Point-of-Service Charge

A point-of-service (POS) charge is the additional cost a TRICARE Prime enrollee pays when they receive non-emergency care from a provider without obtaining a referral from their Primary Care Manager. POS charges are significantly higher than standard TRICARE Prime costs.

POS charge structure: • Annual deductible: $300 individual / $600 family (separate from any other deductible) • Cost-share: 50% of the TRICARE-allowable charge after deductible • These costs do NOT count toward the TRICARE Prime catastrophic cap

When POS charges apply: • You see a specialist without a referral from your PCM • You visit a provider outside your Prime network without authorization • You seek non-emergency care while traveling without contacting your PCM

When POS charges do NOT apply: • Emergency care • Urgent care situations • Care received with a valid referral • Services at your assigned Military Treatment Facility

POS charges can result in substantial out-of-pocket costs. A $1,000 specialist visit without a referral could cost you $500 or more, compared to a small copay with a proper referral.