Travel Reimbursement for Specialty Care
What is the Prime Travel Benefit?
The Prime Travel Benefit reimburses your reasonable travel expensesAmounts you pay when traveling to and from your appointment. This includes costs for gas, meals, tolls, parking, lodging, local transportation, and tickets for public transportation. if you meet the requirements below.
Do You Meet the Following Requirements?
- You, as the patient, aren't an active duty service member.
- Your Primary Care Manager (PCM) refers you for medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition., non-emergency care. (We don’t authorize travel reimbursement for elective procedures or non-covered benefits.)
- The specialty care provider is more than 100 miles (one-way) from your PCM’s office.
- The Prime Travel Office or your military hospital or clinic travel office determines the distance for program qualification.
- Distance rule is set in statute and not negotiable.
- There is no other specialty care provider within 100 miles of your PCM who is capable of meeting your health needs. This includes military, network, or non-network providers.
If all these apply to you, you may qualify for the Prime Travel Benefit.
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 TRICARE beneficiary
Need to check your TRICARE eligibility? Visit the Defense Enrollment Eligibility Reporting System (DEERS).
Approved non-medical attendants (NMA) 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 the NMA is medically necessary for the travel.
- TRICARE won’t reimburse travelers for the same expense. This applies to shared expenses like lodging or car rental.
- You must submit all of your itemized travel receipts, including expenses less than $75.00.
* Enrolled in the 50 United States (AK, HI, and enrollees not part of an overseas assignment).
Are you on Active Duty?
|If you're traveling as the patient||If you're traveling as a non-medical attendant (NMA)|
Your unit manages your travel.
Contact your unit's travel representative for guidance.
|If the patient is an active duty service member (ADSM), their unit will manage your travel as part of their travel case. The unit will also manage the travel of the NMA.|
|The Prime Travel Benefit won't apply.||If the patient is a non-ADSM, 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? Are you or your sponsor an active or retired member of the Coast Guard? Contact your Prime Travel Office.
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 before travel
- Compact class for car rental, unless approved before travel
- Local government per diem rate for lodging
Note: You can choose any mode of transportation you desire, but you will only be reimbursed up to the most cost effective amount to the government. Call your Prime Travel Office before buying airfare or traveling more than 400 miles one-way. If you don’t, you may incur unnecessary out-of-pocket expenses TRICARE can’t reimburse.
TRICARE can reimburse you for the actual costs of lodging and meals. This up to the government per diem rate for the zip code of your specialty care provider’s office.
- Lodging allowance includes taxes and fees
- Meal allowance includes taxes and reasonable tips, but excludes alcoholic beverages. Itemized receipts are required.
- Fuel expenses (See below)
TRICARE will apply a mileage rate for driving to and from the appointment. Per the Joint Travel Regulation reimbursement for all patient travel claims is calculated using the “Other Mileage Rate”. DoD personnel (Active Duty/Civilian) NMA claims will be reimbursed at the “TDY Travel” rate. Review this often, as this mileage rate may change once or twice per calendar year.
Step 3: Submit Your Travel Documents
For you travel forms and instructions, visit the Prime Travel Reimbursment Instructions page.
Last Updated 11/13/2020