|
|
|
Beneficiary Standard Handbook
|
|
|
|
Emergency Care
Urgent Care
All Other Care
Care at a Military Treatment Facility
MTF Appointing Priorities
Prior Authorizaton for Care |
|
|
|
|
|
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, that the absence of medical attention would result in a threat to the patient’s life, limb, or eyesight, that the patient requires immediate medical treatment, or that the patient has painful symptoms requiring immediate attention to relieve suffering.
If you require emergency care, call 911 or go to the nearest emergency room. If you are admitted, you may need to obtain authorization from Humana Military.
|
|
Back to Top
|
|
Urgent Care |
|
Urgent care is for an illness or injury that would not result in further disability or death if not treated immediately, but does require professional attention within 24 hours. You would require urgent care for conditions such as a sprain, sore throat, or rising temperature that have the potential to develop into an emergency if treatment is delayed longer than 24 hours. Urgent care is not the same as emergency care and you can schedule a “same day” urgent care appointment with a network or non-network provider without a referral. Some services may require prior authorization (discussed later in this section). |
|
Back to Top
|
|
All Other Care |
|
For all other care, such as routine physicals, ongoing treatment for a chronic condition, or visits to a specialist, you can schedule an appointment with a network or non-network provider without a referral. Some services may require prior authorization (discussed later in this section).
|
|
Back to Top
|
|
Care at a Military Treatment Facility |
|
A military treatment facility (MTF) is a military hospital or clinic usually located on or near a military base. You may receive care at an MTF, but only on a space-available basis. MTF appointments are limited, and you will have the lowest priority for receiving care at an MTF. See Figure 2.2 for MTF appointing priorities.
|
|
MTF Appointing Priorities |
Figure 2.2
|
|
| 1 |
Active duty service members |
| 2 |
Active duty family members enrolled in TRICARE Prime |
| 3 |
Retired service members, their families, and all others enrolled in TRICARE Prime |
| 4 |
Active duty family members NOT enrolled in TRICARE Prime |
| 5 |
Retired service members, their families, and all others NOT enrolled in TRICARE Prime |
|
|
|
If you wish to receive care at an MTF, call first to see if the MTF can provide you with the care you need. Otherwise, seek care from a civilian network or non-network provider. |
|
Back to Top
|
|
Prior Authorization for Care
|
|
You can access care from the TRICARE-authorized provider you choose whenever you need it. Referrals are not required, but some services will require prior authorization.
A prior authorization is a review of the requested health care service to determine if it is medically necessary at the requested level of care. Some providers may call Humana Military to obtain prior authorization for you. If you have questions about authorization requirements, call Humana Military for assistance before seeking care.
The following services require prior authorization:
|
|
- Adjunctive dental services
- Home health services
- Hospice care
- Nonemergency inpatient admissions for substance use disorders or behavioral health
- Outpatient behavioral health care beyond the eighth visit
- Transplants—all solid organ and stem cell
- TRICARE Extended Care Health Option services
|
|
Humana Military has additional prior authorization requirements. Call the toll-free number to learn about these requirements, as they may change periodically. |
|
Back to Top
|
