If you are currently enrolled in TRICARE Prime, TRICARE Prime Remote or TRICARE Young Adult-Prime in the United States, you now have the ability to get urgent care twice (per fiscal year) from a provider other than your PCM (primary care manager) without a referral from your PCM. This pilot program begins on May 23, 2016, and ends May 23, 2019.
What does this mean?
When enrolled in a Prime plan, you usually have two options for getting urgent care:
- Get urgent care from your primary care manager (PCM), or
- Get a referral from your PCM to get urgent care from a different provider
With the Urgent Care Pilot Program, TRICARE will cover two urgent care visits each fiscal year where:
- You don't need a referral or authorization from your PCM
- You can visit any TRICARE-authorized provider with a primary care specialty
Am I eligible?
The Urgent Care Pilot Program is available to:
- Active duty service members enrolled in TRICARE Prime Remote
- Activated Guard/Reserve members enrolled in TRICARE Prime Remote
- All other beneficiaries enrolled in TRICARE Prime, TRICARE Prime Remote, or TRICARE Young Adult-Prime
The Urgent Care Pilot Program is not available to:
- Active duty service members enrolled in TRICARE Prime
- Activated Guard/Reserve members enrolled in TRICARE Prime
- Beneficiaries enrolled in the US Family Health Plan
- Beneficiaries enrolled overseas*
*While traveling in the U.S., you don't need a referral from your PCM and you aren't limited to a two visit limit. The Urgent Care Pilot Program doesn't apply to urgent care you may get overseas.
Find out more about the two visit limit, preauthorizations and the Nurse Advice Line at Tricare.mil.
Find out more about the two visit limit, preauthorizations and the Nurse Advice Line at Tricare.mil.
