Minimize out-of-pocket costs with in-network TRICARE

For active duty family members, the TRICARE Prime point-of-service (POS) option means more flexibility for managing health care, but it also comes with higher out-of-pocket costs. In fact, this option can be very expensive.

What is POS?

The POS option is when Prime and TRICARE Prime Remote (TPR) beneficiaries are required to pay an additional deductible and cost-share when they choose to receive non-emergency services outside the network of TRICARE Prime providers without a referral from their Primary Care Manager (PCM) or an authorization from TriWest Healthcare Alliance.

The POS cost share also applies when active duty family members receive routine care while traveling, or when electing to have prescriptions filled at a non-network civilian pharmacy.

For example, if a beneficiary’s annual deductible has been met and the visit cost and TRICARE allowable charge is $500, the beneficiary must pay 50 percent of the remaining POS charge, or $250. Additionally, POS costs are not applied towards the annual catastrophic cap.

  In-Network Deductible & Cost Share POS Deductible & Cost Share
Individual $0 deductible / $0 cost share $300 / 50% of allowable
Family $0 deductible / $0 cost share $600 / 50% of allowable

*Note: Non-active duty Prime beneficiaries are responsible for applicable co-pays.

The POS option does not apply to:

Payment of claims will be denied for active duty service members (ADSMs) who visit a civilian provider without a referral from their Military Treatment Facility or the Military Medical Support Office in Great Lakes Illinois. In those cases, the ADSM will be required to pay all costs and will not be reimbursed by the government.

To avoid costly POS charges, simply use the following rules-of-thumb whenever seeking non-emergency care:

Visit www.triwest.com for more information about POS and other TRICARE benefits.