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TRICARE covers health care services you receive when you are away from home. But to avoid extra out-of-pocket expenses, you should always schedule routine appointments before or after traveling. Ideally, you should seek medical attention while traveling only in cases of urgent or emergency care.
Receiving Urgent Care
TRICARE defines urgent care as care that is required for an illness or injury that is not life threatening, but might worsen or cause you to suffer unnecessarily if not treated immediately. If you require urgent care while traveling, contact your primary care manager (PCM) for a referral. Your PCM will assess your situation and refer you to urgent care services at the closest facility. If you seek urgent care without a referral from your PCM, you are utilizing the TRICARE Prime point-of-service (POS) option, which will result in higher deductibles and cost-shares.
Active duty service members (ADSMs) and their family members do not have a copayment for urgent care received with a referral. Retirees and eligible family members pay $12 per urgent care visit with a referral when care is received from a network provider at a physician’s office. If the urgent care is received from an emergency room, the copayment is $30.
Be sure to contact your PCM when you return home to coordinate any follow-up care that may be needed from the illness or injury you received.
Receiving Emergency Care
An “emergency medical condition” means a condition with the presence of acute symptoms of sufficient severity (including severe pain, psychiatric disturbances or symptoms of substance abuse) such that a prudent layperson could reasonably expect the absence of immediate medical attention to result in the following:
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Placing the health of the individual (or with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy
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Causing serious impairment to any bodily functions or serious dysfunction of any bodily organ or part
With respect to a pregnant woman who is having contractions, an emergency medical condition also means that there is inadequate time to effect a safe transfer to another hospital before delivery and that a transfer may pose a threat to the health or safety of the woman or the unborn child.
If you require emergency care while traveling, call 911 or go to the nearest emergency room. You (or someone acting on your behalf) should contact your PCM as soon as possible to ensure continuity of care. ADSMs and their family members do not have a copayment for emergency care. Retirees and eligible family members pay $30 per emergency room visit.
Filing Claims
If you seek urgent or emergency care while traveling, claims must be filed with the regional contractor in the area in which you live—not the area in which you received the care. If you are referred to or go to a provider/ facility that is not in the TRICARE network (your PCM will always refer you to a network facility when possible), you may be responsible for filing your own claim with TRICARE. Facilities and providers in the TRICARE network will file claims for you.
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When it comes to getting the most up-to-date information about your TRICARE benefits, you don’t have to leave the comfort of your own home. Just log onto www.humana-military.com. Humana Military developed this Web site as an easy way for you to stay informed about TRICARE and the latest health care trends.
Are You Registered?
First things first. Although there is quite a bit of information available to anyone who visits the Web site, the most personalized, helpful information is reserved for registered TRICARE beneficiaries. Registration is free, secure and easy. By registering, you are making the most of Humana Military’s Web site by making it your own.
The requirements: To register, you must first make sure that your Defense Enrollment Eligibility Reporting System (DEERS) information is current. You can do so by telephone at 1-800-538-9552, by fax at 1-831-655-8317 or online at www.tricare.osd.mil/DEERS/default.cfm. Web site registration also requires that you be a current TRICARE beneficiary with at least one claim processed by Humana Military. Registration typically takes about 3 minutes. Upon completion, you’ll be able to access “secured” services, so named because your health information in this section is highly protected by the site’s sophisticated security technologies.
Secured Services
You can find the Secured Services section by going to the home page and clicking on “Online Beneficiary Services.” The services in this secured area let you manage your TRICARE coverage. You can change your address, check on your TRICARE eligibility, obtain online referrals and authorizations for specialty care, print a temporary Prime enrollment verification document and request a Prime enrollment card.
Universal Services
Universal Services lets you conduct much of your TRICARE business online, as well. You can find a provider,enroll in TRICARE Prime, pay TRICARE Prime enrollment fees and access TRICARE forms.
The Answer Place and Site Search
If you can’t seem to find the information you need, simply type a question into “The Answer Place” or the site’s search tool. Both are developed with artificial intelligence to recognize the content of your question and find the most accurate answer. The technology is far more sophisticated than the typical key word search.
Located in the Beneficiary Resources area of the site, The Answer Place offers topics you can browse, including phone numbers, information about benefits and your privacy rights, and a form to request information.
Health and Wellness
While in the Beneficiary Resources area of the site, don’t forget to click on “Health and Wellness” to read (or hear in the audio library) tips for maintaining an overall healthy lifestyle. One particularly helpful area is the “Behavioral Health” section, which answers your questions about coverage, costs and obtaining behavioral health services.
Disease Management (New!)
With medical breakthroughs constantly being made, a big part of disease management stems from what you know. Whether you are prone to a family history of a particular disease or have been diagnosed with one, keeping healthy can depend on your ability to manage your condition. In July, we started with the most important issue first—your heart. We developed the Humana Military Heart Failure Program to monitor your treatment plan and personal activities, all in an effort to increase your quality of life. The Humana Military Web site now features a section of articles and references to educate you on managing your condition. Just go to Beneficiary Resources and click on “Disease Management.”
Visiting www.humana-military.com regularly will improve the way you manage your TRICARE benefits. Visit today!
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