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If you are wondering how to make the most of your health care, we are here to answer all your questions.
If you can't find an answer to your question below, try the Advanced FAQs.
Is the Plan separate from TRICARE or part of TRICARE?
The Johns Hopkins US Family Health Plan is separate from TRICARE, but has been selected by the Department of Defense to be a provider of TRICARE Prime. As a Johns Hopkins US Family Health Plan member, you receive all the benefits offered by the DoD's TRICARE Prime program, plus the medical expertise of Johns Hopkins Medicine and additional advantages and features at no extra cost. It has already proven to be a winning combination. The US Family Health Plan has served the health care needs of military beneficiaries in this area since 1993, under an earlier contract with the DoD. When TRICARE, the three-option military health care program, was implemented, the DoD contracted with the USFHP to be a TRICARE Prime designated provider.
How much does the program cost?
For active-duty family members there are no enrollment fees. For military retirees who do not carry Medicare Part B and retiree family members are required to pay an enrollment fee. Enrollment fees are:
Individual rates - $282.60 (yearly) / $70.65 (quarterly) / $23.55 (monthly)
Family rates - $565.20 (yearly) / $141.30 (quarterly) / $47.10 (monthly)
Am I eligible to become a member of the Johns Hopkins US Family Health Plan?
To be eligible for membership in the Johns Hopkins US Family Health Plan, you must be under age 65 and registered on the DEERS (Defense Enrollment Eligibility Reporting System) database. You also must have a valid military I.D. and keep your DEERS records up to date. To find out more about DEERS eligibility, call the DSO directly at 1-800-538-9552.
What kind of medical care is covered?
The Johns Hopkins US Family Health Plan is a TRICARE Prime option modeled after a health maintenance program (similar to an "HMO"). This means that members select a medical provider who acts as a primary care manager, working with the member to oversee their entire health care, including referrals to specialty care. The US Family Health Plan provides a comprehensive range of preventive, diagnostic and treatment services, including dental and vision discounts. Hospital stays and emergency care are covered when deemed medically necessary. Medical care while traveling is also covered, as long as it is authorized by your primary care provider and reported in a timely fashion. If you would like more details about what is covered, please call our Customer Service Department at 410-424-4528 or 1-800-808-7347.
We're a military family and we move often. Is this plan national?
The US Family Health Plan is a contracted benefit for military beneficiaries and retirees through the Department of Defense. The operational benefit of this managed care plan is the affordability of a program designed to minimize out-of-pocket costs. Therefore, the program is offered through six plans nationally:
- Seattle, Washington
- Houston, Texas
- Portland, Maine
- Boston, Massachusetts
- Staten Island, New York
- Baltimore, Maryland
If you move or transfer to another area with a US Family Health Plan contractor, you may continue your coverage in the Plan. However, if you move to an area outside one of these serviced by the plan, you must choose a different TRICARE option for your medical coverage.
I already have health insurance through my employer. Why do I need this coverage?
This Plan requires that you report any other health insurance you carry to the Customer Service office when enrolling. The TRICARE Prime benefit requires that any medical claims be filed against your primary insurance plan first, and only then using TRICARE funds to pay your medical bills. After your health insurance pays, the Johns Hopkins US Family Health Plan will pay any eligible balance up to the allowable charge. If you change your insurance coverage, or if you obtain commercial insurance coverage after joining the Johns Hopkins US Family Health Plan, you must report it by calling our Customer Service Department at 410-424-4528.
Are there co-pays?
Yes. All TRICARE Prime programs have co-pays, cost shares and enrollment fees, which are set by the DoD. Active-duty family members are not required to pay co-pays (except for prescription drugs). Retirees who are 65 or over and can provide evidence of current Medicare Part B premium payments are not required to pay co-pays (except for prescription drugs).
Are prescriptions covered under US Family Health Plan?
Yes. You may obtain your prescriptions at any of the 5,100 Rite Aid pharmacies nationwide or through home delivery. For the location of a Rite Aid pharmacy near you, call 1-800-748-3243 or visit www.riteaid.com.
Home delivery is available for up to a 90-day supply of approved medications through Rite Aid at Wyman Park. With home delivery you enjoy the convenience of free delivery to your home or any designated address. Home delivery is best suited for medications you take on a regular basis. To obtain your prescription through home delivery, complete the mail order form (found at www.hopkinsmedicine.org/usfhp/members_visitors/member_forms) and send it in with your new prescription or, for a refill, with your prescription number, plus a check or credit card number for your co-payment.
Note: You may not obtain prescriptions from a military treatment facility while enrolled in the USFHP. Prescriptions that originated at a military treatment facility may not be transferable to Rite Aid pharmacies.
What are the co-pays for prescriptions?
The co-pay for prescription drugs at Rite Aid retail is $10 for Generic drugs, $24 for Brand Name drugs and $50 for Non-Formulary drugs for a 30-day supply. For Home Delivery and Rite Aid retail up to 90-day supply (maintenance medications), the Co-pays are $0 for Generic drugs, $20 for Brand Name drugs and $49 for Non-Formulary drugs.
Are co-pays required for preventive services?
Preventive services or screenings do not require a co-pay as long as the services are performed following the schedule recommended by TRICARE. For example, mammograms are recommended every two years for women age 40 to 50. When this test is performed on that schedule, no co-pay is required.
Additionally, co-pays are not required for nurse visits, and lab and X-ray services. If these services are provided in conjunction with an office visit with your primary care manager or a specialist, then only the office co-pay will be collected. However, X-ray services provided independent of a physician visit do require a co-pay.
How long is the enrollment commitment?
POnce you enroll in the Plan, you are required to make an enrollment commitment for a 12-month period.
How do I find a primary care provider?
Use the following link to find a Primary Care doctor, Participating Hospital, and Specialists.
If you need additional assistance, contact Customer Service at 410-424-4528 or 1-800-808-7347.
Are there any exclusions or limitations to coverage that I should know about?
Generally, services covered include those considered medically necessary by your physician. Major limitations include:
- Services not considered medically necessary or clinically appropriate for diagnosis and treatment as determined by a physician
- Services or procedures that are experimental or of a research nature, except for approved NCI trials
- Any services (including vaccinations) provided for employment, licensing, immigration, recreational travel, or other administrative reasons
- Care or supplies not furnished or prescribed by a Plan provider
- Cosmetic, plastic, or reconstructive surgery not related to medical treatment
- Most custodial or convalescent care (caring for someone’s daily needs, such as eating, dressing and simple bandage changes) in an institution or at home
- Routine dental care and dental X-rays; treatment of teeth, gums, alveolar process or gingival issues; cranial mandibular disorders, and other issues related to the joint. (Call United Concordia at 1-866-357-3304 for information on discounts provided by US Family Health Plan Dental Plan)
- Services provided or charges incurred prior to the effective date of coverage under the Plan
- Services provided or received after the date your coverage is terminated under the Plan
Note: This list is not complete and other limitations may exist.
If you have specific questions about limitations, please call the Customer Service Department at 410-424-4528 or 1-800-808-7347.
I have a doctor I would like to keep but he is not in the Johns Hopkins US Family Health Plan network. What can I do?
Like all managed care plans, the Johns Hopkins US Family Health Plan requires members to use providers in their contracted network. This allows the Plan to keep the costs of your medical care down and is the reason why the Plan is an affordable health care plan. If you go outside the network, you will be responsible for the costs associated with your care. If you choose to do that, you may find that another TRICARE option, either TRICARE Standard or Extra, would be better for you.
Is there a limit to the number of active-duty family members and/or retirees who are accepted into the Johns Hopkins US Family Health Plan?
I have a Medicare supplement. Can I use it while I'm enrolled in the Johns Hopkins US Family Health Plan?
No. Once you become a Johns Hopkins US Family Health Plan member, you are expected to receive ALL your health care through the Plan. You must not use your Medicare Part A or Part B or any Medicare supplement.
May we use a military treatment facility while enrolled in the Johns Hopkins US Family Health Plan?
No. Under the Johns Hopkins US Family Health Plan you are unable to use military treatment facilities. The only exceptions to this limitation are if you have an acute medical emergency and the military treatment facility is closest to you.
I have a prescription drug plan through AARP. Can I still use it?
No. All prescriptions must go through Rite Aid Pharmacy.