Get to Know Your US Family Health Plan Coverage
The US Family Health Plan (USFHP) is a TRICARE Prime option. It’s available through networks of community-based, not-for-profit health care systems in six areas of the U.S. If you’re enrolled in USFHP, you can’t get care at military hospitals or clinics or use military pharmacies. USFHP follows the same rules as TRICARE Prime. That means you can participate in TRICARE Open Season, or change your enrollment after experiencing a Qualifying Life Event (QLE). If you want to switch from USFHP to TRICARE Prime, you don’t need to wait for open season or a QLE to do so.
“USFHP enrollees receive the same benefits offered by the TRICARE Prime program,” said Vickie Laperle, USFHP program manager at the Defense Health Agency. “They get access to advanced medical care and services in the communities where they live.”
As outlined in the TRICARE Plans Overview, you must live in one of the designated areas to enroll in USFHP. These areas include:
- Brighton Marine Health Center: Serves Massachusetts, including Cape Cod, as well as Rhode Island and parts of Northern Connecticut
- Christus Health US Family Health Plan: Serves Southeast Texas and Southwest Louisiana
- Martin’s Point Health Care US Family Health Plan: Serves Maine, New Hampshire, Vermont, and parts of New York state
- Pacific Medical Centers: Serves the Puget Sound area of Washington state
- Saint Vincent’s Catholic Medical Centers US Family Health Plan: Serves parts of New York (including New York City), all of New Jersey, Southeast Pennsylvania, and Western Connecticut
- Johns Hopkins Medicine: Serves Maryland, District of Columbia, Delaware, and parts of Virginia, West Virginia, and Pennsylvania
Learn more about these USFHP designated areas.
Who can enroll in USFHP?
To enroll in USFHP, you must live in a designated USFHP area and also meet eligibility requirements. Active duty family members (ADFMs), retirees, and their family members are among those who are eligible. Visit US Family Health Plan on the TRICARE website for a complete listing of beneficiaries who can participate.
How do you enroll?
Like TRICARE Prime, enrollment is required. You have three options to enroll in USFHP:
- Online: Go to the milConnect website. Click the “Sign In” button at the top of the page. Then click the “Benefits” tab and then click “Beneficiary Web Enrollment (BWE).” Once you log in, select the “Medical” tab to enroll.
- Phone: You can call USFHP at 1-800-748-7347. Or, call a USFHP site directly.
- Mail: Mail your enrollment form to the appropriate USFHP site. Find the mailing address on the form.
Coverage begins the day the designated provider receives your completed enrollment application. You may transfer from one region to another without an interruption in benefits. If you move to one of the other areas across the country where USFHP is available, you may transfer your enrollment without an interruption in benefits. If you disenroll from USFHP or move out of one of the USFHP service areas, you regain eligibility for other TRICARE health plans.
You don’t have to reenroll every year to continue USFHP coverage, but certain events will cause you to be disenrolled. All members of a family don’t have to enroll in USFHP. Learn more about split enrollments.
How do you get care with USFHP?
You’ll choose a primary care provider in the health care system where you’re enrolled. Your provider will refer you for specialty care. In most cases, your provider will file your claims when you see a provider approved by USFHP.
You don’t have access to care at military hospitals and clinics or from TRICARE-authorized network providers and Medicare providers when enrolled in USFHP.
“USFHP includes prescription drug coverage,” said Laperle. “But you won’t be able to use military pharmacies to fill your prescriptions.”
If you’re enrolled in USFHP, you’re not eligible for the TRICARE Pharmacy Program. You must use USFHP pharmacy providers. USFHP members may fill one-time or urgent care prescriptions at a retail network pharmacy or at one of their plan’s onsite pharmacies. Long-term or maintenance prescriptions are filled through the USFHP mail order pharmacy service.
What are the costs associated with USFHP?
ADFMs pay no enrollment fees and no out-of-pocket costs for any type of care received from a USFHP provider. All others pay annual enrollment fees and copayments, which are the same as for TRICARE Prime. There’s no annual deductible.
Visit US Family Health Plan to learn more about the key features of this plan. Getting to know your health plan will help you make informed choices and take command of your health.
Last Updated 2/11/2020