US Family Health Plan

Effective until December 31, 2020. 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 $25|$50 individual $49.50| $61 family
Annual Deductible $0 $0
Catastrophic Cap Per Year $1,000| $1,044 $3,000|$3,655
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 $31
Emergency Room Visit $0 $62
Urgent Care Center $0 $31
Ambulatory Surgery $0 $62
Ambulance Service (not including air) $0 $41
Durable Medical Equipment $0 20%
Inpatient Admission $0 $156 per admission
Inpatient Skilled Nursing / Rehab Admission $0 $31 per day
Pharmacy Benefits Active Duty Family Members Retirees & Retiree Family Members
Generic Perscription Drugs Mail Order $10
Retail $13
Mail Order $10
Retail $13
Brand Name Drugs Mail Order $29
    Retail:$33

Mail Order $29
Retail: $33

Non-Formulary Drugs Mail Order: $60
Retail: $60
Mail Order: $60
Retail: $60
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 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.

Last Updated: 11/04/2019