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Understanding Urgent Care Rules

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TRICARE Health Program

Urgent care clinics are useful for non-emergency care. If you have TRICARE, here are a few rules about getting urgent care. Urgent care is care you need within 24 hours for a non-emergency illness or injury that requires treatment. Examples of urgent care conditions include a sprain, rising fever, or sore throat.

Most TRICARE beneficiaries can visit an urgent care center whenever they have a need. When possible, you should go to a TRICARE network urgent care provider to avoid additional out-of-pocket costs.

Urgent care rules depend on who you are:

  • Active Duty Service Members (ADSMs): ADSMs enrolled to a military hospital or clinic must get a referral before going to a TRICARE network urgent care center. ADSMs who need care when military hospitals or clinics are closed or when traveling should use the Military Health System (MHS) Nurse Advise Line for help. If you’re an ADSM enrolled in TRICARE PrimeA managed care option available in Prime Service Areas in the United States; you have an assigned primary care manager who provides most of your care.TRICARE Prime RemoteA managed care option for active duty service members and their families who live in designated remote locations in the U.S. (usually more than 50 miles or one hour's drive time from a military hospital or clinic).TRICARE Prime Remote not living near a military hospital or clinic, you don’t need a referral when seeking urgent care.
  • Other TRICARE Prime Enrollees: This includes active duty family members (ADFMs) and retirees. You can seek urgent care from TRICARE authorized urgent care centers without a referral. To find an urgent care center or provider, you can use the TRICARE provider search tool, MHS Nurse Advice Line, or contact your regional contractor.
  • TRICARE SelectStarting on January 1, 2018, TRICARE Select replaces TRICARE Standard and Extra. TRICARE Select is a self-managed, preferred provider network plan. TRICARE Select is a fee-for-service option in the United States that allows you to get care from any TRICARE-authorized provider.  Enrollment is required to participate. TRICARE Select Enrollees: If you’re enrolled in TRICARE Select, you may visit any TRICARE authorized network or non-network provider for urgent care. These rules also apply to anyone in premium-based plans: TRICARE Reserve SelectA premium-based plan for qualified Selected Reserve members and their families.TRICARE Reserve Select, TRICARE Retired ReserveA preimum-based plan for qualified Retired Reserve members and their families.TRICARE Retired Reserve, TRICARE Young AdultA premium-based plan for qualified adult children.TRICARE Young Adult, and the Continued Health Care Benefit Program.
  • Overseas Enrollees: Overseas ADFMs enrolled in TRICARE Overseas Program (TOP) Prime or TOP Prime Remote plans must contact the TRICARE overseas contractor for authorization before seeking urgent care. Otherwise, they may pay at the time of service and file a claim later for reimbursement.

TOP Prime enrollees who need urgent care while on temporary duty or leave status in the 50 United States and District of Columbia can seek urgent care without a referral or an authorization. ADSMs must follow up with their primary care manager in accordance with applicable Department of Defense and service regulations.

“We want our service members’ families and others to have easier access to urgent care,” said Navy Capt. Edward Simmer, chief clinical officer, TRICARE Health Plan at the Defense Health Agency. “It’s important to understand the rules to avoid unintended out-of-pocket expenses.”

Unsure whether to seek urgent care? Use the 24/7 MHS Nurse Advice Line. You can call, chat online, or video chat with a registered nurse. The nurse can answer your questions and give medical advice. You can also get help with scheduling an appointment. In the U.S., call the MHS Nurse Advice Line at 1-800-TRICARE (1-800-874-2273), option 1. Find country-specific numbers on the MHS Nurse Advice Line website.

If you have an emergency, you should call 911 or go to the nearest emergency room. An emergency threatens life, limb, or eyesight.

Learn more about urgent care coverage on the TRICARE website.

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