• The wait time for an urgent care appointment should not exceed 24 hours (one day).
• The wait time for a routine appointment should not exceed one week (seven days).
• The wait time for a specialty care appointment or wellness visit should not exceed four weeks (28 days).

These access standards begin at the time of your call or contact with the provider. It is important to contact your provider as soon as possible. At times, appointments may not be available within the time frames listed above due to high demand for specialty care services. If the provider does not have appointments available within the access standards, you can choose to schedule the earliest available appointment with the provider or contact Humana Military for assistance with locating another provider.

You should have access to a PCM whose office is within 30 minutes of your home under normal circumstances. Specialty care should be available within one hour from your home. See “Specialty Care Far From Home—Travel Reimbursement” in this section for information about travel reimbursement if you are referred for specialty care more than 100 miles from your PCM’s office.

Additionally, it is important to understand your provider’s specific policies regarding cancelled or missed appointments. Some providers charge a missed appointment fee, which is not covered by TRICARE. Please be sure to notify your provider’s office within the appropriate time, usually 24 to 48 hours prior, if you will not be able to make your scheduled appointment.
        

Waiving Access Standards

Non-active duty TRICARE Prime beneficiaries may choose to receive care at a military treatment facility (MTF). Assignment of a PCM at an MTF is determined by provider availability and the MTF’s policy for the TRICARE Prime Service Area (PSA).

If you live more than a 30-minute drive from the MTF where you want to enroll, you must waive TRICARE’s access standards for both routine (primary) care and specialty care using one of the following options:

• Enroll through the Beneficiary Web Enrollment web site to confirm that you waive your access standards.
• Submit a TRICARE Prime Enrollment Application and PCM Change Form (DD Form 2876) to Humana Military, and sign Sections V and VI.

Note: A signed waiver is also required when choosing a civilian PCM outside the access standards.

If the waiver is approved by the MTF for beneficiaries residing less than 100 miles from the MTF, it remains in effect until the beneficiary changes residency location. A waiver for beneficiaries who reside more than 100 miles from an MTF must be approved by the TRICARE Regional Office and the MTF. It will remain in effect through the beneficiary’s current enrollment period, so long as he or she does not change residences.

Note: Each MTF can specify whether or not they will accept beneficiaries who live more than 30 minutes’ drive time from the MTF and can make a determination on mileage limitations or include specific ZIP codes. Signing a waiver of access standards does not guarantee enrollment to the MTF of your choice.

Since an MTF’s provider availability can change over time, the MTF may not always renew your waiver at the end of your enrollment period. Should this occur, Humana Military will notify you at least two months before your enrollment expires.

If your request is initially denied or your waiver is not renewed at the end of your enrollment period, you have several other TRICARE options:

• Enroll at another MTF within your area
• Enroll with a civilian PCM if you live in, or within 100 miles of, a PSA
• Enroll in the US Family Health Plan (USFHP) if you live in an area where it is offered
• Use TRICARE Standard and TRICARE Extra for your health care needs

Back to Top