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US Family Health Plan


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US Family Health Plan Copayments

If you're an active duty family member, you won't pay out-of-pocket for any type of care. All others pay the following copayments:

Type of Care  Cost 
Ambulance Services $20 per occurance
Ambulatory (Same Day) Surgery  $25 per visit 
Behavioral Health


  • $25 (individual visit)
  • $17 (group visit)

Inpatient: $40 per day (no charge for separately billed professional charges)

Clinical Preventive Services  $0
Durable Medical Equipment, Prosthetics, Orthotics & Supplies  20% of the negotiated fee
Emergency Room Visit  $30 per visit
Home Health Care $0
Hospice Care $0
Hospitalization  $11 per day ($25 minimum)
Lab & X-Ray Services $12 per visit (unless billed as a clinical preventive service)
Maternity Care

Global fee for office visits and hospitalization for delivery in a hospital: $11 per day ($25 minimum)

Office visits for delivery planned in a TRICARE-authorized birthing center: $25 per visit

Office visits for deliver planned at home or another setting: $12 per visit

Newborn Care $11 per day ($25 minimum)
Outpatient Visit $12 per visit
Skilled Nursing Care $11 per day ($25 minimum)

Last Updated 9/17/2014