West Region Instructions
If you have a civilian PCM, the following documents must be submitted via mail, fax, or secured email to the TRICARE Regional Office (TRO)-West Prime Travel Benefit Office. To protect personal information, we strongly discourage sending documents via email.
|Prime Travel Reimbursement Request Form
Submit this form with all other supporting documents to get reimbursed under the Prime Travel Benefit.
|Electronic Funds Transfer Authorization Form
Submit this form to establish the automatic transfer to recieve the reimbursement electronically. You will only need to submit this form once unless there is a change.
|PCM Referral or UnitedHealthcare Referral Authorization Letter
The PCM referral must be authorized by UnitedHealthcare. If the appointment is at a military hospital or clinic, a copy of the PCM's referral letter and the patient's Composite Health Care System Appointment Schedule is required in place of the UnitedHealthcare authorization letter. Contact UnitedHealthcare 1-877-988-WEST (1-877-988-9378) or www.uhcmilitarywest.com.
Note: If you received specialty care under the authorization waiver (April 1-July 2, 2013) you must submit a copy of the written PCM referral and the waiver letter to qualify for travel reimbursement.
|Non-Medical Attendant (NMA) Letter
If applicable, submit a letter from your PCM recommending that a NMA is appropriate and medically-necessary. Without this recommendation, the NMA will not be eligible for travel expense reimbursement. Federal regulations authorize only one NMA. The NMA must be a parent, guardian, or an adult member of the patient's family who is at least 21 years of age. This requirement is waived when the patient is a minor, less than 18 years of age.
|Confirmation of Specialty Care
For verification and audit purposes, complete the attached Confirmation of Specialty Care Form when attending appointments.
|Active Duty Service Member/Government Employee NMA Memo
This form must be completed by command or appropriate agency official to authorize TDY travel reimbursement for the NMA (if NMA is on active duty or a federal employee).
If you are traveling alone, complete the Travel Voucher or Subvoucher (DD 1351-2) and Statement of Actual Expenses (DD 1351-3) with receipts.
If you are accompanied by a NMA who is a non-active duty or non-government employee, both the patient and NMA submit the Travel Voucher or Subvoucher (DD 1351-2) and Statement of Actual Expenses (DD 1351-3) with receipts.
If the NMA is an active duty service member, only the Travel Voucher or Subvoucher (DD 1351-2) with receipts is required.
Travel reimbursement claims for travel occurring on or after April 26, 2012 must be filed no later than one year after the qualifying travel date.
Original or legible receipts are required to support all travel documentation.
|Prime Travel Benefit Checklist
This form should be completed and signed to acknowledge that if you submit an incomplete packet, it may result in your reimbursement being delayed or not processed. All documents on the checklist must completed and included in the packet submission for reimbursement.
Contact the TRO-West Travel Benefit Office via phone or e-mail:
Submit your complete packet to the TRO-West office via fax or mail:
TRICARE Regional Office-West
Attn: Prime Travel
401 West A Street, Suite 2100
San Diego, CA 92101
- Travel claims are processed using the Defense Travel System.
- Include receipts for all reasonable travel expenses with each claim.
- Government rates are used to estimate the reasonable cost.