With the point-of-service option, you:
- Can visit any TRICARE-authorized providerClick to closeAn 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.
- Get routine care
- Don’t need a referral
- Pay more out of pocket (see fees below)
The point-of-service option doesn't apply if you:
- Are an active duty service member
- Use a non-Prime plan
- Have a referral. (If you have a referral and/or authorization, your costs are the same as network costs.)
- Have a newborn or adopted child (until enrolled in TRICARE Prime)
- Note: Children are covered by TRICARE Prime for 90 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.
- Have other health insuranceClick to closeHealth insurance you have in addition to TRICARE, such as Medicare or an employer-sponsored health insurance. TRICARE supplements don’t qualify as "other health insurance."
- Use the following type 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 copaymentClick to closeA fixed dollar amount you may pay for a covered health care service or drug.
- 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.
Outpatient Services: 50% of TRICARE allowable chargeClick to closeThe maximum amount TRICARE pays for each procedure or service. This is tied by law to Medicare's allowable charges.
Hospitalization: 50% of TRICARE allowable charge
Last Updated 6/28/2019