Travel Reimbursement for Specialty Care
- Are you a non-active duty beneficiary?
- Do you have a referral from your primary care manager (PCM)?
- Is the specialty provider's office more than 100 miles from your PCMs office?
If you answered yes to all three questions, you may qualify for the Prime Travel Benefit.
The benefit and qualifications are the same in all three regions (North, South, West). The process for getting your reimbursement is different in each region.
Not sure which region you live in? >>Visit the Regions Page to Find Out
What is the Prime Travel Benefit?
The Prime Travel Benefit reimburses your travel expensesThe actual expenses you incur while traveling to and from your appointment--includes costs for gas, meals, tolls, parking, lodging, local transportation (i.e. taxi or rental car) and tickets for public transportation (i.e., airplane, train, bus, etc.). when:
- Your PCM refers you for medically necessary, non-emergency care*
- The specialty care provider is more than 100 miles (one-way) from your PCM’s office
- There is no other specialty care provider (military, network or non-network) within 100 miles
*We don’t authorize travel reimbursement for elective procedures or non-covered benefits.
Who may qualify for the Prime Travel Benefit?
You may qualify if you have TRICARE Prime (or TRICARE Prime Remote) and are:
- An active duty family member
- A retired service member or family member
- A Medal of Honor veteran or family member
- Any other non-active duty beneficiary
Approved non-medical attendants may also qualify.
- You must be a parent, spouse, other adult family member (age 21 years or older), or a legal guardian.
- If the patient is age 18 or older, the referring or treating provider must verify in writing that they need a non-medical attendant.
- No two travelers can get reimbursed for the same expense. This applies to shared expenses like lodging or car rental.
- You must save all of your own itemized travel receipts.
Are you on active duty?
If you’re traveling as the patient:
- Your unit arranges your travel
- The Prime Travel Benefit won’t apply
If you’re traveling as the non-medical attendant:
- Contact your Prime Travel Office before traveling
- You may get reimbursed for TDY expenses if you get approval from your unit or organization
- You must submit a memo from your unit or organization authorizing you to act as the non-medical attendant
- If you don’t get the memo or approval from your organization for TDY status, you’ll get reimbursed for actual expenses
How does the Prime Travel Benefit work?
Once you have a referral for specialty care that qualifies for the Prime Travel Benefit, follow these steps:
Step 1: Contact your Prime Travel Office
- If you have a military PCM, call the travel representative at your military hospital or clinic
- If you have a civilian PCM, call your TRICARE Regional Office:
- North: 1-866-307-9749
- South: 1-800-576-0375
- West: 1-800-449-6408
- Coast Guard: 1-800-9HB-AHBA (1-800-942-2422)
Step 2: Make Your Travel Arrangements and Go to Your Appointment
Book the least expensive travel possible.
- Economy class for air or train travel, unless approved
- Compact class for car rental, unless approved
- Local government per diem rate for lodging
Note: You can choose any mode of transportation you want, but you’ll only be reimbursed up to the most cost effective amount to the government. Please call your Prime Travel Office before purchasing airfare or traveling more than 400 miles one-way. If you don't, you may incur unnecessary out-of-pocket expenses that can’t be reimbursed.
You can get reimbursed for the actual costs of lodging and meals up to the government per diem rate for the area where you’re traveling:
- Lodging includes taxes
- Meals include taxes and tips, but excludes alcoholic beverages
You can also get your fuel expenses reimbursed if you decide to drive to and from your appointment. The rules for fuel reimbursement are changing on September 1, 2014. >>Learn More
Step 3: Submit Your Travel Documents
Select your region for specific travel forms and instructions:
Your invoices and receipts must:
- Be in the name of the person submitting the travel claim (patient or non-medical attendant)
- Show valid inclusive dates, billing itemization (e.g. room and tax rate per day), and payment in full (zero balance)
- Show form of payment (cash, check, credit/debit card, etc.)
Your claims must have all the necessary documentation, including:
- Itemized receipts
- Proof of appointment attendance
- Non-medical attendant letter, when necessary
- Active duty or civilian organizational memos, when necessary
- Signed and completed claim form (DD 1351-2/3)
If your claim doesn’t have all the necessary documentation, we will consider it incomplete and hold it until you provide it.
Is your sponsor in the Coast Guard?
Call the Coast Guard Health Safety Work-Life Service Center Health Benefits Team at 1-800-9HB-AHBA (1-800-942-2422)