Tricare Prime beneficiaries now have new requirements for obtaining host nation care for urgent health problems. Effective immediately, Prime beneficiaries must contact the Overseas Managed Care Contractor, International SOS, before obtaining urgent care after hours on the economy. International SOS is available 24 hours a day at 0800-589-1599 or civ. 044-20-8762-8384.
International SOS will accept collect calls and will also return calls, if requested.
The purpose of obtaining pre-authorization is to ensure that the patient can see a host nation provider who is part of the network and offers cashless and claimless services to the patient. It also provides an immediate benefits review to ensure that the care to be obtained is a covered benefit.
Pre-authorization is not required for emergencies.
Tricare defines urgent care as medically necessary services required for an illness or injury that would not result in further disability or death if not treated immediately, but does require professional attention within 24 hours. Urgent care could be required for a condition such as a sprain, sore throat or rising temperature, as each of these has the potential to develop into an emergency if treatment is delayed.
Emergency care is defined as a medical, maternity or psychiatric condition that would lead someone with average knowledge of health and medicine to believe that a serious medical condition exists; that the absence of immediate medical attention would result in a threat to life, limb or sight; when a person has severe, painful symptoms requiring immediate attention to relieve suffering; or when a person is at immediate risk to self or others.
Such care does not require pre-authorization; however, beneficiaries may call International SOS to locate the nearest network provider or emergency room, and to obtain assistance if an admission is required.
For more information, visit www.tricare-overseas.com.
