TRICARE covers emergency care to include professional and institutional charges and services and supplies that are ordered or administered in an emergency department. Emergency care means care for an illness or injury that threatens your life, limb, sight, or safety. If you reasonably believe you have an emergency, always call 911 or your international emergency number. Or, go to the nearest emergency roomThe hospital department that provides emergency services to patients who need immediate medical attention..
Call 911 or Go to the Emergency Room
Make sure you go to an emergency room. Urgent care clinics offer quick walk-in services without an appointment, but these facilities are not considered to be "emergency rooms." If you go to an urgent care clinic, make sure you follow your plan's rules for getting urgent care.
Enrolled in TRICARE Prime?
If you're enrolled in a TRICARE Prime plan, contact your primary care manager within 24 hours or the next business day after you receive emergency care. Also, be sure to follow up with your PCM for a referral for all specialty careSpecialized medical/surgical diagnosis, treatment, or services a primary care provider isn’t qualified to provide. to avoid point-of-service fees.
What is an Emergency?
Examples of emergencies include:
- No pulse
- Severe bleeding
- Spinal cord or back injury
- Chest pain
- Severe eye injury
- Broken bone
- Inability to breathe
See the chart below for more information.
|Type of Emergency||Description|
The sudden and unexpected onset of a medical condition or the acute exacerbation of a chronic condition that is:
|Maternity||A sudden unexpected medical complication which puts the mother or baby at risk|
When the patient is at immediate risk of serious harm to self or others as a result of mental disorder and requires immediate continuous skilled observation at the acute level of care.*
*Based on a psychiatric evaluation performed by a physician or other qualified mental health care professional with hospital admission authority.
This list of covered services is not all inclusive. TRICARE covers services that are medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. and considered proven. There are special rules or limits on certain services, and some services are excluded.
Last Updated 6/30/2023