If you have referral for specialty care more 100 miles (one way) from your PCM's office, you may be able to have "reasonable travel expenses"The actual costs incurred while traveling, including meals, gas, tolls, parking and tickets for public transportation (i.e., airplane, train, bus, etc.). reimbursed by TRICARE through the TRICARE Prime Travel Benefit.
- Available to non-active duty beneficiaries and Medal of Honor veterans enrolled in TRICARE Prime.
- Active duty travel (and reimbursement) is coordinated through the service member's unit.
- Specialty care referral must be for medically-necessary, non-emergency care. Travel expenses are not authorized for elective procedures or non-covered benefits.
- Limited to specialty referrals when no other specialist (military, network or non-network) is within 100 miles (one way) of the PCM’s office.
- Distance from your PCM's office to the specialty care provider's office is more than 100 miles, one way. (determined by the Defense Table of Official Distances)
Note: If you transitioned to TRICARE Standard on October 1, 2013 under planned reductions in Prime Service Areas, your Prime Travel Benefit may be affected.
A non-medical attendant (NMA) may also be authorized for travel reimbursement.
- Parent, spouse, another adult family member (age 21 years or older) or a legal guardian.
- Referring provider must verify in writing that an NMA is medically necessary and appropriate to travel with the patient.
- When approved, the NMA is authorized reimbursement of actual travel expenses.
Note: If the NMA is an active duty service member, he/she is entitled to TDY allowances (per diem and mileage), not actual expenses.
Making Your Travel Arrangements
After you have an approved PCM referral, make your own travel arrangements using the least-costly mode of transporation. All invoices or receipts must:
- be in the name of person submitting the claim (patient or NMA)
- show valid inclusive dates, billing itemization (e.g. room rate per day), and payment in full (zero balance)
- show form of payment
TRICARE reimburses the actual costs of lodging (including taxes and tips) and the actual cost of meals (including taxes and tips, but excluding alcoholic beverages) up to the government rate for the area. Receipts are required regardless of amount for the following items:
- Air or Rail Travel—limited to "economy" class (unless approved)
- Car Rental—limited to "compact" class (unless approved)
- Lodging—may not exceed the local per diem rate
TRICARE may reimburse the actual fuel expense used to drive to the appointment and back.
- Fuel will not be reimbursed for any dates outside the approved timeframe.
- Travel in-and-around the destination should be limited as much as possible to only the medical needs of the trip.
To qualify for fuel reimbursement:
- Fill the gas tank before leaving home (regardless of the amount of gas currently in the tank). This receipt is not reimbursable but will establish a common starting point to calculate the actual fuel expense.
- During the trip, add gas as needed. Save these receipts—make sure they are legible.
- Immediately upon return home, refill the gas tank (regardless of the amount of gas currently in the tank). This receipt establishes a common endpoint to calculate the fuel used during the trip.
Getting Travel Orders & Submitting Receipts
- If your PCM is at a military hosptial or clinic, you must have a referral and travel orders from the travel representative at the military hospital or clinic.
- If you have a civilian PCM, click on your region below for instructions:
Is your sponsor in the Coast Guard?
For care received after November 1, 2011, contact the Coast Guard Health Safety Work-Life Service Center Health Benefits Team at 1-800-9HBAHBA (1-800-942-2422) or by writing to Commanding Officer HSWL SERVICE, ATTN: Health Benefits, 300 E. Main St Suite 1000, Norfolk, VA 23510. If filing travel reimbursement claims for care before October 31, 2011, follow the instructions for your region.