With the point-of-service option, you:
- Can visit any TRICARE-authorized provider
- Get routine or urgent care
- Don’t need a referral
- Pay more out of pocket (see fees below)
The point-of-service option doesn't apply to:
- Active duty service members
- Newborn or adopted children until enrolled in TRICARE Prime
- Note: Children are covered by TRICARE Prime for 60 days (120 days overseas) after birth or adoption as long as one other family member is enrolled. The point-of-service option won't apply to children during this time or until the date the contractor receives the enrollment form.
- Beneficiaries with other health insurance
- The following types of care
*If you visit a network provider in another region without a referral from your PCM, you're using the point-of-service option.
When you use the point-of-service option, you’ll pay:
- Point-of-service fees instead of your regular copayment
- Any other fees charged by non-network providers
These fees don’t apply to your annual catastrophic cap.
You must pay this amount before cost sharing begins for outpatient services.
- Individual: $300
- Family: $600
Outpatient Services: 50% of TRICARE allowable charge
Hospitalization: 50% of TRICARE allowable charge