To increase access to care, the Department of Defense is
launching an Urgent Care Pilot Program for TRICARE Prime beneficiaries. This
program allows Prime enrollees two visits to a network or TRICARE authorized
provider without a referral or prior authorization.
The Urgent Care Pilot Program, scheduled to begin May 23, is
for:
• Active duty service members – including National Guard or
Reserve members activated for more than 30 consecutive days – in TRICARE Prime
Remote or ordered to active duty service for more than 30 days in a row in
TRICARE Prime Remote
• Non-ADSMs in TRICARE Prime, TRICARE Prime Remote or
TRICARE Young Adult Prime
• TRICARE Overseas Program beneficiaries traveling in the
U.S. (not limited to two visits)
Active duty service members enrolled in TRICARE Prime are
not eligible for this program as their care is managed by their service. This
program excludes Uniformed Services Family Health Plan enrollees. TRICARE
Overseas Program enrollees can receive an unlimited number of urgent care
visits, but only when they are traveling stateside and seeking care.
There are no point-of-service deductibles or cost shares for
these two urgent care visits, but network co-payments still apply.
Once you receive urgent care, you must notify your Primary
Care Manager about that care within 24 hours or the first business day after
the urgent care visit. Authorization requirements have not changed for
follow-up care, specialty care or inpatient care.
When you are not sure of the type of care you need or
require care outside of standard business hours, call the Nurse Advice Line at
1-800-874-2273. If the NAL recommends an urgent care visit and a referral is
submitted, that visit will not count against the two pre-authorized visits
allowed under the Urgent Care Pilot. However, if you call the NAL and get a
referral to a military hospital or clinic and you go elsewhere for care, that
visit will count against your two preauthorized visits.
For more details, visit
http://www.tricare.mil/Plans/SpecialPrograms/UrgentCarePilot.aspx.