The TRICARE Prime access standards are another advantage to enrolling in TRICARE Prime. The following access standards apply:
The wait time for an urgent care appointment will not exceed 24 hours (one day).
The wait time for a routine appointment will not exceed one week (seven days).
The wait time for a specialty care appointment or wellness visit will not exceed four weeks (28 days).
Additionally, you should have access to a PCM whose office is within 30 minutes of your home. Specialty care travel time should not exceed on hour under normal circumstances, unless a longer time is necessary because of the absence of providers in the area.
TRICARE Prime Travel Entitlement
If you are referred by your PCM for specialty care at a location more than 100 miles (one way) from your PCM, you may be eligible to have your reasonable travel expenses reimbursed by TRICARE. You must have a valid referral and travel orders from a TRICARE representative at the MTF where you are enrolled or from the TRICARE regional office (TRO) if your PCM is a TRICARE network provider. Note: The above only applies to enrollees in Continental United States locations.
TRICARE Prime Point of Service Option
You are required to obtain all care from your PCM or through referrals from your PCM to specialists within the TRICARE provider network, when available. However, the point of service (POS) option allows you to receive nonemergency health care services from any TRICARE-authorized provider without requesting a referral from your PCM. Using the POS option results in higher out-of-pocket costs.
The POS option does not apply to the following:
Active duty service members
Newborns or adopted children in their first 60 days
Emergency care
Preventive care services from a network provider
First eight behavioral health outpatient visits from a network provider
If you have other health insurance
TRICARE Prime Enrollment Portability
Enrollment portability allows you to easily transfer your TRICARE Prime coverage to another TRICARE region, if TRICARE Prime is offered at your new location. We recommend that you transfer your enrollment if you will be staying at your new location for at least 30 days (even if the relocation is only temporary). Retirees, their family members, survivors, and former spouses may transfer enrollment twice during an enrollment year, as long as the second transfer is back to the original region of enrollment. There are no limitations on the number of transfers for ADSMs and ADFMs.
If you move within the same region, you are not affected by enrollment portability (if the move is to an area that offers TRICARE Prime) and are only required to fill out a TRICARE Prime Enrollment Application and PCM Change Form to update your address and designate your new PCM.
Note: ADSMs and ADFMs moving to or from a designated TPR ZIP code area can transfer between TRICARE Prime and TPR/TPRADFM.
