Tricare Prime Er Copay

These plans do not pay the TRICARE Prime annual enrollment fee. The Prime Supplement Plans A and B are not available in NC and ND. Plan B is not available in FL or IA. Check with TRICARE to confirm your actual copay portion. TRICARE’s portion of coverage is provided here for your convenience, but is subject to change by DHA (Defense Health. TRICARE Prime beneficiaries will not incur point-of-service deductibles and cost shares if the urgent care center or convenience clinic is TRICARE-authorized and either network or non-network. TRICARE Prime cost-shares for urgent care center visits: ADFM - Group A/Group B: $0; Retiree - Group A/Group B: $31. Emergency Room Visit $63 $63 Inpatient Admission (Hospitalization) $158/ admission $158/ admission TRICARE Prime Point-of-Service Option When you see a TRICARE-authorized provider other than your primary care manager for any nonemergency services without a referral, you pay:. A yearly deductible before TRICARE cost-sharing will.

Coronavirus (COVID-19) Update:

Testing copayment waiver: Retroactive to March 18, 2020, TRICARE will waive copayments/cost-shares for medically necessary COVID-19 diagnostic and antibody testing and related services, and office visits, urgent care or emergency room visits during which tests are ordered or administered. COVID-19 diagnostic and antibody tests must meet Families First Coronavirus Response Act (FFCRA) criteria in order to be eligible for the cost-share and copayment waivers.
Telemedicine copayment waiver: TRICARE is waiving copayments and cost-shares for covered audio-only or audio/video telemedicine rendered by network providers on or after May 12, 2020. This waiver applies to covered in-network telehealth services, not just services related to COVID-19. Beneficiaries who seek telehealth from non-network providers are liable for their regular copayment or cost-share. TRICARE Prime beneficiaries who seek care from specialists without an approved referral when required are subject to Point of Service fees.

Providers are expected to refund cost-sharing amounts to beneficiaries as appropriate.

Note: Visit our Copayment and Cost-Share Information page to view 2020 costs.

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-share information, based on the TRICARE plan type.

A beneficiary's cost is determined by the sponsor's initial enlistment or appointment date:

Group A: Sponsor's enlistment or appointment date occurred prior to Jan. 1, 2018.
Group B: Sponsor's enlistment or appointment date occurred on or after Jan. 1, 2018.

TRICARE Prime and TRICARE Prime Remote (not including TRICARE Young Adult)

Active Duty Family Members	Retirees and Their Family Members
Group A: $0 Group B: $0	Group A: $63 Group B: $63

Active Duty Family Members

Retirees and Their Family Members

Group A: $0

Group B: $0

Group A: $63

Group B: $63

TRICARE Select (not including TRICARE Young Adult)

Active Duty Family Members	Retirees and Their Family Members
Group A: Network Provider: $93 Non-Network Provider: 20% Group B: Network Provider: $42 Non-Network Provider: 20%	Group A: Network Provider: $125 Non-Network Provider: 25% Group B: Network Provider: $84 Non-Network Provider: 25%

Active Duty Family Members

Retirees and Their Family Members

Group A:

Network Provider: $93
Non-Network Provider: 20%

Group B:

Network Provider: $42
Non-Network Provider: 20%

Group A:

Network Provider: $125
Non-Network Provider: 25%

Group B:

Network Provider: $84
Non-Network Provider: 25%

TRICARE Reserve Select (TRS) and TRICARE Retired Reserve (TRR)

TRS	TRR
Network Provider: $42 Non-Network Provider: 20%	Network Provider: $84 Non-Network Provider: 25%

TRICARE Young Adult (TYA)

TYA Prime		TYA Select
Active Duty Family Members	Retiree Family Members	Active Duty Family Members	Retiree Family Members
$0	$63	Network Provider: $42 Non-Network Provider: 20%	Network Provider: $84 Non-Network Provider: 25%

Covered Services

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.

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.

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.

Tricare Reserve Select Emergency Room

Last Updated 6/18/2020

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Tricare Prime Er Copay Program

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