Back to Top Skip to main content

Understanding Urgent Care Rules

Take Command of your health Take Command of your health

Recommended Content:

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.

You also may be interested in...

Join Feb. 21 webinar on TRICARE dental options for service members, families

Article
2/14/2019
Take Command of Your Health

During the webinar, dental experts from the Active Duty Dental Program (ADDP) and TRICARE Dental Program (TDP) will provide detailed information on these programs

Recommended Content:

TRICARE Health Program

Cancer Screenings 2019

Infographic
1/30/2019
This infographic lists the types of cancer screenings as part of the TRICARE Health Promotion and Disease Prevention benefit

This infographic lists the types of cancer screenings as part of the TRICARE Health Promotion and Disease Prevention benefit.

Recommended Content:

TRICARE Health Program

Transformation underway across the Military Health System

Article
1/29/2019
Thomas McCaffery, principal deputy assistant secretary of defense for health affairs, with Vice Adm. Raquel Bono, director, Defense Health Agency, celebrated the Defense Health Agency's fifth anniversary on Oct. 1, 2018, by welcoming the first military hospitals and clinics transitioning to the DHA. This was first step for the MHS to emerge as a more integrated and efficient system of health and readiness. (MHS photo by Military Heath System Strategic Communications Division)

All of these changes – the Military Health System transformation, MHS GENESIS, TRICARE enhancements – are aimed at taking the DoD’s health enterprise to the next level

Recommended Content:

Access to Health Care | Health Readiness | TRICARE Health Program | MHS GENESIS | Military Hospitals and Clinics

New to TRICARE? The basics you need to know

Article
1/17/2019
TRICARE logo

Learning about your benefit will help you make the most of your coverage

Recommended Content:

TRICARE Health Program

TRICARE Preventive Services

Video
1/14/2019
TRICARE Preventive Services

Watch this video to learn more about all the preventive services your TRICARE benefit covers.

Recommended Content:

TRICARE Health Program | Preventive Health

TRICARE Comprehensive Autism Care Demonstration Program

Congressional Testimony
1/7/2019

S. 2943, SASC Report for FY 2017, 114-255, Pg. 205

Recommended Content:

TRICARE Health Program | Autism Care Demonstration

New codes for applied behavior analysis services begin in New Year

Article
12/18/2018
Take Command of Your Health

Change should not impact beneficiaries, DHA leaders emphasize

Recommended Content:

TRICARE Health Program

Enroll before TRICARE, FEDVIP Open Season closes Dec. 10

Article
12/7/2018
Take Command of your health

Take action, take command and do so before open season closes next week

Recommended Content:

TRICARE Health Program

Know your costs before making a choice during TRICARE Open Season

Article
12/4/2018
Take Command of your health

Before you choose a plan, make sure you know what’s covered and what it costs

Recommended Content:

TRICARE Health Program

Print PSA: Open Season Grace Period 2018

Infographic
12/4/2018
Print PSA: Open Season Grace Period 2018

Print this PSA and display it locally to help spread the word about what to do if you missed TRICARE Open Season

Recommended Content:

TRICARE Health Program

What to Do if You Missed Open Season 2018

Infographic
12/3/2018
What to Do If You Missed Open Season

This Infographic describes the options that are available to you if you missed enrolling in FEDVIP before the end of Open Season

Recommended Content:

TRICARE Health Program

Active Duty Family Members Open Season 2018

Infographic
11/26/2018
Open Season for Active Duty Family Members

This Infographic provides detailed information about the health care coverage changes and the vision coverage changes that active duty family members are eligible for during the 2018 Open Season

Recommended Content:

TRICARE Health Program

Retiree Open Season 2018

Infographic
11/26/2018
Open Season Infographic for Retired Service Members and Families

This Infographic provides detailed information about the health care coverage changes and the dental and vision coverage changes that Retirees are eligible for during the 2018 Open Season

Recommended Content:

TRICARE Health Program

Reserve Component Members Open Season 2018

Infographic
11/26/2018
Open Season Infographic for Reserve Component Members and Families

This Infographic provides detailed information about the health care coverage changes and the vision coverage changes that Reserve Component Members are eligible for during the 2018 Open Season

Recommended Content:

TRICARE Health Program

TRICARE Prime versus TRICARE Select: Should you change or keep your plan?

Article
11/23/2018
Take Command of Your Health

If you miss open season, you’ll only be able to make enrollment changes within 90 days of a Qualifying Life Event or during the next TRICARE Open Season in fall 2019

Recommended Content:

TRICARE Health Program
<< < 1 2 3 4 5  ... > >> 
Showing results 1 - 15 Page 1 of 9

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.