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You can enroll in Johns Hopkins US Family Health Plan by either downloading the application and submitting via mail or fax, or through the TRICARE Beneficiary Web Enrollment website.


Meet our Baltimore Based Field Services Team

If you have any questions or need assistance with any of the forms below, please
contact our Field Services Team.

Hear what Laurie, a Johns Hopkins US Family Health Plan member, has to say about enrolling in the Plan.

 

Enrollment (Mail or Fax)

Complete the steps below and download the application as well as other forms that you may need. The files are in Adobe Acrobat PDF format. Only the Enrollment Application Form (DD2876) will allow you to fill it in online and print it. The other forms must be printed and then hand written. If you are not sure how to download these documents to your computer, please view these Instructions

Start the enrollment process here:

View a Step-by-Step Video
We'll guide you on how to fill out the Enrollment Application

Helpful Guide for Enrollment Application
Need help filling out the application? Read this first.

Enrollment Application Form
Remember you can type information into this form before you print it.
Note: Enrollment Fee changes October 1, 2013

TRICARE Young Adult Application Form
Fill out this form if you are also applying for TYA coverage. Current rate: $180/per month.

Automatic Payment Form 
You only need to use this form if you choose monthly premium payment from a savings, checking or credit card account.

Mail or fax your completed forms to:

Johns Hopkins US Family Health Plan
Enrollment Department 
P.O. Box 815
Glen Burnie, MD 21060-0815

Fax: 410-424-4770

Please note: If you want to confirm application receipt or status of your application, please call Customer Service at 800-808-7347.

Online at TRICARE Beneficiary Web Enrollment (BWE)

You will need to log into the Beneficiary Web Enrollment Web site. Depending on who you are, you will log in differently:

  • Active duty service members need a Common Access Card (CAC)
  • Active Duty Family Members need a DoD Self Service Logon (DS Logon)
  • Retired Service Members and Families need a Defense Financial and Accounting Services (DFAS) "myPay" login ID

Go to http://www.tricare.mil/bwe to begin the online enrollment process.

Enrollment Period

Enrollment in the US Family Health Plan is for a 12-month period. At the end of the enrollment period, members are automatically re-enrolled for another 12-month period.

Enrollment Fee

Active-duty family members - $0 
Individual rates - $273.84 (yearly) / $68.46 (quarterly) / $22.82 (monthly) 
Family rates - $547.68 (yearly) / $136.92 (quarterly) / $45.64 (monthly)

You may pay your enrollment fee, if applicable, in one annual payment or quarterly payments. Members will receive notice of when annual or quarterly payment is due. Visa, MasterCard and Discover are all accepted. There is also a convenient automatic payment plan that debits a checking account or credit card account. 

US Family Health Plan members may also use monthly allotments (deductions made by the Department of Defense) from military retirement pay. The deducted amount will be applied automatically to your Plan enrollment fee each month. Monthly deductions will be $22.82 for an individual or $45.64 for a family.

Disenrollment

If you are involuntarily disenrolled because of non-payment, you must wait 12 months before you may re-enroll in the US Family Health Plan.

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