Tricare Select Emergency Room Copay

Covered Services

Retirees covered under TRICARE Prime will also see minor copay increases. These will apply to emergency room visits, outpatient surgery and ground ambulance. Copays for these items will increase by $1. Also, copays for inpatient admissions will increase by $4 per admission. If you reasonably think you have an emergency, go to the nearest emergency room or call 911. A copay of $31 is required for all retirees and retiree family members seen at a TRICARE-authorized network UCC. Active duty family members will not have a copay. TRICARE Reserve Select reminders: Beneficiaries may be required to pay up to 15% above the TRICARE allowed amount when using a nonparticipating provider. Annual deductibles apply to outpatient services only.Costs may apply for durable medical equipment (DME) and medications/drugs. TRICARE Select, TRICARE Young Adult Select, TRICARE Reserve Select, and TRICARE Retired Reserve annual deductibles apply. TRICARE Young Adult costs are based on the sponsor's status. Transitional Assistance Management Program (TAMP) beneficiaries (service members and their family members) follow the active duty family member copayment/cost.

Learn more about what we cover -
including health, dental, and pharmacy.

TRICARE covers emergency care to include professional and institutional charges and services and supplies that are ordered or administered in an emergency department.

Call 911 or Go to the Emergency RoomThe hospital department that provides emergency services to patients who need immediate medical attention.

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.

Tricare Select Er Copay

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.

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.

Tricare Emergency Room Policy

This list of covered services is not all inclusive. TRICARE covers services that are medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. and considered proven. There are special rules or limits on certain services, and some services are excluded.

Last Updated 6/18/2020

Find a Doctor

Dental
Prescriptions
Vision
Mental Health Therapeutic Services

If you feel emergency care is needed, call 911 or go to the nearest military or civilian emergency room. An approval from Health Net Federal Services, LLC (HNFS) is not required for this care.

Tricare Reserve Select Emergency Room

Emergency conditions are those that threaten life, limb or eyesight. Emergency conditions include medical, maternity or psychiatric problems that would lead a layperson to believe a situation exists that without medical help could lead to loss of life, limb or eyesight. An emergency may also include the need for immediate help to treat severe pain or relieve suffering.

Care that does not threaten life, limb or eyesight, but needs attention to prevent it from becoming a serious risk to health is known as urgent care. Visit our urgent care page to learn more.

Note: Care for accidental injury to the teeth alone or emergency room visits for dental pain are not covered by the TRICARE medical benefit.

After Emergency Care

TRICARE Prime beneficiaries must coordinate all follow-up care with their primary care manager (PCM). If the TRICARE Prime beneficiary is not assigned to a PCM, he or she must coordinate all follow-up care with HNFS. Follow-up care that is not coordinated with the PCM or HNFS may be subject to Point of Service cost-shares and deductibles.
TRICARE Select, TRICARE For Life and beneficiaries with other health insurance do not need to coordinate any follow-up care with HNFS, but should notify their family physician of an emergency room visit.