| Service |
Coverage |
Authorization Requirements |
Co-Pay: Active duty dependents & retirees with Medicare Part B |
Co-Pay: Retirees without Medicare Part B |
| Abortion, elective |
Not covered |
N/A |
N/A |
N/A |
| Acupressure |
Not covered |
N/A |
N/A |
N/A |
| Acupuncture |
Not covered |
N/A |
N/A |
N/A |
| Acute Rehabilitation Facility Admisison |
Covered |
Yes |
No |
Yes |
| Adjunctive Dental Care |
Limited |
Yes |
No |
Yes |
| Allergy, Diagnostic Testing and Treatment |
Covered |
No |
No |
Yes |
| Alteration to living space |
Not covered |
N/A |
N/A |
N/A |
| Alternative or Complementary Medicine |
Not covered |
N/A |
N/A |
N/A |
| Ambulance Service |
Limited |
Emergency - no; all others yes |
No |
Yes |
| Ambulatory Blood Pressure Monitoring |
Limited |
Yes |
No |
Yes |
| Ambulatory Surgery (same day surgery) |
Covered |
Some ambulatory surgical procedures require authoration |
No |
Yes |
| Ambulette Service |
Not covered |
N/A |
N/A |
N/A |
| Anesthesia |
Covered |
No |
No |
No |
| Ankle replacement surgery |
Covered |
Yes |
No |
Yes |
| Annual Preventative Eye Exam |
Covered. Limit one every 12 months |
No |
No |
No |
| Annual Preventative Hearing Exam |
Covered. Limit one every 12 months |
No |
No |
No |
| Annual Preventative Physical Exam |
Covered. Limit one every 12 months |
No |
No |
No |
| Apnea Monitor |
Covered |
Yes |
No |
Yes |
| Arch Supports |
Not covered |
N/A |
N/A |
N/A |
| Artificial Insemination |
Not covered |
N/A |
N/A |
N/A |
| Artificial Limb (Prosthetic) |
Covered |
Yes |
No |
Yes |
| Augmentative Communiation Device (ACD) |
Limited |
Yes |
No |
Yes |
| Autopsy or Post-Mortem Examination |
Not covered |
N/A |
N/A |
N/A |
| Aversion Therapy |
Not covered |
N/A |
N/A |
N/A |
