US Family Health Plan

Summary of Benefits

2020 USFHP Summary of Benefits

2021 USFHP Summary of Benefits 

Claims & Reimbursement Forms 

• USFHP Medical Reimbursement Form
• USFHP OOA and RX Reimbursement Form

Enrollment Applications

• USFHP TRICARE Prime East Enroll/Disenroll PCM Change Form (PDF)
• USFHP TRICARE TYA Enrollment Application (PDF)
• USFHP TRICARE 2019 Enrollment Exception Request (PDF)

Legal Documents

• Form 2001: Notification of Appointment of Personal Representative (PDF)
• TX Out-of-hospital DNR (PDF)
• TX Statutory Advance Medical Directive (PDF)
• TX Statutory Durable Power of Attorney (PDF)
• US Family Health Plan Privacy Notice (PDF)

Member Resources

• Child Well-care and Immunization Recommendations (PDF)
• 2021 USFHP Member Handbook (PDF)
• USFHP Appeals and Processing Form (PDF)

Pharmacy Resources

• USFHP MaxorPlus DoD Mail Order Form (PDF)
• Maxor Pharmacy Benefits Booklet 

Provider & Pharmacy Directory

Provider Search Tools

• Online Searchable Provider Directory

Southeast Texas and Louisiana

• 2021 USFHP Provider & Pharmacy Directory (PDF)

Houston Texas

• 2021 USFHP Provider & Pharmacy Directory (PDF)

South Texas

• 2021 USFHP Provider & Pharmacy Directory (PDF)

Northeast Texas

• 2021 USFHP Provider & Pharmacy Directory (PDF)

Other

• 2021 USFHP Provider & Pharmacy Directory (PDF)

 

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If you don’t see what you’re looking for, contact us or call 1-844-282-3100. We can help you find the plans, forms and resources you need.