TRICARE Emergency Care: Rules, Costs, and ER Guidelines | TRICARE.com

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## Definition Emergency care refers to the immediate medical treatment provided for a serious medical condition or injury that a "prudent layperson" would believe poses a threat to life, limb, sight, or cause severe pain.

## What it means in practice In the TRICARE system, emergency care does not require prior authorization. If you are experiencing a true medical emergency—such as chest pain, severe bleeding, shortness of breath, or a broken bone—you should go to the nearest emergency room (ER) or call 911 immediately. You do not need to call your Primary Care Manager (PCM) first, regardless of whether you are enrolled in TRICARE Prime or TRICARE Select.

Once you are admitted or treated, you must notify your regional contractor (Humana Military in the East or TriWest Healthcare Alliance in the West) within 24 hours or the next business day. This ensures that follow-up care is coordinated and that your claims are processed correctly. If you are a Prime enrollee, your PCM will need to manage any post-emergency specialty care.

Costs for emergency care vary significantly by beneficiary status and plan. For **2026**, TRICARE Prime active duty family members typically have a $0 copayment for ER visits. However, TRICARE Select Group A retirees may face an ER copayment of approximately $175 per visit, while Group B beneficiaries encounter different tiered rates. If you utilize an emergency room for a non-emergency issue (like a common cold or minor scrape), TRICARE may reclassify the visit as urgent care or deny the claim, leaving you responsible for a larger portion of the bill.

If you are overseas, the process is similar: seek immediate care at the nearest hospital. You should then contact International SOS to coordinate your care and ensure the facility is recognized for payment.

## Related terms * **Urgent Care:** Treatment for non-life-threatening illnesses or injuries that require attention within 24 hours (e.g., sprains, high fever). * **Prudent Layperson Standard:** A legal standard used to determine if a person with average medical knowledge would believe an emergency exists. * **Point-of-Service (POS) Option:** An additional cost incurred by Prime enrollees who seek non-emergency care without a referral. * **PCM (Primary Care Manager):** The doctor responsible for coordinating your overall health care, who must be notified after an emergency visit. * **Catastrophic Cap:** The maximum out-of-pocket amount a beneficiary pays for covered services each calendar year.

## Sources * TRICARE.mil - Emergency Care: https://www.tricare.mil/emergency * Humana Military (East Region): https://www.humanamilitary.com/ * TriWest Healthcare Alliance (West Region): https://www.triwest.com//en/beneficiary/