Looking for 2018 Benefits & Costs?

Understand the TRICARE® Options

TRICARE is a health care program managed by the Defense Health Agency (DHA) that provides comprehensive coverage to uniformed service members and their families.

Choose TRICARE Prime® From Johns Hopkins USFHP

As a member of Johns Hopkins USFHP, you’ll get all the TRICARE Prime benefits—including full medical and mental health services, prescription drug coverage, and preventive and routine care—plus extras like discounted services, care management, dental cleanings, and more.

Active-duty family members pay no enrollment fees or out-of-pocket costs for any type of care received through the Johns Hopkins provider network.

TRICARE Prime Benefits

Cost for Active-Duty
Family Members

Cost for Retirees and their
Family Members / Survivors

Group A* / Group B**
Group A*
Group B**

Annual Enrollment Fees

$0

$297 individual
$594 family

$360 individual
$720 family

Annual Deductibles

$0

$0

$0

Outpatient Services (subject to medical review)

Cost for Active-Duty
Family Members

Cost for Retirees and their
Family Members / Survivors

Group A* / Group B**
Group A*
Group B**

Preventative visit

$0

$0

$0

Office Visits (Primary Care)

$0

$20

$20

Specialty office visits

$0

$30

$30

Maternity care
(prenatal, postnatal)

$0

$0

$0

Well-child care (birth to age 6)

$0

$0

$0

Routine physical examinations6

$0

$0

$0

X-ray and lab tests1

$0

$0

$0

Ambulatory surgery
(same day)

All surgical procedures (regardless of where they are performed; excluding some venipuncture and fetal monitoring procedures) and birthing centers (prenatal care, outpatient delivery, and postnatal care)

$0

$61

$61

Physical Therapy
(when medically necessary)

$0

$30

$30

Cardiac Rehabilitation

$0

$0

$30

$30

Inpatient Services (subject to medical review)

Cost for Active-Duty
Family Members

Cost for Retirees and their
Family Members / Survivors

Group A* / Group B**
Group A*
Group B**

Hospitalization
(semi-private room and board)

$0

$154/admission

$154/admission

Physician services

$0

$0

$0

General nursing services

$0

$0

$0

Diagnostic tests including lab and X-ray

$0

$0

$0

Operating room, anesthesia and supplies

$0

$0

$0

Medically necessary supplies and services

$0

$0

$0

Physical therapy (when medically necessary)

$0

$0

$0

Mental Health Services (subject to medical review)

Cost for Active-Duty
Family Members

Cost for Retirees and their
Family Members / Survivors

Group A* / Group B**
Group A*
Group B**

Outpatient care individual

$0

$30/visit

$30/visit

Outpatient group / family therapy

$0

$30/visit

$30/visit

Partial hospitalization, mental health

$0

$30/visit

$30/visit

Inpatient hospital psychiatric care

$0

$154/admission

$154/admission

Substance Abuse Treatment (subject to medical review)

Cost for Active-Duty
Family Members

Cost for Retirees and their
Family Members / Survivors

Group A* / Group B**
Group A*
Group B**

Outpatient care individual

$0

$30/visit

$30/visit

Outpatient group / family therapy

$0

$30/visit

$30/visit

Inpatient services (up to 7 days for detoxification per year)

$0

$154/admission

$154/admission

Inpatient rehabilitation

$0

$30/visit

$30/visit

Other Service (subject to medical review)

Cost for Active-Duty
Family Members

Cost for Retirees and their
Family Members / Survivors

Group A* / Group B**
Group A*
Group B**

Ambulance, outpatient ground5 (when medically necessary)

$0

$41/occurrence

$41/occurrence

Ambulance outpatient air5 (when medically necessary)

$0

$20/occurrence

$20/occurrence

Dental Care (basic preventative)

Reduced fees

Reduced fees

Reduced fees

Durable medical equipment

$0

20%

20%

Emergency room services2 (including out of the area)

$0

$61

$61

Urgent Care Center

$0

$30

$30

Routine eye examination (1 per Plan year)

$0

$0

$0

Radiation / chemotherapy office visits

$0

$30

$30

Prescription drug co-pays(up to a 30-day supply - Walgreens Retail)

$11 generic
$28 brand name
$53 non-preferred brand name

$11 generic
$28 brand name
$53 non-preferred brand name

$11 generic
$28 brand name
$53 non-preferred brand name

Prescription drug co-pays(up to a 90-day supply for maintenance medications - Home Delivery & Walgreens Retail)

$7 generic
$24 brand name
$53 non-preferred brand name

$7 generic
$24 brand name
$53 non-preferred brand name

$7 generic
$24 brand name
$53 non-preferred brand name

Skilled nursing facility care

$0

$30/day

$30/day

Home health care (part-time skilled nursing care)

$0

$0

$0

Out of area (emergency services only)

$0

$60

$60

Catastrophic cap7 (Maximum out-of-pocket expense per family)

$1,000/enrollment year (Group A*)
$1,028/enrollment year (Group B**)

$3,000/enrollment year

$3,598/enrollment year

*For enlistment or appointment prior to January 1, 2018 / **For enlistment or appointment after January 1, 2018
1
If lab services are provided on the same day as the office visit and a co-pay is collected for the visit, no additional co-pay will be collected. No co-pay will be collected when services are billed and provided as clinical preventative services. Exceptions: Co-pay may be required for certain radiation oncology, vascular and pulmonary procedures and studies. Contact Customer Service for details.
2
Unless you are admitted to the hospital, in which case only the inpatient co-payment applies.
3
Prescription drug availability is limited to drugs prescribed by a Plan provider and covered as a Plan benefit. Availability of non-emergency prescriptions when out of the area is also limited. Over-the-counter medications and supplies are not covered. Retail vendors for prescriptions are Rite Aid and Walgreens pharmacies.
4
Outpatient treatment following the initial intake evaluation and testing is limited to a maximum of 36 sessions per cardiac event.
5
Upon arrival of the ambulance and member refuses transport, the member is liable/responsible for services rendered.
6
Routine Physical Examinations – while there is no co-pay for a Routine Physical; an office visit co-pay may be assessed if other procedures (not considered routine) are conducted during the examination.
7
Annual premiums do not apply toward the catastrophic cap.

See How TRICARE Plans Compare

Plans

Johns Hopkins US Family Health Plan
A TRICARE Prime® option

TRICARE Select®

Coverage

Active-Duty Family Members

Retirees up to age 65

Active-Duty Family Members

Retirees up to age 65

Annual Premium Fees3

None

$297 ind / $594 fam (Group A*)

$360 ind / $720 fam (Group B**)

None

$0 (Group A*)

$462 ind / $924 fam (Group B**)

Annual Deductible

None

None

Group A*
$50 ind / $100 fam (E1-E4)
$150 ind / $300 fam (E5+)

Group B**
$51 ind / $102 fam (E1-E4)
$154 ind / $308 fam (E5+)

$150 ind / $300 fam (Group A*)

$154 ind / $308 fam (Group B**)

Routine Physical Exam1

$0

$0

$0

$0

Office Visit (Primary Care)
Network Provider

$0

$20

$21 (Group A*)

$15 (Group B**)

$29 (Group A*)

$25 (Group B**)

Specialty Care
Network Provider

$0

$30

$31 (Group A*)

$25 (Group B**)

$41

Emergency Room Visit

$0

$61

$83 (Group A*)

$41 (Group B**)

$111 (Group A*)

$82 (Group B**)

Hospital Admission

$0

$154 per admission

$19.05 per day or $25 per admission, whichever is more (Group A*)

$61 (Group B**)

$250/day up to 25% of hospital charges (Group A*)

$179 per admission (Group B**)

Prescription Drugs-Retail

Walgreens
(up to a 30 day supply)

Any Retail
Network Pharmacy

Generic

$11

$11

$11

$11

Brand Name

$28

$28

$28

$28

Non-Formulary
(unless est. as med. necessity)

$53

$53

$53

$53

Prescription Drugs-
Home Delivery

Home Delivery, Walgreens2
(up to a 90 day supply for maintenance medications)

Home Delivery Only

Generic

$7

$7

$7

$7

Brand Name

$24

$24

$24

$24

Non-Formulary
(unless est. as med. necessity)

$53

$53

$53

$53

Durable Medical Equipment

$0

20% of negotiated fee

15% of negotiated fee (Group A*)

10% of negotiated fee (Group B**)

20% of negotiated fee

Mental Health Outpatient Visit

$0

$30

$31 (Group A*)

$25 (Group B**)

$45

Catastrophic Cap3

$1000/family per plan year (Group A*)

$1028/family per plan year (Group B**)

$3000/family per plan year (Group A*)

$3598/family per plan year (Group B**)

$1000/family per plan year (Group A*)

$1028/family per plan year (Group B**)

$3000/family per plan year (Group A*)

$3598/family per plan year (Group B**)

*For enlistment or appointment prior to January 1, 2018 / **For enlistment or appointment after January 1, 2018
1
Includes screening mammogram, blood pressure, immunizations, and counseling services.
2
Johns Hopkins has elected to extend the same lower home delivery copay to medications used for management of chronic conditions and filled at a community Walgreens pharmacy.
3
Annual premiums do not apply toward the catastrophic cap.