Patient Travel

TRICARE Prime Travel Benefit:

As a TRICARE Prime enrollee you can receive reimbursement for your travel expenses when:

• Your PCM refers you for medically necessary care
• The specialty care provider is more than 100 miles one way from your PCM’s office
• There is no other specialty care provider (military, network or non-network) within 100 miles

What is covered?:

• Least expensive government fare/rate possible
  • Economy class air travel
  • Compact class car rental
  • Fuel expenses
• Reimbursement for the actual costs of lodging up to government per diem rate
• Meals, including tax and reasonable tips, but excluding alcoholic beverages, can be reimbursed for the actual costs up to the government per diem rate      
• Lodging and meals are defined by the Joint Travel Regulation and local travel policies
• Keep all receipts

Non-Medical Attendant:

A Non-Medical Attendant (NMA) is an individual that will travel with you and is deemed medically necessary (appropriate,  reasonable, and adequate for your condition) by the PCM. Please note, TRICARE will only cover one NMA.

The following are examples of APPROVED justification for NMA travel:

• Surgery
• Procedure with sedation
• Appointment for a minor dependent

The following are NOT justification for NMA travel:

• Language barriers
• No driver’s license
• NMAs must be 21 years old unless:
• Active Duty Service member is under 21 years old
• Spouse of Active Duty Service member is under 21 years old and traveling with the Active Duty Service member or dependent child

STEP 1: I have a referral, now what?

• Your provider will complete your referral and submit it to the Integrated Referrals Management & Appointing Center (IRMAC) for review and processing.
• For routine referrals, you can expect TRICARE to take approximately 7 to 10 business days to process your referral.
• After approval you can schedule your appointment with the clinic or hospital to which you have been referred.
• Now that you have an appointment scheduled you will need to work with the Patient Travel Office to complete your travel authorization. Complete the DHA Form 131 TRICARE Prime Travel Benefit request on this page and email the completed request using any email you check often to the Patient Travel Group at dha.wainwright.Bassett-ACH.mbx.patient-travel@health.mil and your request will be verified and follow on instructions sent to your email.

IMPORTANT NOTES:
It is highly recommended that the patient start the travel authorization process 21 days prior to the scheduled appointment.
Do not pay for any expenses before travel authorization has been approved. Expenses incurred before approval, i.e. pre-payment for hotel/rental car, will not be reimbursed.

STEP 2: How to check referral status 

• Utilize TRICARE Online: tricare-west.com/idp/bene-login.fcc
• If you are referred to a military Medical Treatment Facility, or if you are a Medicare recipient, you will receive a call from the BACH IRMAC with information on where your referral is being sent.
• ​Additionally, you can check your status and appointment date and time on the MHS Genesis Patient Portal if you are referred to a military Medical Treatment Facility.

STEP 3: Reimbursement

Once your authorization has been approved, you will be emailed instructions on how to file your voucher upon return.

• Must have DHA Form 126 Confirmation of Specialty Care Form, located on this page, signed by treating provider
• Keep all receipts

Download Forms:

DHA Form 131
DHA Form 126
 

FAQ:

Q: In the past  I’ve been allowed treatment/travel to _____ location. Why is it no longer authorized?

A: There are two possible reasons:

• If there is a specialty care provider within 100 miles that can provide the same type of service, travel is not authorized.
• You are no longer covered under the Prime Travel Benefit.

Q: Who approves a Non-Medical Attendant?

A: The PCM decides whether a non-medical attendant is medically necessary for referral travel and includes that decision in the referral. The IRMAC has no control over NMA approval or disapproval.

Q: Why can’t dependent parents travel?

A: Dependent parents or parents-in-law can be enrolled in TRICARE Plus only, which does not cover care outside the MTF and does not cover travel.

Q: I’m over 65 years of age. Why isn’t my  travel covered?

A: After 65 years of age. Medicare becomes your primary insurance. Medicare does not cover medical travel.

Q: I’m TRICARE Select but my sponsor is active duty.  Do I have travel benefits?

A: Patients with TRICARE Select are not     eligible for travel benefits no matter their sponsor’s status. However, if the active duty sponsor is the patient and you are traveling as a NMA, you are authorized travel benefits.

Q: My doctor referred me to _____, but I want to receive care at _____.

A: We will cover your travel to the original   referral location based on the JTR and local travel policies. Self-directed care will result in a point-of-service charge and all travel costs will be out-of-pocket.