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Types of 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 sight; 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 (depending on the type of care) by contacting Humana Military.
Care at a Military Treatment Facility
A military treatment facility (MTF) is a military hospital or clinic, usually located on or near a military installation. You may receive care at an MTF on a space-available basis only. MTF appointments are limited, and you will be assigned the lowest priority for receiving MTF care. To locate an MTF, access the MTF Locator.
Prior Authorization for Care
You may access care from any 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. Prior authorizations must be obtained prior to services being rendered or within 24 hours of an admission. Some providers may call Humana Military to obtain prior authorization for you. If you have questions about your authorization requirements, contact Humana Military for assistance before seeking care.
The following services* require prior authorization in all three TRICARE regions:
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Adjunctive dental services
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Extended Care Health Option (ECHO) services
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Home health services
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Hospice care
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Nonemergency inpatient admissions for substance use disorders and behavioral health
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Outpatient behavioral health care beyond the eighth visit each fiscal year (October 1–September 30)
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Transplants—all solid organ and stem cell
* This list is not intended to be all-inclusive.
Humana Military has additional prior authorization requirements.
Note: For overseas prior authorization information, see “Getting Care Overseas”.
Getting Care While Traveling
While you are traveling, you may visit any TRICARE network provider or any non-network, TRICARE-authorized provider. You may be required to pay non-network providers directly and file your claim, requesting reimbursement (See the Claims section.). You should file the claim with the contractor in your home region, not in the region in which you received the care.
Getting Care Overseas
You may receive care from any qualified host-nation provider without a referral. We recommend that you contact your TRICARE Service Center (TSC), TRICARE Area Office (TAO), or the nearest U.S. Embassy Health Unit for assistance in locating a provider. Locate a U.S. Embassy or Consulate by visiting the U.S. Embassies, Consulates and Diplomatic Missions website list.
Prior Authorization Requirements Overseas
Since authorization requirements may vary by overseas area, contact the nearest overseas TAO for assistance before seeking care. See Figure 3.2, “Overseas Claims Addresses,” in the Claims section of this handbook for TAO contact information.
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