Point-of-Service Option

With the point-of-service option, you:

• Can visit any TRICARE-authorized providerAn authorized provider is any individual, institution/organization, or supplier that is licensed by a state, accredited by national organization, or meets other standards of the medical community, and is certified to provide benefits under TRICARE. There are two types of TRICARE-authorized providers: Network and Non-Network.
• Get routine or urgent care
• Don’t need a referral
• Pay more out of pocket (see fees below)

The point-of-service option doesn't apply to:

• Active duty service members
• Newborn or adopted children until enrolled in TRICARE Prime
  • Note: Children are covered by TRICARE Prime for 60 days (120 days overseas) after birth or adoption as long as one other family member is enrolled. The point-of-service option won't apply to children during this time or until the date the contractor receives the enrollment form.
• Beneficiaries with other health insuranceHealth insurance you have in addition to TRICARE, such as Medicare or an employer-sponsored health insurance. TRICARE supplements don’t qualify as "other health insurance."
• The following types of care
  • Emergency care 
  • Preventive care from a network provider in your region*
  • First 8 outpatient mental health visits per fiscal yearOctober 1 – September 30 from a network provider in your region*

*If you visit a network provider in another region without a referral from your PCM, you're using the point-of-service option.

Point-of-Service Fees

When you use the point-of-service option, you’ll pay:

• Point-of-service fees instead of your regular copayment
• Any other fees charged by non-network providers

These fees don’t apply to your annual catastrophic cap.