Understanding the TRICARE Prime Travel Benefit
There are times when TRICARE Prime active duty family members (ADFMs) require specialty care that is available only long distances away from their primary care manager (PCM). If the nearest specialist’s office is over 100 miles away, the ADFM may be eligible to receive reimbursement for reasonable travel expenses.
Entitlement is limited to those specialty referrals when no other specialist (i.e., Military Treatment Facility (MTF), network or non-network specialist) is available within 100 miles of the PCM’s office. The only exception is when the beneficiary/patient agrees to a referral to an MTF.
Travel orders and reimbursement are also authorized for one non-medical attendant to accompany a non-active duty TRICARE Prime patient referred for medically necessary specialty care more than 100 miles from the patient’s PCM location.
MTFs are responsible for validation of travel expense entitlement and issuing travel orders for specialty referrals issued by military PCMs. The TRICARE Regional Office-West (TRO-W) and TriWest are responsible for travel entitlement determinations and orders for specialty referrals from civilian PCMs.
Travel expenses will be reimbursed in accordance with the Joint Federal Travel Regulations (JFTR). TriWest will refer civilian travel requests for MTF-enrolled beneficiaries to the MTFs and civilian-enrolled requests to the TRO-W for validation, orders and payment if it appears that the beneficiary may be entitled to the travel benefit. Note: the JFTR applies to all ADFMs, not just to Prime enrollees. This means that TRICARE Standard ADFMs may also be directed to their sponsor's unit for travel orders and assistance when medically warranted.
Providers can follow a few easy steps to help the ADFMs:
- Ask if the beneficiary is enrolled in TRICARE Prime
- Prime beneficiaries enrolled to an MTF will have their orders and travel arrangements made through the MTF where they are enrolled.
- Prime beneficiaries not enrolled to an MTF are assisted by the TRO-W
- Ask if the beneficiary has an authorization from TriWest
- The beneficiary must have received an authorization through TRIWEST for care more than 100 miles from their PCM. They will receive the authorization number provided by TRIWEST on their referral/authorization approval letter.
- Remind the beneficiary to keep all receipts. The travel benefit allows for coverage of actual expenses up to the government’s maximum per diem. Upon completion of their travel, they will need to file a claim for lodging and per diem expenses with the Travel Coordinator.
- Travel allowance (actual expenditures) can be covered for a non-medical attendant when medically warranted as identified by the referring provider.
- When the patient is an adult, the non-medical attendant accompanying them must be required for reasons of medical necessity and a letter so stating from the patient’s PCM must accompany the Prime Travel Request. If the patient is a child (17 years old or less), a letter from the PCM is not required; it is assumed that a parent or responsible guardian will be accompanying the patient.
Providers wishing to assist beneficiaries with questions about the Prime travel benefit and the non-medical attendant entitlement should direct the beneficiary to contact their local MTF or the TRO-W travel representative or beneficiary counseling and assistance coordinator (BCAC) for assistance.
Providers or the beneficiary may also contact the Travel Coordinator at the TRICARE Regional Office West in San Diego at 1-800-449-6408 or e-mail travel.coordinator@trow.tma.osd.mil.
Information is also available in the TRICARE Reimbursement and Operations manuals at http://manuals.tricare.osd.mil/ or in the TRICARE Prime Travel frequently asked questions section at http://www.tricare.mil/primetravel/pte_faqs.cfm.