US Family Health Plan

Summary of Benefits

• 2023 USFHP Summary of Benefits

Claims & Reimbursement Forms 

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

Enrollment Applications

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

• 2023 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

 

2023

Southeast Texas and Louisiana

• 2023 USFHP Provider & Pharmacy Directory (PDF)

Houston Texas

• 2023 USFHP Provider & Pharmacy Directory (PDF)

South Texas

• 2023 USFHP Provider & Pharmacy Directory (PDF)

Northeast Texas

• 2023 USFHP Provider & Pharmacy Directory (PDF)

Other

• 2023 USFHP Provider & Pharmacy Directory (PDF)

  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.