Online Intro
US Family Health Plan is a TRICARE Prime option offering an excellent program of health care coverage built on a sound mission and unsurpassed commitment to our members. This commitment is displayed every day through high-quality service and strong physician-patient relationships. The result: exceptional member satisfaction.
US Family Health Plan is the only TRICARE Prime program that offers benefits to active duty family members and all military retirees and their eligible family members, including those 65 years of age and over, regardless of whether or not they participate in Medicare Part B. So no matter what their age, members can stay healthy with US Family Health Plan.
This chart presents an overview of services that are covered by the Plan when they are provided or authorized by your US Family Health Plan primary care provider (PCP). All specialist visits and hospital admissions must be arranged by your PCP (except for unforeseen medical emergencies). Most co-payments are due at the point of service.
| Active Duty Family Members | Retirees, Survivors & Family Members | Retirees, Survivors & Family Members Age 65 and Over Who Are Enrolled in Medicare Part B | |
| Annual Enrollment Fee | $0 | $230/individual* $460/family* | $0 (with proof of Part B enrollment) |
| Covered Services | YOUR COST | YOUR COST | YOUR COST |
| Annual Physical | $0 | $0 | $0 |
| Outpatient Visits | $0 | $12 | $0 |
| Home Health Care | $0 | $12/visit | $0 |
| Emergency Room Visits | $30 | $0 | |
| Ambulatory Surgery | $0 | $25 | $0 |
| Inpatient Hospitalization (general) | $0 | $11/day $25 minimum |
$0 |
| Skilled Nursing Facility Care | $0 | $11/day $25 minimum |
$0 |
| Ambulance Service | $0 | $20 per occurrence | $0 |
| Physical Therapy | $0 | $12/visit | $0 |
| Occupational Therapy | $0 | $12/visit | $0 |
| Rehabilitation Therapy (including cardiac) | $0 | $12/visit | $0 |
| Radiation Therapy | $0 | $12/visit | $0 |
| Prescription Drugs | |||
| Retail Pharmacy (30-day supply) | Co-payment per prescription | Co-payment per prescription | Co-payment per prescription |
| Name-Brand Drug | $9 | $9 | $9 |
| Generic Drug | $3 | $3 | $3 |
| Mail Order Pharmacy (90-day supply) | Co-payment per prescription | Co-payment per prescription | Co-payment per prescription |
| Name-Brand Drug | $9 | $9 | $9 |
| Generic Drug | $3 | $3 | $3 |
| Other Services | |||
| Durable Medical Equipment (prostheses,supplies) | 0% | 20% of cost | 0% |
| Routine PAP Smear | $0 | $0 | $0 |
| Well Child Care & Immunizations (up to 24 months of age) | $0 | $0 | $0 |
| Maternity (Hospital & Professional Services, pre/post natal) | $0 | $11/day $25 minimum |
$0 |
| Eye Exams | $0 | $12 | $0 |
| Mental Illness | $0 | $40/day | $0 |
| Outpatient Mental Health Visits, individual | $0 | $25/visit | $0 |
| Outpatient Mental Health Visits, group | $0 | $17/visit | $0 |
| Inpatient Hospitalization, Mental Health | $0 | $40/day $25 minimum |
$0 |
| Partial Hospitalization, Mental Health | $0 | $40/day $25 minimum |
$0 |
| Substance Abuse Treatment (inpatient partial) | $0 | $40/day $25 minimum |
$0 |
The summary is not an all-inclusive list. Check with the US Family Health Plan in your area for complete details of benefit coverage and exclusions.
* If an individual is paying into Medicare Part B, there is no US Family Health Plan enrollment fee for that person.
Catastrophic Cap: Co-payment collections will be subject to a catastrophic cap of $1000 per year for active duty families and $3000 per year for retiree families. This means you won't have to pay more than that for covered medical services received in a single year. The enrollment fee (if applicable) and all out of pocket co-payments are included in determining the catastrophic cap.
