Travel Reimbursement for Specialty Care
Do you need to check your TRICARE health plan enrollment? Visit the Defense Enrollment Eligibility Reporting System.
What is the Prime Travel Benefit?
The Prime Travel Benefit reimburses reasonable 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. for a qualified trip by a TRICARE Prime enrollee.
Does Your Trip Qualify for the Prime Travel Benefit?
Your trip may qualify for reimbursement if you’re enrolled in TRICARE Prime or TRICARE Prime Remote for Active Duty Family Members and:
- You, as the patient,
- Aren't an active duty service member (ADSM).
- Aren’t an active duty family member living with your active duty sponsor on orders in Alaska and Hawaii. Contact your nearest military hospital or clinic to see if you might qualify for a separate overseas travel benefit program.
- You are assigned to Primary Care Manager (PCM) in the United States.
- Your PCM refers you for non-emergency, medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. care covered by TRICARE.
- A trip for health services not covered by TRICARE doesn't qualify for reimbursement.
- You have a referral to a specialty careSpecialized medical/surgical diagnosis, treatment, or services a primary care provider isn’t qualified to provide. provider who is more than 100 miles (one-way) from your PCM’s office.
- Your military hospital or clinic’s travel office or the Defense Health Agency (DHA) Prime Travel Benefit office determines the distance for program qualification.
- There’s no suitable specialty care provider within 100 miles of your PCM to provide the referred care. This includes military, network, or non-network TRICARE-authorized providers.
Does the Prime Travel Benefit Cover a Non-Medical Attendant (NMA)?
It depends. Travel for an approved NMA may qualify for the Prime Travel Benefit.
- The patient’s trip must qualify for the Prime Travel Benefit (as described above) and the NMA must travel with the patient on that qualified trip.
- The NMA must be a parent, spouse, other adult family member (age 21 years or older), or a legal guardian.
- Is the patient age 18 or older? The referring or treating provider must verify in writing that the NMA is medically necessary for the patient’s trip.
- You must submit all of your itemized travel receipts, including expenses less than $75.00.
- TRICARE won’t reimburse travelers for the same expense. This includes shared expenses like lodging or car rental.
Are you an Active Duty Service Member?
|If you're traveling as the patient
|If you're traveling as a non-medical attendant (NMA)
Is the patient an Active Duty Service Member (ADSM)?
If the patient:
Then, contact your servicing Prime Travel Benefit office. See below on how to contact your Prime Travel Benefit office.
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
- Do you have a military PCM? Contact the travel representative at your military hospital or clinic.
- Do you have a civilian PCM? Is your sponsor an active or retired member of the Coast Guard? If yes, then you should contact the DHA Prime Travel Benefit office.
Toll-free: (844) 204-9351
Step 2: Make Your Travel Arrangements and Go to Your Appointment
- Book the least expensive travel possible.
- Economy class for air or train travel.
- Compact class for car rental, unless approved before travel.
- You can choose any reasonable mode of transportation you desire. But your reimbursement won’t exceed the most cost-effective amount as determined by the government.
- Call your servicing Prime Travel Benefit office before booking airfare or traveling more than 400 miles one-way. You must confirm the maximum amount you may be reimbursed.
- Your reimbursement only includes the actual costs of lodging and meals. This is not to exceed the government per diem rate for the ZIP code of your specialty care provider’s office.
- Lodging allowance includes taxes and fees.
- If taxes and fees aren’t itemized, only the daily room cost is reimbursable up to the maximum allowance.
- Booking agency fees aren’t reimbursable.
- Meal allowance includes taxes and reasonable tips but excludes alcoholic beverages.
- Driving your own vehicle?
- You’ll receive reimbursement for the miles you drive to and from the appointment.
- The “Other Mileage Rate” applies, unless:
- You have an authorized NMA and the NMA is either an ADSM or a Department of Defense federal employee.
- Then the “TDY Travel” mileage rate applies.
- Mileage rates may change at least once a year.
Step 3: Submit Your Travel Documents
- Get the required travel forms from the Prime Travel Reimbursement Instructions page.
- Follow all instructions. Fill out each required form completely and sign as required.
- Enclose all itemized receipts. You may tape them (clear tape) on plain paper, 8½ by 11 inches.
- Follow instructions on submitting your completed package.
Please send all Prime Travel Benefit email correspondences to firstname.lastname@example.org.
Last Updated 2/3/2023