Point-of-Service Option

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 
  • 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.

Point-of-Service Fees

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.

Outpatient Deductible  Cost Shares 

You must pay this amount before cost sharing begins for outpatient services.

  • Individual: $300
  • Family: $600

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 1/22/2019