All Others Enrolled in a TRICARE Prime Plan
You'll get most care from your primary care manager (PCM). Call your PCM to schedule an appointment.
- You must have a referral from your PCM for any *urgent, routine or specialty care he or she can't provide.
- Your PCM works with your regional contractor for the referral and authorization.
- Your contractor will try to refer you to a military hospital or clinic first.
- If not available, you're referred to a network provider (in your region).
- You don't need a PCM referral for preventive services or the first eight mental health visits if you see a network provider (in your region).
- If you get any of the following types of care without a PCM referral, you're using the point-of-service option and will pay more out-of-pocket:
- *Urgent, routine or specialty care from any provider other than your PCM
- Mental health care from a non-network provider
- Preventive care from a non-network provider
*The Urgent Care Pilot Program began on May 23, 2016. This pilot allows you to get two urgent care referrals per fiscal yearOctober 1 - September 30 without a referral from your PCM.
Your Primary Care Manager
- May be a military hospital or clinic or a network provider.
- If enrolled to a military hospital or clinic, you can book some appointments online.
|TRICARE Prime Remote
- May or may not have an assigned PCM depending on the network providers in your remote location.
- If you don't have an assigned PCM, you can use any TRICARE-authiorized proveder as your PCM
|TRICARE Prime Overseas
- You'll have an assigned PCM at a military hospital or clinic
- You'll get most care from your assigned PCM
- Call International SOS if you need an appointment with an overseas provider
|TRICARE Prime Remote Overseas
- Contact your Regional Call Center to schedule all appointments.
- In Canada, you'll get most care from your PCM at a Canadian Forces Health Facility. For help finding a provider, contact the Canadian Forces Medical Group at 1-613-945-6653.
Types of Care
You'll have different access standards and rules for the type of care you need:
- Urgent care is care needed for conditions such as a sprain, sore throat or rising temperature.
- You can expect to get an urgent care appointment within 24 hours (1 day), even if you are traveling.
- Routine (primary) care includes general office visits for the treatment of symptoms, chronic or acute illnesses and diseases and follow-up care for an ongoing medical condition.
- You can expect to receive a routine care appointment within 1 week (7 days)
- You can expect to get a specialty care appointment within 4 weeks (28 days)
- Preventive services are health screenings, tests and examinations.
- You'll usually get these during regular office visits
- You can expect to get an appointment within 4 weeks (28 days)