Prime Travel Benefit
If your Primary Care Provider (PCM) is at a military hospital or clinic, please contact them for specific forms and submission instructions.
If your PCM is a civilian provider, you must submit the following required documents packet to the TRICARE Prime Travel Benefit Office.
Note: If you or your sponsor is an active or retired member of the Coast Guard, with a military or civilian PCM, please follow the guidance below.
- Download and read the Prime Travel Information Sheet and the Prime Travel Benefit Tip Sheet.
- Use the Prime Travel Benefit Traveler Checklist to make sure you include all required documents with your travel claim.
If you don't include all of the required documents, your claim can't be processed. Be sure to make copies of everything for your records. See tip below if you're having problems accessing any of the forms.
|Patient Information Form||
The form must be completely filled out and signed.
Travel Claim Forms:
Proof that you Attended the Appointment
DHA 126 Confirmation of Specialty Care: Proof that you attended the appointment
|A note from the specialty care provider's office verifying that you attended the appointment or submit the DHA 126 Form.
Non-Medical Attendant Letter
A letter from your doctor stating that a non-medical attendant (NMA) is appropriate and medically-necessary. (Only required when you have a NMA). For chronic conditions, the doctor may request the letter be valid for up to one year.
|Direct Deposit Authorization Form||
All payments are made by electronic funds transfer (EFT).
You must file your travel claim within one year of the travel date. Send all required documents via email, fax or mail.
- Email: firstname.lastname@example.org
- Note: DoD SAFE (Secure Access File Exchange) is a service to make it easy for you to exchange unclassified files up to 8.0 GB that can’t be sent through email. Visit https://safe.apps.mil/. If you don’t have a Common Access Card (CAC), please let us know (email above). We'll send you a drop-off request so you can use DoD SAFE.
- Fax: 1-210-536-6176
Prime Travel Office
7800 IH 10 West, Ste. 400
San Antonio, TX 78230
Important Note: Don’t send Protected Health Information via unencrypted email. Also, don’t send encrypted messages to email@example.com.
- Travel claims are processed using the Defense Travel System (DTS).
- Include legible, itemized receipts for all travel expensesAmounts you pay when traveling to and from your appointment. This includes mileage, meals, tolls, parking, lodging, local transportation, and tickets for public transportation. with each claim. Fuel receipts aren't needed when using your personal vehicle.
- Government rates are used to reimburse the reasonable expenses. This includes City Pairs for flight allowances.
- Please allow up to four weeks for your payment to be processed.
Tips for Downloading and Signing Forms:
To download certain forms:
- Due to security settings, you may need to download and install the Adobe Acrobat Reader software
- Right-click on the form number
- Select "Save Link As"
To sign certain forms. If you’re:
- Getting the forms on a non-government computer:
- Create a digital signature ID
- Digitally sign the form
- Getting the forms on your phone or tablet:
- Use the “Fill & Sign” tool in Adobe Acrobat to create a digital signature ID
- Digitally sign the form
Note: If your devices aren’t compatible, you’ll need to print and manually sign the forms.
Last Updated 6/14/2021