

TRICARE covers most medical care, psychotherapy, physical therapy and occupational therapy, and Applied Behavioral Analysis (ABA) services by telehealth when medically necessary.

Will my military or civilian hospital or clinic be able to test for COVID-19?

Yes, if it has the ability to test for COVID-19. If it lacks the ability to test in-house, it will send the sample to an outside laboratory. 

I heard a patient who tested positive for COVID-19 was seen in my primary care office.  Should I be concerned if I have an appointment, surgical procedure, or to have my baby in the same MTF?

No, clinics and hospitals follow federal or state guidelines for keeping sick patients away from others.  They also follow strict guidelines on infection control and cleaning public areas and treatment rooms.  You should feel safe to get treatment, elective procedures, or even deliver your baby.

What about if I’m told I have been exposed?

If you were exposed, you should contact your local military clinic or hospital, the Military Health System Nurse Advice Line at 1-800-874-2273, Option 1 or online at https://mhsnurseadviceline.com/, or your local health department. They can arrange for information to be gathered by the public health team.

I have a vacation coming up.  I plan on going to an area affected by COVID-19.  What should I do?

The CDC recommends that travelers avoid certain countries and delaying travel if you have chronic medical conditions. The country list changes.  For the latest travel guidelines, check the CDC website at:  https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html

How can I prepare for possible quarantine and protect myself?

Develop a household plan based on daily needs and routine. Check your food and supplies; make care arrangements for children, elders and pets; and make sure you have enough critical prescription drugs. 

Public health officials may recommend actions if there is a local community outbreak.  They will likely take actions that limit exposure, such as cancelling large gatherings. Check out the CDC website on how to prevent illness and protect yourself:  https://www.cdc.gov/coronavirus/2019-ncov/protect/index.html

What is the treatment if I’m diagnosed with COVID-19? 

Most people can recover from COVID-19 at home. Treatment is similar for that of the flu - rest and fluids. There are currently no antiviral drugs recommended or licensed by the U.S. Food and Drug Administration for COVID-19 for adults or children.  Families should try to prevent the spread of respiratory infections, by covering coughs and sneezes, cleaning hands often with soap and water or 60% alcohol-based hand sanitizer, and staying up to date on vaccinations, including the flu vaccine.  Follow the Center for Disease Control (CDC) instructions on how to take care of yourself at home (https://www.cdc.gov/coronavirus/2019-ncov/about/steps-when-sick.html).

Doctors treat severe cases in the hospital - with intravenous fluids and breathing machines if necessary. 

How can the infection be prevented in children?

Children should clean their hands often using soap and water or 60% alcohol-based hand sanitizer.  They should use tissues if they cough or sneeze, throw the tissues away, and then wash their hands.  Children should stay away from people who are sick.  They should stay up to date on vaccinations, including the flu shot. 

Are children more likely to get the COVID-19 virus versus adults? 

No, there are no data that show children are more likely to get ill.  In fact, most confirmed cases of COVID-19 are in adults.

Are symptoms of COVID-19 different in children than adults?

They aren’t that different.  Children have the same cold-like symptoms, such as fever, runny nose, and cough. One child had vomiting and diarrhea.  Severe symptoms are uncommon. For more information, go to FAQS for Children. (https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/children-faq.html )

Are children at increased risk for severe illness or death with COVID-19 than adults?

No. Reports suggest that infected children have mild symptoms.  Though some have severe complications (acute respiratory distress syndrome, septic shock), those appear to be uncommon.  Children with underlying health conditions may be more at risk.

Are there any treatments available for children with COVID-19?

Treatment is similar for that of the flu - rest and fluids.  There are currently no antiviral drugs recommended or licensed by the U.S. Food and Drug Administration for COVID-19 for children or adults.  Children and their family members should try to prevent the spread of infection by covering coughs, cleaning hands often with soap and water or 60% alcohol-based hand sanitizer, and staying up to date on vaccinations, including influenza.  

Are pregnant women more likely to get infected or at greater risk for severe illness or death?

Pregnant women experience changes in their bodies due to pregnancy.  This may make them more likely to get viral respiratory infections, including COVID-19.  Pregnant women should avoid people who are sick. They should avoid infection by washing hands often, cleaning food preparation areas and frequently touched surfaces (tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks & cell phones). 

Are pregnant women with COVID-19 at greater risk for pregnancy loss, including miscarriage and stillbirth?

We don’t have information on adverse pregnancy outcomes in pregnant women with COVID-19. High fevers during the first trimester of pregnancy can increase the risk of certain birth defects.

Can a pregnant woman with COVID-19 pass the virus to her fetus or newborn during delivery?

We don’t know. The virus that causes COVID-19 is thought to spread mainly by close contact with an infected person through droplets from coughing or sneezing. In a recent study of a small number of infants born to mothers with COVID-19, none of the infants tested positive for COVID-19. The virus wasn’t noted in the amniotic fluid or breastmilk.

Is a mother with COVID-19 a risk to a breastfeeding infant?

There is no evidence on the spread of COVID-19 virus through breast milk.  In the recent study, above, no evidence of the COVID-19 virus was found in the breast milk of women with COVID-19. The infection is thought to spread mainly by close contact with an infected person through droplets from coughing or sneezing. 

Who’s at higher risk for getting very sick from COVID_19?

People at higher risk includes:

  • Older adults (those 65 years of age or older)
  • People with serious chronic medical conditions like:
    • Heart disease
    • Diabetes
    • Lung disease
    • Immune disorders

What should I do if I’m at higher risk for getting sick from COVD-19?

If you’re at higher risk for serious illness, it’s extra important you take action to reduce your risk of getting sicker.  Most people can recover from COVID-19 at home. Follow the Center for Disease Control and Prevention (CDC) instructions on https://www.cdc.gov/coronavirus/2019-ncov/about/steps-when-sick.html.

 You should:

  • Have drugs and supplies on hand
    • Call your military or civilian health care team to ask if you need extra prescription drugs in case there is a COVID-19 outbreak in your area and you need to stay home for longer than your prescriptions will last.
    •  for more information.) You may be able to have an authorized person pick up your drugs from the military or retail pharmacy or get them delivered to your home – call your pharmacy for information. If you are sick and should stay home, think about using the TRICARE mail-order pharmacy program. (Certain rules may apply that you’ll need to follow.  See tricare.mil/pharmacy
    • Be sure you have over-the-counter medicines and supplies (tissues, fever-reducing drugs, etc.) on hand to treat fever and other symptoms.
    • Have enough household items and groceries on hand so that you can stay at home for a long period of time – as determined your care provider and local guidance
  • Take everyday safety measures:
    • Avoid contact with people who are sick.  Stay home as much as possible
    • Wash your hands often - with soap and warm water for at least 20 seconds.  Wash your hands after blowing your nose, coughing, or sneezing, or being in a public place.
    • If soap and water aren’t available, use a hand sanitizer that is at least 60% alcohol.
    • Avoid crowds, especially in poorly ventilated spaces.  Don’t shake hands or hug others.   Your risk of exposure to respiratory viruses like COVID-19 is higher in crowded, closed-in settings with little air flow if there are people in the crowd who are sick.  Use extra caution if you have to go out in public. 
      • Limit your touching of frequently touched surfaces: elevator buttons, door handles, hand rails.
      • Use a tissue or your sleeve to cover your hand or finger if you must touch something.
      • Wash or sanitize your hands after touching often-touched public surfaces
    • Avoid touching your face, nose, and eyes, much as possible.
    • Clean and disinfect your home to remove germs: clean and disinfect frequently touched surfaces (for example: tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks & cell phones).
    • If COVID-19 is spreading in your community, take extra steps to distance yourself from other people.  Think about ways of getting food to your home, for example, have family, or social and commercial services drop them off.

What should I watch for and what are some emergency warning signs?

  • Pay attention for COVID-19 symptoms including, fever, cough, and shortness of breath. If you feel like you are developing symptoms, call the MHS Nurse Advice Line or your primary care provider for advice.
  • If you start having emergency warning signs for COVID-19 get medical care quickly. In adults, emergency warning signs may be:
    • Difficulty breathing or shortness of breath
    • Constant pain or pressure in the chest
    • New confusion or inability to arouse
    • Bluish lips or face

What should I do if I have any of the emergency warning signs of a COVID-19 infection?

  • If you start having emergency warning signs for COVID-19 get medical care quickly. In adults, emergency warning signs may be:
    • Difficulty breathing or shortness of breath
    • Constant pain or pressure in the chest
    • New confusion or inability to arouse
    • Bluish lips or face
  • Stay home and call your provider or local military or civilian clinic or hospital.  Let them know about your symptoms.
  • If your breathing or chest pains are severe, call 911.  Tell them you may have COVID-19. This will help them take care of you and keep other people from getting infected or exposed.
  • If you are not sick enough to be hospitalized, you can recover at home. Follow the Center for Disease Control (CDC) instructions on how to take care of yourself at home. (https://www.cdc.gov/coronavirus/2019-ncov/about/steps-when-sick.html )

Teledentistry

What is teledentistry?

  • Teledentistry is the use of telehealth systems in dentistry.  It isn’t the same as face-to-face exams or treatment.  It:
    • Limits exposure to COVID-19 through social distancing
    • Delivers virtual health and education. 
    • Lets dentists and dental specialists advise patients.  They can consult with other dental providers. They can assess and direct a patient to the right source of care (if needed). 
    • Serves patients with certain dental conditions and concerns.
    • Can decrease the number of patients seeking dental care at emergency departments (ED).
  • Providers offer advice and education through: 
    • Live video interaction
    • Store-and-forward.  This is when a patient, provider, or location sends records or data to a different dental provider or specialist.  This happens using secure system.  
  • There may not be a way to conduct a teledentistry appointment.  The patient may not have internet access. The patient’s locate is too remote – there’s not enough bandwidth.  A provider may call to provide advice, consultation, and/or triage.

Does the Military Health System (MHS) offer teledentistry?

  • The Military Health System (MHS) offers teledentistry.  Providers may use it, for example, when: 
    • A patient quarantined at home needs a virtual appointment
    • A dentist has to assess a Service member’s dental risk before deployment
    • A dental providers need to consult with other dental or medical providers
    • Providers base its use on good clinical judgment. 
  • Service Members and the Corporate Dental System (CDS).  CDS will let service members know if they can get teledentistry appointments at local dental treatment facilities.
  • A diagnosis may not be possible in a teledentistry appointment.  It may require a physical exam and new x-days.  But, impressions may be helpful to advice, educate, or triage the patient.
  • Dental providers must follow HIPAA rules. Providers should:
    • Only use DoD or DHA-approved means to conduct the visit (This only applies to military providers.)
    • Confirm the patient’s identity.
    • Avoid others being in the room during the visit to protect the patient’s privacy.
    • Send documents and images through secure means.  For example, use encrypted email, a secure system.

Does the TRICARE Dental Program (TDP) or Active Duty Dental Program (ADDP) cover teledentistry?

TRICARE doesn’t usually cover teledentistry. The Defense Health Agency is granting a temporary waiver due to COVID-19.  Dental providers may now offer limited exams or consults through teledentistry.  Check with your dentist to see if he or she offers this service.  

United Concordia Companies Inc. (UCCI), is the contractor for TDP and ADDP.  UCCI recognizes teledentistry codes.  Visit TDP and ADDP for more information.

 

Last Updated 5/22/2020