Emergency care is covered for medical, maternity, or psychiatric conditions that would lead a prudent layperson (someone with average knowledge of health and medicine) to believe that a serious medical condition exists or that the absence of immediate medical attention would result in a threat to life, limb, or sight; or when the person manifests painful symptoms requiring immediate palliative effort to relieve suffering. This includes situations where a beneficiary arrives at the emergency room with severe pain (except dental pain), or is at immediate risk of serious harm to self or others. In the case of a pregnant woman, the danger to the health of the woman or her unborn child must be considered. In the absence of other qualifying conditions, pain associated with pregnancy or incipient birth after the 34th week of gestation when associated with a pregnancy, are not emergency conditions for adjudication purposes.

In the event of a life-, limb-, or eyesight-threatening emergency, the beneficiary should go, or be taken, to the nearest appropriate medical facility for care. 
       

In all emergency situations, the TRICARE Prime beneficiary must notify his or her PCM or Humana Military of any emergency inpatient admission within 24 hours or the next business day so that ongoing care can be coordinated. Requests for authorizations may be entered at MyHMHS for Providers or faxed to Humana Military at 1-877-548-1547.