TRICARE’s point of service (POS) option allows a TRICARE Prime or TRICARE Prime Remote for Active Duty Family Members (TPRADFM) beneficiary to receive medically necessary TRICARE-covered services from any TRICARE-authorized provider without a referral from his or her primary care manager (PCM).
 
You should remind these beneficiaries, however, that the POS option involves outpatient deductibles and higher out-of-pocket costs. And the POS deductible and cost-shares are not applied to the annual catastrophic cap.
 
The POS deductible and cost-share apply when:

• A TRICARE Prime or TPRADFM beneficiary receives nonemergency care from a network or non-network provider without a referral from his or her PCM or Humana Military Healthcare Services, Inc. (Humana Military). See exceptions below.
•  A TRICARE Prime or TPRADFM beneficiary has a referral from Humana Military to a military
  treatment facility (MTF) specialty care provider, but self-refers to a civilian network or non-network specialty care provider.
• An MTF-enrolled beneficiary self-refers to a civilian network or non-network provider for a
  primary care (routine) service or urgent care.

POS does not apply to the following:

• Emergency care
• Clinical preventive services from a network provider
• The first eight behavioral health outpatient visits per fiscal year (Oct. 1–Sept. 30) from a network provider
• TPRADFM beneficiary without an assigned PCM receiving a primary care (routine) service
  from a TRICARE-authorized general practice, family practice, internal medicine, physician assistant, nurse practitioner, pediatrician or urgent care provider
• TRICARE Prime or TPRADFM beneficiaries with other health insurance
• TRICARE Prime or TPRADFM newborns or newly adopted children*
• TRICARE Standard beneficiaries
• Active duty service members (authorization is required for any civilian health care)
• Overseas-enrolled active duty family members seeking care in the U.S. (however, authorization
  is required for nonemergency inpatient behavioral health care, and POS will apply if it is not
  obtained)

It is also important to remind beneficiaries that certain prior authorization requirements still apply even though a referral is not required when using the POS option.
 
For more information about the POS option, advise your beneficiaries to visit www.humana-military.com
or call Humana Military at 1-888-444-5445.

* A newborn or newly adopted child is deemed to be enrolled in TRICARE Prime for the fi rst 60 days after birth or adoption, as long as one additional family member is enrolled. POS does not apply through the 60th day or until an enrollment decision is made, whichever is earlier.  

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