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These procedures are covered for non-active duty beneficiaries who suffer from morbid obesity and meet specific medical criteria. For a TRICARE beneficiary to medically qualify he or she must weigh 100 pounds or more over their ideal weight for height and bone structure, and the excess weight must be associated with a severe medical condition. Beneficiaries who weigh more than twice their ideal weight for height and bone structure are also eligible.
Additionally, TRICARE covers surgery for beneficiaries who had a previous intestinal bypass or other surgery for obesity and, because of complications, require a second surgery.
"TRICARE covers procedures that have been proven safe and effective, and are accepted by the medical community," said John Kugler, chief medical officer, TRICARE Management Activity. "For some beneficiaries, gastric surgery may be the right course of action to preserve their health."
Nonsurgical treatment of obesity, morbid obesity, dietary control or weight reduction, biliopancreatic bypass and gastric bubble or balloon for the treatment of morbid obesity are not covered by TRICARE.
Bariatric surgery represents a major and permanent change in the digestive system and beneficiaries are required to maintain a strict adherence to a specific dietary regimen, which may interfere with the operational deployment of active duty service members (ADSMs). Because of this, ADSMs are not allowed to have bariatric surgery and may be separated from the service if they choose to have the procedure. If an ADSM has bariatric surgery without Military Health System authorization - e.g., by using other health insurance carried by a spouse - he or she is permanently non-deployable and may be considered for separation.
Before gastric bypass or Lap-Band procedures are considered, TRICARE encourages beneficiaries to use healthy diets and exercise to prevent obesity. Military personnel, retirees and their families can use the tools provided by TRICARE at the Healthy Living Web site at http://www.tricare.mil/getfit/ or the Defense Commissary Agency, http://www.commissaries.com, including dietary advice columns, recipes and information on making healthy food choices. The Department of Agriculture's "MyPyramid" tool at http://www.mypyramid.gov can help in creating personalized meal and physical activity plans.
Physical activity is important for physical health and weight management. Exercise reduces the risk of cardiovascular disease, diabetes and other diseases. Consistent physical activity is helpful in weight loss and helps prevent regaining the weight.
The Centers for Disease Control and Prevention recommends 30 minutes of daily physical activity for adults and 60 minutes for children. Everyday activities provide opportunities for being more active. Visit the CDC Healthy Living Web Page at http://www.cdc.gov/healthyliving and try a few of these suggestions:
Walk, cycle, jog, skate, etc., to work, school, the store or place of worship.
Park the car farther away from your destination.
Take the stairs instead of the elevator or escalator.
Use leg power by taking small trips on foot to get your body moving.
Take fitness breaks by walking or doing desk exercises instead of taking cigarette or coffee breaks.
Perform gardening or home repair activities.
Details of TRICARE's coverage of surgical treatments for morbid obesity are available in Chapter 4, Section 13.2 of the TRICARE Policy Manual, and can be found at http://manuals.tricare.osd.mil.
