US Family Health Plan

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USFHP Update: Up until August 20, 2012, U.S. Family Health Plan enrollees were not required to participate in Medicare or TFL. However, due to a change in the law, anyone who enrolls after the August deadline will be required to exit USFHP on their 65th birthday. All those who enrolled prior to the deadline may remain in the USFHP system.

One TRICARE Prime option, called US Family Health Plan is available to eligible persons -- including those age 65 and over (limited to exisitng enrollees) -- who live near selected civilian medical facilities on the East, West and Gulf coasts. The US Family Health Plan, sponsored by the DoD, has cared for military families for more than 28 years and has serves nearly 100,000 members. Its national member satisfaction ratings are 40% higher than the national average for satisfaction with health plans, as reported by the National Committee for Quality Assurance (NCQA) in its Quality Compass 2009 Public Report. The following is a summary of the US Family Health Plan:

US Family Health Plan Overview

The US Family Health Plan is the only TRICARE Prime option that offers benefits to family members of active-duty military, including activated Reservists and National Guard members, as well as all military retirees and their eligible family members, including those age 65 and over, regardless of whether they participate in Medicare Plan B. Further, the US Family Health Plan provides all the benefits of TRICARE Prime at the same cost structure -- and enhances them by providing such extras as additional preventive care and screening programs, and discounts on hearing aids, dental care, lasik surgery, contact lens and eyeglasses. These enhancements vary by region, but all are aimed at improving the lives of military healthcare beneficiaries.

Enrollees in the US Family Health Plan must live in specific, ZIP codes near one of the six not-for-profit healthcare networks through which the Plan delivers care. (See "Where You Can in Enroll" below.) Non-emergency care must be obtained through the US Family Health Plan hospital and doctor network in your area, but the Plan covers medical emergencies wherever you are. In an emergency, your costs for everything above your co-payment will be covered as long as you show your US Family Health Plan member ID card and have the bills sent to the plan. You may use a Military Treatment Facility (MTF) for medical emergencies only if it is the nearest emergency facility when you become acutely ill or severely injured, or if you are referred there by the US Family Health Plan in certain other circumstances.

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Enrollment

You can enroll in the US Family Health Plan anytime and coverage begins on the first day of the month following receipt of your application, when it is received by the 20th of the month. There's no waiting period for benefits. As with any TRICARE Prime program, when you enroll in the US Family Health Plan, you commit to remaining enrolled for 12 months. If you move within the area served by your local Plan, you simply provide the Plan with your new address. If you move to another region served by the US Family Health Plan, your enrollment can be transferred. If moving outside the Plan?s service area, you can transfer your enrollment to the regional TRICARE Prime program, and any enrollment fees paid will be transferred.

The US Family Health Plan enrollment fees are the same as for TRICARE Prime non-active enrollees: $230 for one person or $460 for a family. If you are 65 or older, you need not carry Medicare Part B to join the US Family Health Plan, but the Plan recommends that you enroll in Part B when eligible. That?s because your US Family Health Plan enrollment fees and co-pays (except prescription drug co-pays) will be waived, and you"ll have coverage for end-stage renal disease.

Where You Can Enroll in the USFHP

Enrollment in the US Family Health Plan is offered through the networks of community-based hospitals and physicians listed below. Contact the one in your area if you"d like to enroll in the Plan.

  • Johns Hopkins Medicine (1-800-801-9322) -- serving Maryland, Washington D.C., and parts of Pennsylvania, Virginia and West Virginia
  • Martin's Point Health Care (1-888-241-4556) -- serving Maine, Vermont, New Hampshire and northern New York
  • Brighton Marine Health Center (1-800-818-8589) -- serving Massachusetts, including Cape Cod, plus Rhode Island and northern Connecticut
  • St. Vincent Catholic Medical Centers (1-800-241-4848) -- serving parts
    of New York, all of New Jersey, eastern Pennsylvania and southern Connecticut
  • CHRISTUS Health (1-800-678-7347) -- serving southeast Texas and southwest Louisiana
  • Pacific Medical Centers (1-888-958-7347) -- serving the Puget Sound area of Washington State.

 

For more information, call 1-800-748-7347, or visit the US Family Health Plan Web site at www.usfamilyhealthplan.org.

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