Point-of-Service Option

With the point-of-service option, you:

  • Can visit any TRICARE-authorized provider
  • Get routine or urgent care
  • Don’t need a referral
  • Pay more out of pocket (see fees below)

The point-of-service option doesn't apply to:

  • Active duty service members
  • Newborn or adopted children until enrolled in TRICARE Prime
    • Note: Children are covered by TRICARE Prime for 60 days (120 days overseas) after birth or adoption as long as one other family member is enrolled. The point-of-service option won't apply to children during this time or until the date the contractor receives the enrollment form.
  • Beneficiaries with other health insurance
  • The following types of care

*If you visit a network provider in another region without a referral from your PCM, you're using the point-of-service option.

Point-of-Service Fees

When you use the point-of-service option, you’ll pay:

  • Point-of-service fees instead of your regular copayment
  • Any other fees charged by non-network providers

These fees don’t apply to your annual catastrophic cap.

Outpatient Deductible  Cost Shares 

You must pay this amount before cost sharing begins for outpatient services.

  • Individual: $300
  • Family: $600

Outpatient Services: 50% of TRICARE allowable charge

Hospitalization: 50% of TRICARE allowable charge

Last Updated 9/25/2015