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Key Features of the US Family Health Plan

TRICARE Prime option offers an additional health care plan referred to as the US Family Health plan which is made available in the networks of not-for-profit health care systems in the six zones of the United States. The applicant needs to be residing in of the designated services to avail benefits under the US Family Health Plan. This is the only program offered under the TRICARE Prime program which offers benefits to the beneficiaries who are 65 years of age or above. This is offered irrespective of the coverage to the beneficiaries under the Medicare Part B.

The six designated centers under the US Primary Health Plan are:

  1. Johns Hopkins Medicine

Service Regions: Washington D.C., Maryland, parts of Delaware, West Virginia and Pennsylvania. Website: www.hopkinsmedicine.org

  1. Martin’s Point Health Care

Service Regions: New Hampshire, upstate and western New York, the northern tier of Pennsylvania, Maine and Vermont Website: www.martinspoint.org

  1. Brighton Marine Health Center

Service Regions: Rhode Island, northern Connecticut, Massachusetts and Cape Cod Website: www.brimarine.org

  1. Vincent Catholic Medical Centers

Service Regions: New York, Southeast Pennsylvania, Western Connecticut and New Jersey Website:  www.svcmc.org

  1. CHRISTUS Health

Serving Regions: Southwest Louisiana and Southeast Texas Website: www.christus

  1. Pacific Medical Center

Serving Regions: Puget Sound area of Washington State Website: www.pacificm

Whenever an enrollment is done under the US Family Health Plan, the applicant doesn’t get to access TRICARE network providers, Military treatment facilities or the Medicare providers. Care is instead provided by a primary care physician who the applicant needs to choose from the network of physicians who are affiliated with the not-for-profit health care systems. The primary care physician offers assistance in getting assistance from the specialists depending upon the case in the designated area.

No enrollment fee has to be paid by the active duty family members. The applicants under the US Family Health Plan don’t have to incur any out-of-pocket costs as long as they are governed by the plan. All other beneficiaries have to make network co-payments and annual enrollment fees.

Type of

Care

Co-payment

 

Outpatient $12 per visit

 

Inpatient

 

$11 per day ($25 minimum Inpatient charge)

 

The US Family Health Plan can be considered by any eligible member living in the six designated centers. It is a robust option offered under the TRICARE Prime program. Enhanced coverage is offered at each location. Further information can be obtained by accessing the link: Error! Hyperlink reference not valid.

An application form needs to be submitted for getting enrolled in the US Family Health Plan, This can be done at any time during the year. The appropriate plan needs to be selected from the list to get the correct enrollment application.

What if the Sponsor dies?

TRICARE continues to offer coverage to the family members of the sponsor if he/she dies after retiring from the active duty. Until and unless widows remarry, they are eligible to avail TRICARE services. Adopted and biological children are eligible to avail benefits till the normal age limits. The surviving members can continue to remain enrolled under the TRICARE Prime program as long as the enrollment fees are paid by them.

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