Looking for 2019 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

Premium Fees

$0

$289.08 individual / $578.16 family

Outpatient Services (subject to medical review)

Cost for Active-Duty Family Members
Cost for Retirees and their Family Members / Survivors

Office visits

$0

$20

Specialty office visits

$0

$30

Maternity care
(prenatal, postnatal)

$0

$0

Well-child care (birth to age 6)

$0

$0

Routine physical examinations6

$0

$0

X-ray and lab tests1

$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

$60

Physical Therapy
(when medically necessary)

$0

$30

Cardiac Rehabilitation

$0

$30

Inpatient Services (subject to medical review)

Cost for Active-Duty Family Members
Cost for Retirees and their Family Members / Survivors

Hospitalization
(semi-private room and board)

$0

$150/admission

Physician services

$0

$0

General nursing services

$0

$0

Diagnostic tests including lab and X-ray

$0

$0

Operating room, anesthesia and supplies

$0

$0

Medically necessary supplies and services

$0

$0

Physical therapy (when medically necessary)

$0

$0

Mental Health Services (subject to medical review)

Cost for Active-Duty Family Members
Cost for Retirees and their Family Members / Survivors

Outpatient care individual

$0

$30/visit

Outpatient group / family therapy

$0

$30/visit

Partial hospitalization mental health

$0

$30/visit

Inpatient hospital psychiatric care

$0

$150/admission

Substance Abuse Treatment (subject to medical review)

Cost for Active-Duty Family Members
Cost for Retirees and their Family Members / Survivors

Outpatient care individual

$0

$30/visit

Outpatient group / family therapy

$0

$30/visit

Inpatient services

$0

$150/admission

Inpatient rehabilitation / Partial hospitalization program

$0

$30/day

Other Service (subject to medical review)

Cost for Active-Duty Family Members
Cost for Retirees and their Family Members / Survivors

Ambulance services5 (when medically necessary)

$0

$40/occurrence

Dental Care - basic preventive

Reduced fees

Reduced fees

Durable medical equipment

$0

20%

Emergency room services2 (including out of the area)

$0

$60

Urgent care center

$0

$30

Routine eye examination (1 per year)

$0

$0

Radiation/chemotherapy office visits

$0

$30

Prescription drug co-pays3 (Walgreens)
(up to a 30-day supply)

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

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

Prescription drug co-pays3 (Home delivery only)
(up to a 90-day supply)

$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

Home health care (part-time skilled nursing care)

$0

$0

Out of area (emergency services only)

$0

$60

Catastrophic cap7

$1,000/enrollment year

$3,000/enrollment year

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 preventive 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

$289.08 individual / $578.16 family

None

None

Annual Deductible

None

None

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

$150 ind / $300 fam

Routine Physical Exam1

$0

$0

$0

$0

Office Visit (Primary Care)
Network Provider

$0

$20

$27

$35

Specialty Care
Network Provider

$0

$30

$34

$45

Emergency Room Visit

$0

$60

$87

$116

Hospital Admission

$0

$150 per admission

$18.60 per day or $25 per admission, whichever is more

$250 per day, or up to 25% hospital charge, whichever is less, plus 20% separately billed services

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

20% of negotiated fee

Mental Health Outpatient Visit

$0

$30

$34

$45

Catastrophic Cap3

$1000 per family per plan year

$1000 per family per plan year

$1000 per family per plan year

$1000 per family per plan year

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.