Plan Benefits
Find a full breakdown of your plan with US Family Health Plan below. If you have any further questions about your plan, feel free to give us a call at (800) 241-4848.
| Outpatient Services | Active Duty Family Members & Retirees with Medicare Part B | Retirees without Medicare Part B |
|---|---|---|
| Office Visits | $0 | $21 Per Visit |
| Specialty Visit | $0 | $31 Per Visit |
| Maternity Care (Prenatal, Postnatal) | $0 | $0 |
| Well-Baby Care (Up To Age 6) | $0 | $0 |
| Annual Well-Child Care (Age 6 And Older) | $0 | $0 |
| Annual Physical Examination | $0 | $0 |
| X-Ray and Lab Tests | $0 | $0 |
| Ambulatory Surgery and Procedures, including Anesthesia | $0 | $63 Per Visit |
| Physical Therapy, Occupational Therapy, Speech Therapy | $0 | $31 Per Visit |
| Inpatient Services | Active Duty Family Members & Retirees with Medicare Part B | Retirees without Medicare Part B |
|---|---|---|
| Semi-Private Room and Board | $0 | $158 Per Admission |
| Physician Services | $0 | $0 |
| General Nursing Services | $0 | $0 |
| Diagnostic Tests, Including Lab and X-Ray | $0 | $0 |
| Operating Room, Anesthesia, and Supplies | $0 | $0 |
| Medically Necessary Supplies and Services | $0 | $0 |
| Physical Therapy | $0 | $0 |
| Behavioral Health Services | Active Duty Family Members & Retirees with Medicare Part B | Retirees without Medicare Part B |
|---|---|---|
|
Outpatient Care: Individual
|
$0 | $31 Per Visit |
| Outpatient Care: Group | $0 | $31 Per Visit |
| Partial Hospitalization Mental Health (Up To 60 Days Per Enrollment Year, Subject To Medical Review) | $0 | $31 Per Visit – Individual
$31 Per Visit – Group |
|
Inpatient Hospital Psychiatric Care (Subject To Medical Review)
|
$0 | $158 Per Admission |
| Substance Abuse Treatment | Active Duty Family Members & Retirees with Medicare Part B | Retirees without Medicare Part B |
|---|---|---|
| Outpatient – Group Therapy | $0 | $31 Per Visit |
|
Inpatient Services (Up To 7 Days For Detoxification Per Year)
Maximum of one rehabilitation program per benefit yet, three per lifetime. Detoxification and rehabilitation days count toward the limit for mental health benefits. |
$0 | $158 Per Admission |
| Inpatient Rehabilitation (Up To 21 Days Per Year) | $0 | $158 Per Admission |
| Other Services | Active Duty Family Members & Retirees with Medicare Part B | Retirees without Medicare Part B |
|---|---|---|
| Ambulance Service (When Medically Necessary) | $0 | $42 Per Occurrence |
| Durable Medical Equipment, Medical Supplies, and Prosthetic/Orthotic Devices | $0 | 20% Of Purchase Price Or Monthly Rental Rate |
|
Emergency Room Services
Unless you are admitted to the hospital, in which case only the inpatient co-pay applies. |
$0 | $63 Per Visit |
| Urgent Care Center | $0 | $31 Per Visit |
| Eye Exam/Eyeglass, Annual Preventative (1 Per Enrollment Period) | $0 | $0 |
| Radiation/Chemotherapy Office Visits | $0 | $31 Per Visit |
| Skilled Nursing Facility Care (When Medically Necessary) | $0 | $31 Per Day |
| Home Health Care (Part Time Skilled Nursing Care) | $0 | $0 |
| Pharmacy | Active Duty Family Members & Retirees with Medicare Part B | Retirees without Medicare Part B |
|---|---|---|
|
Retail Pharmacy Drugs (Up To 30 Day Supply)
Prescription drug availability is limited to those covered as a Plan benefit. Over the counter medications are not covered. |
$13 Generic/$33 Brand Formulary/ $60 Brand, Non-Formulary
effective 1/1/2020 |
$13 Generic/$33 Brand Formulary/ $60 Brand, Non-Formulary
effective 1/1/2020 |
| Mail Order Pharmacy Drugs (Up To 90 Day Supply) |
$10 Generic/$29 Brand Formulary/$60 Brand, Non-Formulary
effective 1/1/2020 |
$10 Generic/$29 Brand Formulary/$60 Brand, Non-Formulary
effective 1/1/2020 |
| Catastrophic Cap | Active Duty Family Members & Retirees with Medicare Part B | Retirees without Medicare Part B |
|---|---|---|
| Maximum Out-Of-Pocket Expense Per Family | Active Duty family members: $1,000 Per Enrollment Year (Group B: $1,058/year)
Retirees: $3,000 Per Enrollment Year (Group B: $3,703/year) |
$3,000 Per Enrollment Year |
|
Enrollment Fees
Enrollment Fees are subject to change annually |
Active Duty Family Members & Retirees with Medicare Part B | Retirees without Medicare Part B |
|---|---|---|
| Group A: Monthly or Annual Payment | $0 | Retirees: $303 Per Year – Individual
$606 per year – Family TRICARE Young Adult: $459.00 Per Month |
| Group B: Monthly or Annual Payment | $0 | Retirees: $366 Per Year – Individual
$732 per year – Family TRICARE Young Adult: $459.00 Per Month |
pricing is subject to change, and further information is available at www.tricare.mil/cos.