See what’s covered!
These costs are effective 1/1/2018.
|Annual Deductible||Network Providers: $0
Point-of-Service Option: $300 for individuals, $600 for family
|Ambulance Services||$40 per occurrence|
|Ambulatory Surgery (Same Day)||$60|
|Mental Health (Inpatient)||See TRICARE Mental Health Costs|
|Mental Health (Partial Hospitalization)||See TRICARE Mental Health Costs|
|Mental Health (Outpatient)||See TRICARE Mental Health Costs|
|Clinical Preventive Services||$0 from a network provider|
|DME, Prosthetic Devices, Medical Supplies||20% of the negotiated feeThe discounted rate network providers agree to accept for covered services.|
|Emergency Services||$60 per visit|
|Home Health Care||$0.
Note: You may have separate costs for additional services when receiving home health care. For example, DME, drugs, vaccines, orthotics/prosthetics, and nutritional therapy, among others.
|Hospitalization (Inpatient Care)||Network Hospital: $150 per admission|
|Immunizations||$0 from a network provider|
|Laboratory and X-ray||Ancillary* services: $0
Other Radiology services: $0
|Maternity (office visits and hospitalization for delivery planned in a hospital in an inpatient setting)||Office Visits: $0
|Maternity (office visits for delivery planning in a TRICARE-authorized birthing center)||Office Visits: $0
|Maternity (office visits for delivery planned at home or other setting)||
Primary Care Provider: $20 per visit
Specialty Care Provider: $30 per visit
|Outpatient Visit||Primary Care: $20 per visit
Specialty Care: $30 per visit
|Skilled Nursing (Inpatient)||$30 per day|
|Urgent Care||$30 per visit|
The US Family Health Plans offer discounts on some services, such as vision, dental, alternative medicine, and hearing.