Routine (primary) care includes general office visits for the treatment of symptoms, chronic or acute illnesses and diseases, as well as follow-up care for an ongoing medical condition. Routine care also includes preventive care measures to help keep you healthy. You will receive most of your routine (primary) care from your assigned PCM or the TRICARE-authorized provider you choose as your primary care provider.
You do not need a referral or prior authorization to visit your PCM or primary care provider. If your PCM or primary care provider is unable to provide the care needed, he or she will refer you to another provider.
Services That Do Not Require Referrals
Family members may obtain some services without a PCM referral. These include clinical preventive services and the first eight outpatient behavioral health care visits per fiscal year (October 1–September 30). When seeking clinical preventive services or behavioral health care, you must use a network provider, if available. If you seek care from a non-network provider without a referral from your PCM and Humana Military, you will be utilizing the POS option, resulting in higher out-of-pocket costs. See the TRICARE: Summary of Beneficiary Costs flyer to learn about POS fees.
For more information about these services, see the Covered Benefits, Limitations, and Exclusions section. Remember, you will not need a referral for emergency care.
Note: Active duty service members require a referral for any clinical preventive services, behavioral health care, or specialty care.
