TRICARE defines an emergency as a serious medical condition the average person would consider to be a threat to life, limb or eyesight or the ability of the beneficiary to regain maximum function, or to prevent severe pain that cannot be adequately managed without the care or treatment requested that requires immediate medical treatment.
Examples of conditions that require emergency care include:
Maternity-related medical emergencies are also included that involve a sudden unexpected complication which puts the mother, the baby or both at risk.
To avoid penalties, providers must notify Humana Military of any emergency admission through provider self-service or by faxing the information to (877) 548-1547.
Humana Military reviews admission information and authorizes continued care, if necessary. If TRICARE Prime enrollees seek nonemergency care without required referrals and/or authorizations, they are responsible for paying Point-Of-Service (POS) fees.