TRICARE and You: Traveling for Medical Care

If you are traveling for required medical care you may be entitled to funding of travel expenses. Rules regarding medical travel, known as Prime Travel Benefit, can be complex and are governed by federal regulation, not Coast Guard rules. This article will help you navigate the process.

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This blog is the most recent in a series helping members of the Coast Guard family understand how to use their TRICARE benefits. The blog series will continue every Monday, right here on Coast Guard All Hands.

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Written by Cmdr. Paul Fawcett

If you are traveling for required medical care you may be entitled to funding of travel expenses. Rules regarding medical travel, known as Prime Travel Benefit, can be complex and are governed by federal regulation, not Coast Guard rules. This article will help you navigate the process.

 

Who is eligible for Prime Travel Benefit?

  • Eligible dependents of active duty members, retirees and their dependents, dependents of reservists on active duty greater than 30 days are eligible for Prime Travel Benefit. Active Duty Members medical travel expenses are not covered under this program. Active Duty members, or Reservists on orders greater than 30 days, receive funding for medical travel from their units. Eligible beneficiaries must be enrolled to TRICARE Prime; TRICARE Standard beneficiaries are not eligible for medical travel funding.

 

What are the requirements for travel funding?

  • In order to be eligible for Prime Travel Benefit your trip must be greater than 100 miles. The distance is measured from your Primary Care Manager’s location to the location of your Specialty Provider. Distances are measured using the Defense Table of Distances. The care you need must not be available locally.

 

Can I travel with someone to help me?

  • Some patients require assistance to get to their medical appointments due to their condition, medication they are taking or their age. Someone travelling with a patient is called a “Non Medical Attendant” (NMA). Children are almost always entitled to an NMA to travel with them to medical appointments and assist them while they are there. The need for an adult to have an NMA must be verified by the attending Doctor in writing and is subject to review. NMAs receive orders and funding for their expenses.

 

What expenses does Prime Travel Benefit Cover?

  • Prime Travel Benefit pays for mileage, airfare, lodging, actual expenses for meals for dependents, tolls, and other necessary travel fees. In an effort to reduce costs, travelers may be referred to Fisher Houses, Ronald McDonald Houses or other similar locations for lodging if they are appropriate and available. Specific travel requirements are subject to review and approval by the Prime Travel Benefit staff. Patients traveling for less than 12 hours are ineligible for meal reimbursement.

 

What doesn’t Prime Travel Benefit cover?

Prime Travel Benefit doesn’t cover:

  • Travel for medical care under 100 miles as determined by the Defense Table of Distances.
  • Travel for medical care by active duty members.
  • Travel for elective medical care
  • Travel for members outside the Continental United States. This travel is covered under other programs.
  • Travel for emergency medical care.
  • Travel for beneficiaries not enrolled to TRICARE Prime .

 

How do I request Prime Travel Benefit Funding?

  • Before you travel you must contact the Prime Travel Benefit team at D11-HSWLSC-PTBREQUEST@USCG.MIL or (510) 637-1214. Ensure you have your TRICARE approved referral. The PTB team will send you forms to complete and, pending approval, you will be issued travel orders.

 

-FAQs-

Q: Our child has a medical appointment and is eligible for Prime Travel Benefit. My spouse and I both want to accompany them. Can we both receive travel funding as Non Medical Attendants?

A: Unfortunately you cannot. By policy there may always only be one non Medical Attendant. The second parent may accompany the child but any expenses associated with that travel are not reimbursable.

 

Q: The distance to my medical appointment is close, but just under, 100 miles. Can I apply for a waiver?

A: No. Rules for Prime Travel Benefit are specified in the Joint Travel Regulation which applies to all Uniformed Services. They are not subject to waiver or appeal.

 

Q: I have a particular Doctor that I want to see for approved specialty care. They are greater than 100 miles away. Am I eligible for funding to see them?

A: You are only eligible for funding if the care you need is not available locally. If you select a provider that requires travel, the treatment may still be paid for, but travel will not be paid for based on your personal choice if the care is available locally.

 

Q: I received instructions for medical travel from the DOD treatment facility where I see my doctor. I have an appointment that makes me eligible for travel funds. Should I follow the instructions I received at the DOD treatment facility?

A: No. If you are a Coast Guard dependent or retiree you will receive Prime Travel Benefit funds from the Coast Guard. The Coast Guard manages the program differently than DOD. Please contact the Coast Guard Prime Travel Benefit team at D11-HSWLSC-PTBREQUEST@USCG.MIL or (510) 637-1214.

 

Q: My spouse has a medical appointment that requires travel and is eligible for Prime Travel Benefit. They need a non medical attendant and one is authorized. I’m an active duty member, can I be the non medical attendant?

A: Yes. Active Duty members can be non medical attendants. You will receive regular travel orders funded by the Prime Travel Benefit program. You are eligible for Per Diem if your travel is over 12 Hours.

 

For more information about TRICARE medical travel please visit www.tricare.mil. You can also contact a Coast Guard Health Benefits Administrator by calling 1-800-9-HBA-HBA or by emailing CGHBA@uscg.mil, or feel free to leave a comment below!

 

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