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 Understanding the TRICARE
Prime Travel Benefits
Did you know that if your primary care manager (PCM) refers you for medically necessary specialty care and you must travel farther than 100 miles from your PCM’s office, you may be eligible for reimbursement for reasonable travel expenses? The TRICARE Prime travel benefit is limited to those specialty referrals that occur when no other specialist (i.e., military treatment facility [MTF], network or non-network specialist) is available.
If you agree to a referral to a center of excellence, this benefit does not apply. Also, the TRICARE Prime travel benefit does not apply to emergency care services. This benefit only covers care that is rendered more than 100 miles from your PCM’s office. If the distance is less than 100 miles, the TRICARE Prime travel benefit does not apply.
MTFs are responsible for the travel expense entitlements when military PCMs issue referrals. However, TRICARE Regional Offices (TROs) assume responsibility for travel entitlement determinations for civilian PCM referrals.
Upon notification from Humana Military, the TRICARE Prime Travel Program Office at TRO-South verifies the mileage from the PCM’s office to the specialist’s office. Using the Defense Table of Official Distances, the mileage is calculated from your PCM’s ZIP code to the specialist’s ZIP code.
When necessary, travel orders and reimbursement can be authorized for one non-medical attendant to accompany a non-active duty TRICARE Prime beneficiary traveling for specialty care. This is permitted when the patient is a minor child or when the patient is expecting to undergo a surgical procedure. To qualify for reimbursement, the patient’s PCM must submit documentation to the TRICARE Prime Travel Program Office, citing the specific reason for the attendant requirement.
A non-medical attendant must be a parent, legal guardian or adult family member 21 years of age or older. Active duty service members may serve as the non-medical attendant if approved by their command or unit and placed in an appropriate leave status. If the attendant is someone other than a family member, then a copy of a durable power of attorney must accompany the PCM documentation.
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