TRICARE Poisoning Emergency: Coverage, Fees & Steps | TRICARE.com

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## Quick answer If you or a family member has been poisoned, call **911** or go to the nearest emergency room immediately. You do not need prior authorization from TRICARE for emergency care, and you should call the **Poison Control Center at 1-800-222-1222** for immediate guidance while help is on the way.

Details

### Emergency Care Protocols In a life-threatening poisoning situation (loss of consciousness, difficulty breathing, or seizures), TRICARE policy is "medical necessity first." * **No Referral Needed:** You do not need a referral or prior authorization to seek emergency services, regardless of your plan (Prime, Select, or TRS). * **Facility Choice:** Go to the nearest civilian or military emergency room. You do not have to drive past a civilian hospital to find a military facility during a poisoning emergency. * **Notification:** If you are enrolled in **TRICARE Prime**, you or a family member must notify your Primary Care Manager (PCM) within 24 hours or on the next business day following the emergency visit to ensure follow-up care is coordinated and claims are processed correctly.

### Costs for Emergency Visits (2026 Rates) Your out-of-pocket costs depend on your beneficiary status and plan: * **Active Duty Service Members (ADSMs):** $0 out-of-pocket for all emergency care. * **Active Duty Family Members (ADFMs):** * *TRICARE Prime:* $0 copay at an ER. * *TRICARE Select:* Varies by sponsor enlistment date (Group A vs. Group B); typically ranges from $100 to $130 per emergency room visit in 2026. * **Retirees and Families:** * *TRICARE Select:* Usually a flat copayment (approx. $250+ in 2026) or a percentage of the allowable charge after the deductible is met. * *TRICARE Prime:* Copays apply (approx. $75–$100 in 2026) for retirees.

### Pharmacy and Antidotes TRICARE’s pharmacy benefit, managed by **Express Scripts**, covers medically necessary medications administered during an emergency, including charcoal treatments or specific antidotes (like Narcan/Naloxone). If follow-up prescriptions are required, they can be filled at military pharmacies (at no cost) or through the TRICARE Pharmacy Home Delivery or retail network.

### Regional Management If the poisoning leads to an inpatient stay, the regional contractor will manage the clinical necessity review: * **East Region:** Humana Military * **West Region:** TriWest Healthcare Alliance * **Overseas:** International SOS

## Who this affects * **Active Duty Service Members:** Fully covered; must report emergency to command and PCM. * **Active Duty Family Members:** Covered under Prime and Select; emergency fees apply for Select. * **Retirees and their Families:** Subject to plan-specific deductibles and copays. * **National Guard and Reserve:** Beneficiaries using TRICARE Reserve Select (TRS) follow the Select cost-share structure.

## Sources 1. **TRICARE.mil - Emergency Care:** https://www.tricare.mil/emergency 2. **Humana Military (East):** https://www.humanamilitary.com/ 3. **TriWest Healthcare Alliance (West):** https://www.triwest.com/ 4. **Health.mil - Poison Control Information:** https://health.mil/Military-Health-Topics/Health-Readiness/Public-Health/Poison-Prevention-and-Treatment