TPR and TPRADFM provide TRICARE Prime coverage to ADSMs and the family members who live with them in remote locations through a network of civilian TRICARE-authorized providers, institutions and suppliers (network or non-network). ADSMs and their families who live and work more than 50 miles or a one-hour drive time from the nearest military hospital or clinic designated as adequate to provide primary care may be eligible to enroll in TPR or TPRADFM.
Each TPR or TPRADFM enrollee is assigned a PCM unless one is not available in their area. In that scenario, the beneficiary would have an unassigned PCM until a network PCM becomes available.
TPR and TPRADFM beneficiaries should always seek non-emergency care from their PCMs unless they’re using the POS option. In most cases, a TPR or TPRADFM enrollee must obtain a referral and/or prior authorization to receive non-emergency care from another provider who is not his or her PCM.
TPR ADSMs do not need referrals, prior authorizations or fitness-for-duty reviews to receive primary care. Specialty and inpatient services require referrals and prior authorizations from Humana Military and the Defense Health Agency – Great Lakes (DHA-GL) Service Point Of Contact (SPOC). The SPOC determines referral management for fitness-for-duty care.Determine if a particular ZIP Code falls within a TPR coverage area