You receive routine or primary health care from your primary care manager (PCM), and your PCM will refer you to a specialist for necessary specialty care. You are guaranteed access to care within specific time frames, and you may qualify for a travel reimbursement if referred to specialty care that is more than 100 miles from your PCM’s office. This section explains these and other details about using TRICARE Prime.
Making an Appointment
Contact your PCM’s office directly to make an appointment. There is no need to contact Humana Military to schedule appointments.
Access Standards for Care
There are certain access standards for care.
The wait time for an urgent care appointment should not exceed 24 hours (one day).
The wait time for a routine appointment should not exceed one week (seven days).
The wait time for a specialty care appointment or wellness visit should not exceed four weeks
(28 days).
These access standards begin at the time of your call to or contact with the provider. It is important to contact your provider as soon as possible. At times, appointments may not be available within the time frames listed above due to high demand for specialty care services. If the provider does not have appointments available within the access standards, you can choose to schedule the earliest-available appointment with the provider or contact your regional contractor for assistance in locating another provider.
You should have access to a PCM whose office is within 30 minutes of your home under normal circumstances. Specialty care should be available within one hour from your home. See the section titled, Specialty Care far From Home for information about travel reimbursement if you are referred for specialty care more than 100 miles from your PCM’s office.
Emergency Care
TRICARE defines an emergency as a medical, maternity, or psychiatric condition that would lead a “prudent layperson” (someone with average knowledge of health and medicine) to believe that a serious medical condition exists, or the absence of immediate medical attention would result in a threat to life, limb, or eyesight, or when the person has painful symptoms requiring immediate attention to relieve suffering. If you need emergency care, go to the nearest emergency room or call 911. It is important that you know the emergency telephone numbers in your area. Take a minute to look these numbers up and write them here or on the inside front cover of this book.
You do not need to call your PCM or Humana Military before receiving emergency medical care. However, in all emergency situations, you must notify your PCM within 24 hours, or the next business day, so that ongoing care can be coordinated, and to ensure you receive proper authorization for care.
