Frequently Asked Questions

US Family Health Plan is one option of the military health system known as TRICARE. US Family Health Plan was selected by the Department of Defense to be a provider of TRICARE Prime. As a US Family Health Plan member you receive all the benefits offered by the DoD's TRICARE Prime program, plus additional advantages and features at no extra cost. US Family Health Plan has served the health care needs of military beneficiaries since 1993, under an earlier contract with the DoD. When TRICARE, the triple option military health care program, was implemented, the DoD contracted with certain former US Public Health Service hospitals to be TRICARE Prime designated providers through the administration of US Family Health Plan programs.

Any beneficiary who relies on the Military Health System (MHS) for their health care and who is eligible in the Defense Eligibility and Reporting System (DEERS) is eligible to enroll in the Plan. The DEERS list includes anyone who is eligible to receive military health benefits, including active duty family members, retirees, and retiree family members.

Active duty personnel are not eligible as they are required to obtain their health care at Military Treatment Facilities (MTFs).

Enrollment is open all year. You can enroll anytime and coverage begins on the first day of the month following receipt of your application. There's no waiting period for benefits.

No. Medicare Part B is not a requirement to become a US Family Health Plan member. However, selecting Medicare Part B will provide you with some additional benefits:

• All enrollment fees are waived for US Family Health Plan members who also have Medicare Part B. This saves an individual $230 a year.


• Medicare Part B will provide coverage for the limited services not covered by the US Family Health Plan, such as chiropractic coverage.


• If for any reason you decide to disenroll from US Family Health Plan, you are automatically and immediately covered by Medicare Part B and TRICARE for Life benefits.

If for any reason you decide to disenroll for US Family Health Plan and you do not carry Medicare Part B, you will need to apply for Medicare Part B before you can access your TRICARE for Life benefits. There are waiting periods and higher costs for not taking Medicare Part B at the time you became eligible.

Protect yourself and your family-take Medicare Part B when it is offered!

If you're a married couple - one person with Medicare Part B and one person without it - you may still join the Plan as a family. The person without Medicare Part B would pay an individual annual enrollment fee and be responsible for any necessary co-payments for his or her care.

We encourage you to enroll in US Family Health Plan as a complete family unit. However, enrollment in US Family Health Plan is on an individual basis.

The US Family Health Plan covers you for medical emergencies wherever you are. Go to the nearest appropriate medical facility and please be sure that someone calls the Plan (either the 800 number or your PCP's phone number) within 24 hours, so your provider can confer with the attending doctor. Your costs will be covered for everything above your copayment. Show your US Family Health Plan membership ID card and have the bill sent to the address on the back. Plan members may use Military Treatment Facilities for medical emergencies if the MTF is the nearest emergency facility to you when you become ill or injured.

If you move within your current Plan’s zip code-defined service area, simply notify the Plan of your new address. If you want to change your primary care provider to accommodate your new address, there's no problem. Give us a call and we'll send you a new membership card with your new PCP's name and phone number.

If you move to one of the other areas across the country where the US Family Health Plan is available, we will be happy to transfer your enrollment for you.

If you move to an area where the US Family Health Plan is not available, we can give you the information you need to transfer your enrollment to the regional TRICARE Prime program.

Not for routine or urgent care. Under the US Family Health Plan, you may not use military treatment facilities. The only exceptions to this limitation are if you have an acute medical emergency and the military treatment facility is closest to you, if care is not available through US Family Health Plan specialists, or if a new member who is pregnant wishes to complete her prenatal care at her previous MTF.

Yes. Plan members may take (or have their providers call in) their one-time or urgent care prescriptions to pharmacies in their Plan’s retail pharmacy network, or may use one of their Plan’s on-site pharmacies. The co-pays for prescription drugs through the retail pharmacy network are: $3 for generic drugs and $9 for brand name drugs for up to a 30-day supply. The same co-pays apply to your long-term or maintenance prescriptions that should be filled through the US Family Health Plan mail order pharmacy service. However, instead of limiting the supply to 30-days, you receive up to 90-days worth of the drugs filled through the mail-order pharmacy.

The Department of Defense (DoD) reserves the right to determine which drugs are covered under the program. Some examples of medications not covered include; medications for hair restoration, weight loss, smoking cessation, drugs used for cosmetic reasons, such as Retin A (wrinkle cream), and over-the-counter medications.