As of Jan. 1, 2018, most TRICARE Prime enrollees no longer need a referral for urgent care visits and point-of-service charges no longer apply for urgent care claims. This change replaces the previous policy, which waived referrals for the first two urgent care visits per year. Active duty service members (ADSMs) should continue to visit military hospitals and clinics for care. ADSMs enrolled in TRICARE Prime Remote who don’t live near a military hospital or clinic don’t need a referral when seeking an urgent care visit.
“We wanted our service members’ families and others to have easier access to urgent care,” said Ken Canestrini, acting director, TRICARE Health Plan within the Defense Health Agency. “Beneficiaries can go visit an urgent care center right away anytime they have a need.”
If you use TRICARE Select or any other TRICARE plan, you may visit any TRICARE-authorized provider, network or non-network, for urgent care.
Urgent care is care you need for a non-emergency illness or injury requiring treatment within 24 hours. Examples of urgent care conditions include a sprain, rising temperature or sore throat. It isn’t an emergency and doesn’t threaten life, limb or eyesight.
If you’re unsure whether to seek urgent care, call the 24/7 Nurse Advice Line at 1-800-TRICARE (874-2273)—Option 1. You can speak with a registered nurse who can answer your questions and give advice. The nurse can also assist you with finding a provider and scheduling an appointment.
If you need care after hours, while traveling, or if your primary care manager is unavailable, urgent care is a great option. Contact your regional contractor to help you find an appropriate urgent care facility or provider. You may also use the TRICARE provider search tool.
Any TRICARE Overseas Program Prime enrollees requiring urgent care while on temporary duty or on leave status in the 50 United States and the District of Columbia, may access urgent care without a referral or an authorization. However, the ADSMs must follow up with their primary care manager in accordance with applicable DoD and Service regulations concerning ADSM care outside military hospitals and clinics.
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