Network Copayments
Active duty service members and their families pay nothing out-of-pocket for any type of care unless using the point-of-service option.
Retired service members, their families and all others pay the following copayments for care from TRICARE network providers. These cost are for care from civilian primary care managers (PCMs) or for care received with a PCM referral, when required.
If you get care without a referral, it will be subject to point-of-service charges.
| Type of Care | Network Copayment |
| Ambulance Services | $20 per occurrence |
| Ambulatory (same day) Surgery | $25 per visit |
| Behavioral Health |
Outpatient:
Hospitalization:
|
| Clinical Preventive Services | $0 per visit |
| Durable Medical Equipment, Prosthetics, Orthotics, and Supplies | 20% of the negotiated fee |
| Emergency Room Visit |
$30 per visit |
| Home Health Care | $0 |
| Hospice Care | $0 |
| Hospitalization | $11 per day ($25 minimum) |
| Lab & X-Ray Services | $12 per visit (unless billed as a clinical preventive service) |
| Maternity Care |
Office visits & hospitalization for delivery planned in a hospital in an inpatient setting. This is one global fee.
Office visits for delivery planned in a TRICARE-authorized birthing center.
Office visits for delivery planned at home or another setting.
|
| Newborn Care | $11 per day ($25 minimum) |
| Outpatient Visit | $12 per visit |
| Skilled Nursing Care |
$11 per day ($25 minimum) |
Last Modified:May 30, 2012
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