REFERRALS AND PRE-AUTHORIZATIONS
Due to the impacts of Typhoon Mawar, a Primary Care Manager (PCM) Referral Waiver is in place for all TRICARE Prime Overseas and TRICARE Prime Remote Overseas enrolled beneficiaries seeking/receiving care in Guam and the Northern Mariana Islands. For more information, click here.
Please see the below table for pre-authorization guidelines when receiving care overseas:
| TRICARE Prime Overseas | TRICARE Prime Remote Overseas | TRICARE Select Overseas (ADFMs)1 | TRICARE Select Overseas (Retirees)1 | |
|---|---|---|---|---|
| Emergency Care* | Not Required | Not Required | Not Required | Not Required |
| Clinical Preventive Services | ADSM: Required
ADFM: Not Required |
ADSM: Required
ADFM: Not Required |
Not Required | Not Required |
| Mental Health Care | ADSM: Required
ADFM: Not Required** |
ADSM: Required
ADFM: Not Required** |
Not Required** | Not Required** |
| Specialty Care | Required | Required | Not Required | Not Required |
| Services Requiring
Pre-Authorization |
For all beneficiaries, regardless of which TRICARE Health Plan they are enrolled in, the following services require a pre-authorization:
†These services are only covered in the United States and U.S. territories. †† Medicare certification for organ transplant centers is only required for transplants performed in the United States and U.S. territories where Medicare is available. TRICARE may cover organ transplants in overseas locations when medically necessary, reasonable, and commonly accepted in the country where the transplant is performed. |
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The information above is not all-inclusive. There may be other services requiring pre-authorization, as these guidelines may change periodically. Contact your TOP Regional Call Center to learn more before receiving care. Additional information is also available on https://tricare.mil/CoveredServices and https://tricare.mil/FindDoctor/Appointments/Referrals.
*International SOS should be notified within 24 hours of admission.
** Certain types of behavioral health care services, including non-emergency inpatient behavioral health care and inpatient admissions for substance use disorders, are excluded and always require a referral and pre-authorization. Contact International SOS for more details. You can get care from a supervised mental health counselor or pastoral counselor, but a doctor must supervise the care, even if in the TRICARE network. Certified mental health counselors don't need doctor referral and supervision.
1Note: Beneficiaries who live or travel in the Philippines are required to see a certified provider for care. For more information, visit https://www.tricare-overseas.com/beneficiaries/philippines.