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 immediate medical attention would result in a threat to life, limb, or sight; when a person has severe, painful symptoms requiring immediate attention to relieve suffering; or when a person is at immediate risk to self or others.
If you require emergency care, call 911 or go to the nearest emergency room. If you are admitted, you may need to obtain authorization depending on the type of care. You or your provider can contact Humana Military for assistance.
Urgent Care
Urgent care services are medically necessary services required 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 could require urgent care for conditions such as a sprain, sore throat, or rising temperature, as each of these has the potential to develop into an emergency if treatment is delayed longer than 24 hours.
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).
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.
Figure 2.2 MTF Appointing Priorities
1
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Active duty service members |
2
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Active duty family members (ADFMs) enrolled in TRICARE Prime |
3
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Retired service members, their families, and all others enrolled in TRICARE Prime |
4
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ADFMs NOT enrolled in TRICARE Prime. TRICARE Reserve Select for Selected Reserve members and their families. |
5
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Retired service members, their families, and all others NOT enrolled in TRICARE Prime |
If you wish to receive care at an MTF, call the MTF first to see if they can provide you with the care you need. To locate an MTF, visit TRICARE's Military Treatment Facilities (MTF) Locator. Otherwise, seek care from a civilian TRICARE network or non-network provider.
Note: If you are admitted to an MTF and require any service not available within the MTF (e.g., ambulance, MRI, CT Scan, or specialist appointment), those services will be covered by your TRICARE Standard benefit. The MTF will not pay for these services. |
