See what’s covered!
These costs are effective 1/1/2018.
| Service | Cost |
|---|---|
| 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. |
| Hospice Care | $0 |
| 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 Delivery: $150 |
| Maternity (office visits for delivery planning in a TRICARE-authorized birthing center) | Office Visits: $0 Delivery: $60 |
| Maternity (office visits for delivery planned at home or other setting) |
Primary Care Provider: $20 per visit Specialty Care Provider: $30 per visit |
| Newborn Care | $0 |
| Outpatient Visit | Primary Care: $20 per visit Specialty Care: $30 per visit |
| Skilled Nursing (Inpatient) | $30 per day |
| Urgent Care | $30 per visit |
Enhancements
The US Family Health Plans offer discounts on some services, such as vision, dental, alternative medicine, and hearing.