As the summer travel season approaches, it’s not unusual for illness and injury to occur and most often—unexpectedly. Knowing the difference between urgent care and emergency care as a TRICARE Prime enrollee can ease your mind if you or a family member is in need.
What is Urgent Care
Urgent care is required for such conditions as sprains, sore throats, rising fevers and others that are not life-threatening, but can worsen if not treated within 24 hours. While illness and injury don’t always occur during your provider’s regular office hours, you
should see your primary care manager (PCM) for urgent care, unless you have a referral. Please keep in mind that both military treatment facility and civilian PCMs may have on-call services that could meet your needs when treating an urgent illness.
If you are unable to contact your PCM, please notify him or her within 24 hours or the next business day to get a referral and to ensure continuity of care. Otherwise, you’ll be subject to the point of service option, which has higher out-of-pocket costs.
What is Emergency Care
Emergency care is required for serious medical, maternity or psychiatric conditions that would result in loss of life, limb or sight without immediate medical attention. Examples of conditions that would require emergency care include severe bleeding, chest pain, shortness of breath or inability to breathe, spinal cord or back injury, and severe eye injuries.
If an emergency occurs, go directly to the nearest emergency room (ER) for treatment. Remember that ER visits are only for emergencies and you should not go to the ER for routine care. Nonemergency care and urgent care services should be received from your PCM, whenever possible. After you have received treatment in the ER, you should notify your PCM so that any follow-up care can be properly coordinated and authorized.
By understanding and following TRICARE’s urgent care and emergency care guidelines, you can be sure you receive the best care from the proper providers at the lowest cost to you. Before an emergency, serious illness or injury occurs, familiarize yourself with TRICARE’s network or authorized facilities in your area.
For urgent care and emergency care situations that may occur while traveling overseas, you and your family members enrolled in TRICARE Prime should take the phone number for the TRICARE Global Remote Overseas (TGRO) Alarm Center in the area of your travel. Or, if traveling to Puerto Rico, have the TRICARE Puerto Rico Prime phone number with you.
To locate an appropriate hospital, facility or provider, use the
Find a Provider tool.
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