Extended Care Health Option (ECHO) provides additional financial assistance for certain benefits that are not covered under the TRICARE Prime benefit. This is only available for active duty family members with specific qualifying conditions such as:
- Moderate or severe mental retardation
- A serious physical disability
- A physical or psychological condition that causes the beneficiary to be homebound
Participation in the ECHO program requires application and acceptance by the USFHP Care Management Department.
Eligible beneficiaries must be enrolled in the Exceptional Family Member Program (EFMP). There is no enrollment fee for EFMP. To learn more, contact your service branch’s EFMP representative or visit www.tricare.mil.
ECHO provides benefits not available through the basic TRICARE Prime program and may include:
- Medical and rehabilitative services
- Training to use assistive technology devices
- Special education
- Institutional care when a residential environment is required
- Transportation under certain circumstances
- Assistive services, such as those from a qualified interpreter or translator, for beneficiaries whose visual or hearing impairment qualifies them for ECHO benefits
- Durable equipment, including adaptation and maintenance equipment
- In-home medical services (ECHO Home Health Benefit)
- In-home respite care services
ECHO Costs
Active duty sponsors pay a cost-share based on their pay grade and is separate from other TRICARE program cost-shares (see table below). The monthly cost-share is one fee per sponsor, not per ECHO beneficiary. The cost share is paid to the provider only if ECHO benefits are used during that calendar month.
Pay Grade | Monthly Cost share |
E-1 to E-5 | $25 |
E-6 | $30 |
E-7, O-1 | $35 |
E-8, O-2 | $40 |
E-9, W-1, W-2, O-3 | $45 |
W-3, W-4, O-4 | $50 |
W-5, O-5 | $65 |
O-6 | $75 |
O-7 | $100 |
O-8 | $150 |
O-9 | $200 |
O-10 | $250 |
After the monthly cost share is paid, US Family Health Plan will pay up to $2,500 per calendar month for each ECHO-registered beneficiary for authorized ECHO benefits. If an ECHO beneficiary's costs exceed $2,500 in a calendar month, the sponsor is responsible for paying the additional costs or flexing the Durable Equipment benefit over several months.
Note: The limit on ECHO Home Health (EHHC) benefits is separate and not subject to the $2,500 limit. ECHO cost-shares do not count toward the annual catastrophic cap. Coverage for the EHHC benefit is capped on an annual basis (the cap is equivalent to what TRICARE would pay if the beneficiary resided in a skilled nursing facility and is based on the beneficiary's geographic location).
Authorization
US Family Health Plan must pre-authorize all benefits under TRICARE ECHO.
US Family Health Plan members should contact the Customer Service Department at 410-424-4528 or 1-800-808-7347 or USFHPCustomerService@jhhc.com for additional assistance.
