TRICARE PRIME TRAVEL REIMBURSEMENT

TRICARE Prime beneficiaries referred by their primary care manager for specialty services at a location more than 100 miles from their provider’s location may be eligible to have their reasonable travel expenses reimbursed by TRICARE.

Beneficiaries must have a valid referral and travel orders prior to traveling, and file a travel claim upon their return.

TRICARE Prime and Non-Medical Attendant Travel Entitlements

Under provisions of the 2001 National Defense Authorization Act (NDAA), TRICARE Prime beneficiaries referred by their primary care manager (PCM) for services at a location more than 100 miles from their PCM may be eligible to have their "reasonable travel expenses" reimbursed by TRICARE. The travel reimbursement entitlement is retroactive to Oct. 30, 2000.

Eligibility for the TRICARE Prime Travel Entitlement:

The TRICARE Prime travel entitlement is available to non-active duty TRICARE Prime enrollees and TRICARE Prime Remote family members when they are referred for medically necessary, non-emergent specialty care more than 100 miles from the PCM location. Please note that the "greater than 100 mile rule" is stated in statute and is not negotiable when determining applicability of the Prime travel benefit. Beneficiaries must have a valid referral and travel orders from a TRICARE representative at the military treatment facility (MTF) where they are enrolled or from the TRICARE Regional Offices (TROs) if their PCM is a TRICARE network provider. This entitlement does not apply to expenses experienced by active duty uniformed services members, or active duty family members residing with their sponsors overseas, which are reimbursed by other travel entitlements.

Reasonable Travel Expenses:

Reasonable travel expenses are the actual costs incurred by the beneficiary when traveling to their specialty provider-not in an emergency status. Costs include meals, gas, tolls, parking, and tickets for public transportation (i.e. airplane, train, bus, etc.). Beneficiaries must submit itemized receipts for expenses (lodging, meals, gas, taxi receipts, parking, toll bridge, etc.). Taxi cab rides will be reimbursed to, from, and around the appointment area; between lodging, airport, and local restaurants, if necessary for the purpose of meals.

Government rates will be used to estimate the reasonable cost. Beneficiaries are expected to use the least costly mode of transportation. If you choose to travel by Privately Owned Vehicle (POV), the Government will only reimburse you for the travel rate cost for the round trip ticket from White Sands Missile Range (WSMR) to the appointment site and return. Travelers will not be authorized reimbursement for rental vehicles except in Washington, D.C. and Bethesda, MD. Exceptions may be requested through the TRICARE Prime Travel Coordinator, Patient Administration Division, if the patient’s medical disability or medical condition makes use of public transportation impossible.. A physician’s statement/recommendation to this effect is requested along with the requires for exception-to-policy. The POC is Mr. Manuel Ramirez at (915) 569-2378. The actual costs of lodging (including taxes and tips) and the actual cost of meals (including taxes and tips, but excluding alcoholic beverages) may be reimbursed up to the government rate for the area concerned. To make Army Lodging Reservations, call 1-800-462-7691. You will not be reimbursed for personal use items (i.e. personal hygiene, clothing, vehicle maintenance) in accordance with JFT and JFTR regulations. In addition, infant items such as baby food, formula, and diapers are not reimbursable.

General Process for Receiving Travel Reimbursement:

Beneficiaries must obtain official travel orders from the MTF prior to traveling. Beneficiaries will be required to make their own travel arrangements unless the MTF arranges for government travel. Beneficiaries are required to coordinate their own lodging arrangements. Upon completion of travel, the expenses need to be itemized on a SF 1164 or a DD1351-2 (travel voucher) and receipts are required for all expenses.

Traveling with a Non-medical Attendant:

The FY02 NDAA authorizes one parent, guardian or another adult family member to travel with a non-active duty Prime enrolled patient as a non-medical attendant (NMA). The NMA is authorized reimbursement of actual travel expenses. If the NMA family member is active duty authorized by the MTF or TRO to accompany a non-active duty TRICARE Prime enrollee as a non-medical attendant, he/she is entitled to TDY allowances (per diem and mileage), not actual expenses. If the NMA family member is a U.S. Government civilian assigned to TDY by their civilian organization, they may also be entitled to TDY allowances. By statute, the NMA must be a parent, legal guardian or other adult family member. However, if the NMA is not the parent, the NMA must be at least 21 years of age. The NMA is not required to be enrolled in TRICARE Prime or to be TRICARE-eligible. The patient, however, must be enrolled in TRICARE Prime.

The NMA benefit is retroactive to December 28, 2001. NMAs that qualify for reimbursement under this entitlement should save their travel receipts.

For more information about the TRICARE Prime travel entitlement, please contact one of the Beneficiary Counseling and Assistance Coordinators (BCAC),at (915) 569-2543 or (915) 569-2367.

If you have questions or concerns regarding filing claims, please call TRICARE Travel office at (915) 569-2378, which is located in the Patient Administration Division (3rd Floor, Room 224), William Beaumont Army Medical Center. Claims may be faxed to TRICARE Travel, Attention: Travel Coordinator at (915) 569-1960 (fax).