US Family Health Plan

Effective until December 31, 2019. Rates are adjusted annually. Group A enlisted or appointed before Jan.1, 2018. Group B enlisted or appointed on or after Jan. 1, 2018. 

Premium Benefit Active Duty Family Members Retirees & Retiree Family Members
Monthly Enrollment Fees (GRP. A | GRP. B)             $0 $24.75|$30 individual $49.50| $60 family
Annual Deductible $0 $0
Catastrophic Cap Per Year $1,000| $1,028 $3,000|$3,598
Point of Service Option Deductible $300 individual
$600 family
$300 individual
$600 family
Doctors Visits Active Duty Family Members  Retirees & Retiree Family Members 
Preventive Care Visit $0 $0
Primary Care Visit $0 $20
Specialty Care Visit $0 $30
Emergency Room Visit $0 $61
Urgent Care Center $0 $30
Ambulatory Surgery $0 $61
Ambulance Service (not including air) $0 $41
Durable Medical Equipment $0 20%
Inpatient Admission $0 $154 per admission
Inpatient Skilled Nursing / Rehab Admission $0 $30 per day
Pharmacy Benefits Active Duty Family Members Retirees & Retiree Family Members
Generic Perscription Drugs Mail Order $7
Retail $11
Mail Order $7
Retail $11
Brand Name Drugs Mail Order $24
Retail: $28 

Mail Order $24
Retail: $28

Non-Formulary Drugs Mail Order: $53
Retail: $53 
Mail Order: $53
Retail: $53
Non-Covered Drugs                 Excluded from TRICARE coverage (member pays full cost)  
Enhancements / Extras / Value Added Discounts  Active Duty Family Members Retirees & Retiree Family Members
 Vision Care  FREE annual eye exam
 Vision Discount  Discounts on glasses and lenses at select providers
 Dental Care Discount Discounts on services at select providers
 Hearing Care  Free annual hearing exam plus 20% off hearing aids at select providers
Transportation Transportation to covered medical services (up to 8 round trips or 16 one-way trips)

*Negotiated fees: The fees network providers and participating non-network providers have agreed to accept for covered services.