TRICARE Emergency Notification: Rules and Requirements | TRICARE.com

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## Quick answer In a medical emergency, you should call 911 or go to the nearest emergency room immediately. You do not need prior authorization to seek emergency care, but you must notify your Primary Care Manager (PCM) or regional contractor within 24 hours (or the next business day) of being admitted to the hospital to ensure your claims are processed correctly.

Details

Emergency notification is a critical administrative step that bridges the gap between life-saving treatment and insurance coverage. While TRICARE permits any beneficiary to seek emergency care at any facility—military or civilian—failing to notify the proper authorities can lead to higher out-of-pocket costs or denied claims.

### The "Rules of 24" Notification is generally required if you are **admitted** to a civilian hospital. * **Active Duty Service Members (ADSMs):** You must notify your PCM or your service’s Medical Management center within 24 hours. Your command must also be informed. * **TRICARE Prime Enrollees:** You or a family member must notify your PCM or regional contractor within 24 hours of admission. This allows the contractor to issue a retroactive authorization and manage your follow-up care. * **TRICARE Select/For Life:** While notification is not strictly required for Select enrollees (as they do not have a PCM), notifying the regional contractor is recommended to facilitate "Continued Health Care Benefit" coordination if the stay is prolonged.

### Regional Contractor Contact (2026 Contacts) If you are admitted, ensure the hospital's billing or admissions office has your regional contractor’s information: * **TRICARE East (Humana Military):** 1-800-444-5445 * **TRICARE West (TriWest Healthcare Alliance):** 1-888-TRIWEST (1-888-874-9378) * **TRICARE Overseas (International SOS):** Contact the relevant Regional Global Assistance Center.

### What Defines an Emergency? TRICARE defines a medical emergency as a "medical, maternity, or psychiatric condition that would lead a 'prudent layperson' to believe that a delay in treatment would result in a threat to life, limb, sight, or cause severe pain."

### Costs and Claims * **Active Duty:** $0 for emergency care at any facility (2026 rates). * **TRICARE Prime:** $0 for emergency room visits, but there may be copays for the inpatient stay depending on your sponsor's status. For Group A retirees in 2026, the ER visit copay is typically around $75–$80. * **Point of Service (POS):** If you visit an emergency room for a non-emergency reason (as determined by medical review), TRICARE Prime enrollees may be charged under the Point of Service option, which includes a deductible and 50% cost-shares.

## Who this affects * **Active Duty Service Members:** Mandatory notification for command and PCM. * **Active Duty Family Members:** Required notification if enrolled in TRICARE Prime/Select. * **Retirees and their Families:** Required for Prime enrollees; recommended for Select. * **National Guard and Reserve:** Required for those on active duty orders or enrolled in TRICARE Reserve Select.

## Sources * **TRICARE.mil:** [Emergency Care Overview](https://www.tricare.mil/emergency) * **Humana Military (East):** [Provider Notification Requirements](https://www.humanamilitary.com) * **TriWest Healthcare Alliance (West):** [Emergency and Urgent Care](https://www.triwest.com) * **Defense Health Agency:** [TRICARE Plans and Costs](https://health.mil)