With the point-of-service option, you can visit any Tricare-authorized provider, get routine or urgent care, don't need a referral, but you may pay more out of pocket .
You can’t use the point-of-service option if you:
- Are an active duty service member
- Are a newborn or adopted child until enrolled in TRICARE Prime, Children are covered by TRICARE Prime for 60 days after the birth or adoption when any other family member is enrolled. The point-of-service option will not apply to newborns or adopted children during those first 60 days (120 days overseas) or until the date your contractor receives the enrollment form for the child.
- Have other health insurance
- Are getting care that doesn't normally need a referral, including:
- Emergency care
- Preventive care from a network provider
- First 8 outpatient mental health visits per fiscal year from a network provider
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 which is $1,000 per active duty family and $3,000 for all other families annually.
You must pay this amount before cost sharing begins for outpatient services.
Outpatient Services: 50% of allowable charge
Hospitalization: 50% of allowable charge
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