Tricare Select Emergency Room Copay

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.
Note: Visit our Copayment and Cost-Share Information page for 2021 costs. View the cost information below for TRICARE Young Adult (TYA) beneficiaries. The amounts are based on the TYA enrollee's sponsor's active duty or retiree status.

TRICARE Prime cost-shares for urgent care center visits: ADFM - Group A/Group B: $0; Retiree - Group A/Group B: $31; TRICARE Select cost-shares for urgent care center visits: ADFM - Group A: $21 in-network / 20% of allowable for out-of-network; ADFM - Group B: $20 in-network /.

Copayments and cost-shares are subject to change at the beginning of each calendar year.
- Copayments are per occurrence or per visit.
- Cost-shares are a percentage of the contracted rate for network providers and the maximum TRICARE allowable for non-network providers on certain types of services.
Beneficiaries have an out-of-pocket maximum for covered medical expenses; this is known as the catastrophic cap.
Point of Service cost-shares and deductibles may apply to TRICARE Prime and TRICARE Prime Remote beneficiaries (excluding active duty service members).

Important Note: Active duty service members do not have any out-of-pocket costs for care.

2021 Costs

Active Duty Family Members	Retirees and Their Family Members	TRICARE Reserve Select (TRS)	TRICARE Retired Reserve (TRR)	TRICARE Young Adult (TYA)
Enlisted before 01/01/18	Enlisted before 01/01/18	All	All	All
Enlisted on or after 01/01/18	Enlisted on or after 01/01/18	All	All	All

2021 Cost Information by Benefit

Tricare select emergency room copay assistance

Detailed information on copayments and cost-shares is listed below by benefit. You can also view this information using the cost links in our Benefits A-Z list.

Pharmacy

Mental Health

Active Duty Family Members	Retirees and Their Family Members	TRICARE Reserve Select (TRS)	TRICARE Retired Reserve (TRR)	TRICARE Young Adult (TYA)
Enlisted before 01/01/18	Enlisted before 01/01/18	All	All	All
Enlisted on or after 01/01/18	Enlisted on or after 01/01/18	All	All	All

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.

Tricare Select Emergency Room Copay

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.

Last Updated 6/18/2020

Tricare Select Emergency Room Copay Card

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