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Special Needs. Benefit Updates. How a Benefit Becomes Covered. Health Plan Costs. Active duty military will be enrolled in TRICARE Prime and should expect to use the available military healthcare options on-base or nearby before being referred to a private or civilian care provider.
Primary Care Managers are required to see you first before giving a referral to specialists as care or treatment requires. Your PCM works with a regional contractor for authorization of referrals. If you elect care without being referred by the PCM you may be liable for more of the cost of treatment or other services depending on circumstances.
This is especially true for military members who choose to get care without consulting the PCM-when military members skip the PCM, they may be required to pay the full amount for the services provided. Family members should know that different rules apply; you should try to get a referral for most services that are not offered by the Primary Care Manager, but when on-base military care facility is not available, an in-network referral is the next step.
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