New urgent care pilot program for prime beneficiaries

GOODFELLOW AIR FORCE BASE, Texas -- To increase access to care, the Defense Department is launching the Urgent Care Pilot Program for Tricare Prime beneficiaries.

This program allows prime enrollees two visits to a network or Tricare authorized provider without a referral or prior authorization.

The Urgent Care Pilot Program, scheduled to begin spring 2016, is for:
• Active duty family members enrolled in Tricare Prime or Tricare Prime Remote.
• Retirees and their family members enrolled in Prime within the United States or the District of Columbia.
• Active duty service members enrolled in Tricare Prime Remote and stationed overseas but traveling stateside.

Active duty service members enrolled in Tricare Prime are not eligible for this program as their care is managed by their service. This pilot also excludes Uniformed Services Family Health Plan enrollees. Tricare Overseas Program enrollees can receive an unlimited number of urgent care visits, but only when they are traveling stateside and seeking care.

There are no point of service deductibles or cost shares for these two urgent care visits, but network copayments still apply.

After receiving urgent care, individuals must notify their Primary Care Manager within 24 hours or the first business day after the urgent care visit. Authorization requirements have not changed for follow up care, specialty care or inpatient care.

Individuals who require care outside of standard business hours or who are unsure of the type of care they need, can call the Nurse Advice Line. If the NAL recommends an urgent care visit, and a referral is submitted, that visit will not count against the two pre-authorized visits allowed under the Urgent Care Pilot.

However, if calling the NAL to get a referral to a military hospital or clinic and going elsewhere for care, the visit will count against the two preauthorized visits.

For more information, visit the Urgent Care Pilot Program web page on the Tricare website.

Nurse Advice Line:

Urgent Care Pilot Program: