Prime Travel Benefit Offsets Travel Costs to Distant Specialists

When referring TRICARE patients to specialists for treatment when care is not available through your office or the local military treatment facility (MTF), there are times when the nearest available specialist provider is located a considerable distance away.

The TRICARE Prime Travel Benefit program can ease the financial burden on beneficiaries when this happens.

Who’s Eligible?

The entitlement is available to non-active duty beneficiaries enrolled in TRICARE Prime and TRICARE Prime Remote for Active Duty Family Members when they are referred more than 100 miles from their PCM.

For beneficiaries to be eligible for the Prime Travel Benefit, PCMs must first refer them to the specialist, and TriWest must authorize their specialty care through the normal authorization process. Long-distance referrals will only be authorized when there are no network, non-network or MTF specialists available who meet the TRICARE distance or availability standards.

This entitlement does not apply to:

• Expenses incurred by active duty service members
• Expenses incurred by ADFMs living with their sponsors overseas
• Travel costs of beneficiaries who are referred under Department of Defense (DoD) specialized treatment programs and reimbursed under other travel entitlements

What Are the Next Steps?

Once referred, beneficiaries will receive a letter from TriWest. The letter will instruct them to visit or call a designated point of contact (POC) at their MTF or the TRICARE Regional Office–West to determine their eligibility and to apply for travel reimbursement.

What’s Covered?

Reimbursement is based on travel from the beneficiary’s residence to the specialist or from the PCM’s office to the specialist. The benefit pays actual costs for gasoline, parking, tolls, meals, lodging, etc., and beneficiaries must save all travel-related receipts.

A non-medical attendant can travel with and/or drive the patient to the specialty care appointment, if justified by the PCM. The attendant can be a parent, spouse, legal guardian or other family member over age 21. The patient and the attendant cannot be reimbursed for the same travel expenses. If the attendant is a family member and is active duty or a U.S. Government employee, he or she is entitled to TDY allowances (per diem and mileage), not actual expenses like the patient.

For more information, visit www.triwest.com or call 1-888-TRIWEST.