Emergency Care
| Covered by TRICARE? | Limits |
|---|
| Yes
|
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TRICARE covers emergency care to include professional and institutional charges and services and supplies that are ordered or administered in an emergency department.
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.
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 |
| Medical |
The sudden and unexpected onset of a medical condition or the acute exacerbation of a chronic condition that is:
- Threatening to life, limb or eyesight
- Requires immediate medical treatment
- Manifests painful symptoms requiring immediate response to alleviate suffering
|
| Maternity |
A sudden unexpected medical complication which puts the mother or baby at risk |
| Psychiatric |
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.*
- Prior authorization is not required for emergency department care.
- Admissions resulting from a psychiatric emergency should be reported to the regional contractor within 24 hours of admission or the next business day after admission but must be reported within 72 hours of the admission.
*Based on a psychiatric evaluation performed by a physician or other qualified mental health care professional with hospital admission authority.
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