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Prime Travel Benefit (PTB) Program
Prime Travel Benefit Program entitlement is to assist Prime enrollees with expenses incurred for medically necessary
non-emergency scheduled specialty care more than 100 miles (one way) from the Primary Care Manager’s (PCM) office.
If you are a Coast Guard TRICARE PRIME or Coast Guard TRICARE PRIME REMOTE (TPR)
Non-Active Duty enrollee or Medal of Honor Veteran and incurred
medically necessary non-emergency scheduled specialty care more than 100
miles (one way) from the Primary Care Manager's (PCM) office on or after
November 1, 2011, you are to contact the Coast Guard Health Safety Work-Life
(HSWL) Service Center Health Benefits Team for administrative processing of
travel. The HSWL Service Center Health Benefits Team is available 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 the specialty care was incurred on or before October 31, 2011
follow instructions below.
Prime Travel Benefit Eligibility
You must be a TRICARE PRIME or TRICARE PRIME REMOTE (TPR) Non-Active Duty enrollee or Medal of Honor Veteran to be
eligible for this program. The eligible enrollee must be referred by their primary care manager (PCM) for medically necessary non-emergency specialty care
more than 100 miles from their PCM’s office. If the TRICARE Prime or TPR Non-Active Duty enrollee member is enrolled with a Civilian Network PCM, the
patient must have a PCM referral or authorization from Health Net Federal Services (HNFS), the managed care support contractor for the North region, before
they can use this program and claim travel benefits. The medical services must be listed in the TRICARE Manual as a covered benefit.
When benefits for specialty care are approved under the Point of Service
option, the Prime beneficiary is NOT eligible for the TRICARE Prime Travel
Benefit Program.
How the Program Works
When the TRICARE Prime patient is enrolled to a PCM at a Military Treatment Facility (MTF), the patient contacts the military hospital/clinic staff to
arrange travel, obtain orders, and file claims. The MTF determines if the specialty care is more than 100 miles from the PCM and eligibility for travel
benefits. The patient may contact local HBAs or BCACs for information on the program.
When the TRICARE Prime member is enrolled with a Civilian Network PCM, the TRICARE Regional Office-North (TRO-North) determines if the specialty care is
more than 100 miles from the PCM and eligibility for travel benefits. The Prime patient enrolled with a Civilian Network PCM must obtain a Specialty Care Referral
from their PCM or an authorization from HNFS. A copy of the referral or authorization must be submitted to TRO-North with an
Intake Form. Copies of
authorizations can be obtained by calling HNFS at 1-877-TRICARE or 1-877-874-2273. Patients should have the PCM Referral and HNFS Specialty Care
Authorization before they contact TRO-North (Prime Travel) and before they travel. TRO-North is contacted to determine eligibility for the program, obtain orders,
file claims, and answer questions about the benefit. Contact TRO-North by calling 1-866-307-9749 or (703)-588-1867/1869. If the patient qualifies, Invitational Travel
Orders will be generated. Completed and authorized claim forms are submitted to DFAS for payment.
The patient's Civilian PCM must fax the TRICARE Service Request/Notification form to Health Net at 1-888-299-4181 (for Civilian Provider Use Only).
Civilian PCMs can obtain the Health Net Referral Authorization form at www.healthnetfederalservices.net select the Provider Tab and click on forms.
This is a reimbursement program and travelers are reimbursed after actual expenses are incurred. Expenses must be directly associated with scheduled specialty
care to be eligible for reimbursement.
Entitlement is limited to those specialty referrals when no other specialist (i.e., Military Treatment Facility, network or non-network specialist) is available within
100 miles of the PCM’s office.
Non-Medical Attendant (NMA)
A Non-Medical Attendant also known as the Attendant can travel with and/or drive the patient to the specialty care appointment. The Attendant can be a parent, spouse, legal guardian, or other adult family member. If the Attendant is not the parent, he/she must be 21 years of age or older. When supported by a doctor’s statement that a NMA is “medically necessary and appropriate” for a patient to travel for specialty care, expenses for one NMA may be authorized. If the patient is a minor (under the age of 18) establishment of medical necessity for NMA may be waived. Federal regulations authorize only one NMA.
Travel and Claims
When the NMA is an Active Duty Service Member (ADSM), the TRO-North office will issue orders.
Reimbursements for the ADSM or
US Government Employee (GS) acting as the NMA are reimbursed the per diem for meals and lodging.
Receipts are required for hotel, parking, tolls, etc.
The ADSM or government employee submits claim form DD1351-2 AD/GS
with required receipts. Some expenses require preauthorization. Expenses such as hotel, air fare, and car rental have specific receipt requirements.
Click on Reimbursement and Receipts for guidelines,
instructions, and example forms.
When patient is accompanied by a NMA that is a Non-Active Duty or Non-Government employee, both the patient and NMA submit claim forms.
The patient and NMA each submit claims forms DD1351-2 and
DD1351-3 with receipts. The Prime Travel Benefit pays actual costs
(i.e., meals, gasoline, parking, tolls, and lodging). Meals and lodging reimbursements are based on reasonable actual costs and limited to per diem rates.
Patients traveling alone complete claim forms DD1351-2 and
DD1351-3 with receipts. Some expenses require preauthorization. Expenses such as hotel, air fare, and car rental have specific receipt requirements. Click on
Reimbursement and Receipts for guidelines, instructions, and example forms.
All payments will be made by Electronic Fund Transfer (EFT).
The patient and NMA must each submit an EFT form and cannot be reimbursed for the same travel expense.
Government per diem rates are available at
http://www.defensetravel.dod.mil/perdiem/pdrates.html.
Beneficiaries are expected to use the least costly mode of transportation, etc. High dollar expenses such as air fare and car rental require preauthorization.
Intake form, claim forms DD 1351-2, DD 1351-3 and receipts can be sent to
TRO-North via fax 703-588-0634 or mailed to TRICARE Regional
Office-North, ATTN Prime Travel, 1700 N. Moore St., Suite 1200, Arlington
VA, 22209.
TRO-North can be contacted by calling 1-866-307-9749 or 703-588-1867 or
703-588-1869.
Check List for Each Date of Travel
Intake Form
Referral Letter
Signed Claims Forms
EFT Form for each Traveler
Receipts
For More Information:
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