One TRICARE Prime option, called U.S. Family Health Plan is available to eligible persons who live near selected civilian medical facilities on the East, West and Gulf coasts. The U.S. 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 U.S. Family Health Plan meets the minimum required coverage requirements of the Affordable Care Act.
The following is a summary of the US Family Health Plan:
- U.S. Family Health Plan Overview
- Who Is Eligible
- U.S. Family Health Plan Enrollment
- Where You Can Enroll
US Family Health Plan Overview
The U.S. 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 U.S. 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 Enroll" below.) Non-emergency care must be obtained through the U.S. 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 U.S. 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 U.S. Family Health Plan in certain other circumstances.
Who is Eligible
The U.S. Family Health Plan is available to the following beneficiaries who live in a designated U.S. Family Health Plan area:
- Active duty family members
- Retired service members and their families
- Family members of Activated National Guard/Reserve members
- Non-activated National Guard/Reserve members and their families who qualify for care under the Transitional Assistance Management Program
- Retired National Guard/Reserve members (age 60 and receiving retired pay) and their families
- Medal of Honor recipients and their families
- Qualified former spouses
You can enroll in the U.S. 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 U.S. 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 U.S. 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.
Active duty family members pay no enrollment fees and no out-of-pocket costs for any care as long as care is received from the U.S. Family Health Plan Provider. All others pay annual enrollment fees of $282.60 for an individual or $565.20 for a family and copayments.
|Ambulance Services||$20 per occurance|
|Ambulatory Surgery (Same Day)||$25|
|Behavioral Health (Inpatient)||$40 per day|
|Behavioral Health (Outpatient)||Individual: $25 / Group: $17|
|Clinical Preventive Services||$0|
|DME, Prosthetic Devices, Medical Supplies||20% of the negotiated fee|
|Emergency Services||$30 per visit|
|Home Health Care||$0|
|Hospitalization (Inpatient Care)||$11 per day ($25 minimum charge)|
|Laboratory & X-ray||$0 for ancillary services* / $12 per visit for other radiology services|
|Maternity (office visits & hospitalization for delivery planned in a hospital in an inpatient setting)||$11 per day ($25 minimum charge) Note: this is one global fee for all of the maternity care and delivery.|
|Maternity (office visits for delivery planning in a TRICARE-authorized birthing center)||$25 per visit|
|Maternity (office visits for delivery planned at home or other setting)||$12 per visit|
|Newborn Care||$11 per day ($25 minimum charge)|
|Outpatient Visit||$12 per visit|
|Skilled Nursing (Inpatient)||$11 per day ($25 minimum charge)|
|*Ancillary services include:
Where You Can Enroll in the USFHP
Enrollment in the U.S. 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 (800-808-7347) -- serving Maryland, Washington D.C., and parts of Pennsylvania, Virginia, Delaware, and West Virginia
- Martin's Point Health Care (888-241-4556) -- serving Maine, Vermont, New Hampshire, upstate & northern New York, and northern Pennsylvania
- Brighton Marine Health Center (800-818-8589) -- serving Massachusetts, including Cape Cod, plus Rhode Island and northern Connecticut
- St. Vincent Catholic Medical Centers (800-241-4848) -- serving parts of New York, all of New Jersey, eastern Pennsylvania and southern Connecticut
- CHRISTUS Health (800-678-7347) -- serving southeast Texas and southwest Louisiana
- Pacific Medical Centers (888-958-7347) -- serving the Puget Sound area of Washington State.
For more information, call 800-748-7347, or visit the US Family Health Plan Web site at http://www.usfhp.com.