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.