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 $20 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 $62 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 $156 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 $156 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 $156 Per Admission
Inpatient Rehabilitation (Up To 21 Days Per Year) $0 $156 Per Admission
Other Services Active Duty Family Members & Retirees with Medicare Part B Retirees without Medicare Part B
Ambulance Service (When Medically Necessary) $0 $41 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 $62 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: $1,044/year)

Retirees: $3,000 Per Enrollment Year (Group B:  $3,655/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: $300 Per Year – Individual
$600 per year – Family TRICARE
Young Adult: $376.00 Per Month
Group B: Monthly or Annual Payment $0 Retirees:  $366 Per Year – Individual
$732 per year  – Family TRICAREYoung Adult: $376.00 Per Month

pricing is subject to change, and further information is available at www.tricare.mil/cos.