Prime Remote Handbook

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 immediate medical attention would result in a threat to life, limb, or eyesight; or a situation in which a person has painful symptoms requiring immediate attention to relieve suffering. This includes situations where a person is in severe pain or is at immediate risk to self or others.

If you need emergency care, go to the nearest emergency room or call 911. It is important that you know the local emergency telephone numbers. Take a minute to look up these numbers and write them down.

You do not need to call your PCM before receiving emergency medical care. However, in all emergency situations, active duty service members must notify their PCM (if assigned) and Humana Military within 24 hours, or the next business day, so that ongoing care can be coordinated and to ensure you receive proper authorization for care. Additionally, you should contact your service point of contact (SPOC) as soon as possible.

For family members, you must notify your PCM or primary care provider within 24 hours, or the next business day, so that ongoing care can be coordinated and to ensure you receive proper authorization for care. Additional authorization for care from Humana Military may be necessary. Refer to Humana Military’s Web site for referral and authorization requirements.

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If you have an assigned network PCM, you must contact them whenever you require urgent care. Your PCM will either provide the needed care or refer you to a specialist.

For active duty family members who do not coordinate urgent care with their PCM or regional contractor, the care will be covered under the point of service (POS) option, resulting in higher out-of-pocket costs. See the TRICARE: Summary of Beneficiary Costs flyer  to learn about POS fees.

If you live in an area where a TRICARE provider network has not been established by Humana Military, you may seek urgent care from any TRICARE-authorized provider. You must have a referral from Humana Military or the care is covered under the POS option, resulting in higher out-of-pocket costs. See the TRICARE: Summary of Beneficiary Costs flyer  to learn about POS fees.

If you are not sure if a provider is TRICARE-authorized, call Humana Military or visit the TRICARE Web site for an online provider directory.

         
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