Frequently Asked Questions

Yes, it is a full TRICARE Prime^® option. The Department of Defense has contracted with Johns Hopkins as a TRICARE Prime designated provider of the US Family Health Plan in this area. As a member of the Plan, you will receive all the benefits offered by TRICARE Prime, plus the medical expertise of Johns Hopkins Medicine at no extra cost. It has proven to be a winning combination — just ask our members.

If you are a TRICARE-eligible active-duty family member, retiree, or a retiree family member, under age 65 and are registered in DEERS to receive military health benefits, you may be eligible to join today. See if you live in our service area.

Members who joined USFHP before Sept. 30, 2012 can remain with the plan after they turn 65. View our Turning 65 FAQ for more information on how your USFHP coverage continues with Medicare enrollment.

If you joined the plan on or after Oct. 1, 2012, you will be disenrolled automatically. Your TRICARE option will be TRICARE for Life (TFL), and you must enroll in Medicare to maintain your TRICARE eligibility.

Open Season is an annual period when you can enroll in a health insurance plan for the next year. With TRICARE, Open Season will occur each fall, beginning on the Monday of the second full week in November to the Tuesday of the second full week in December. Find out more about Open Season.

As a member of the US Family Health Plan, you can choose your very own personal primary care manager at any one of our locations. For specialty care you can also choose any of our local participating specialists and hospitals, including The Johns Hopkins Hospital.

Use our  Find a Doctor  tool to choose your own PCM. Call the practice to verify that they take the insurance and are accepting new patients. Then call the USFHP Enrollment department at 410-424-4780 or login to HealthLINK@Hopkins to change your PCM in the system.

You can find a PCM through our Provider/ Doctor Directory Search. This search tool allows you access to find a provider by location and provider type. For assistance using the Provider/ Doctor Directory Search, a “Helpful Tips” guide is provided on the page as well.

Talk to your PCM about your needs and request a referral to see a specialist. You will have a choice of seeing a network specialist in your community or selecting any participating world-renowned Johns Hopkins physicians.

Certain medical services and supplies require approval before they will be covered by your plan, such as specialty medical care, inpatient mental health treatment or inpatient substance-abuse treatment. Your Schedule of Benefits indicates which services, supplies or medications require prior authorization. All prior authorization requests are coordinated through your physician’s office, so your provider must ask for and receive approval before you receive care. Johns Hopkins USFHP will review the service, drug or equipment to determine the necessity or appropriateness of the services being authorized. If prior authorization is not given, then coverage for care, services or supplies may be limited or denied. Any costs for denied services that were the result of an in-network provider failing to receive prior authorization are not your responsibility. For more information on prior authorization guidelines, refer to your USFHP Member Handbook.

A referral is a written order from your primary care manager (PCM) giving you permission to see a specialist or receive certain medical services. Before you can see a specialist and be covered for that care, you will need a referral from your PCM. For information on getting a referral for care, refer to your USFHP Member Handbook.

Site of service is a term used to indicate the facility in which you receive care. Many surgical procedures can be performed safely in an outpatient hospital setting, such as an ambulatory surgery center (ASC). Certain procedures require prior authorization when performed in an outpatient hospital setting. For information on covered outpatient services, refer to your USFHP Member Handbook.

Some medications require prior authorization from our plan before they can be dispensed by your pharmacy. This helps us ensure that your prescriptions are medically necessary. To determine if a medication requires a prior authorization, use the TRICARE Pharmacy Formulary Search Tool. To initiate a prior-authorization for medications, your provider must complete and fax the Prior Authorization form to the Johns Hopkins Health Plans Pharmacy Review department at 410-424-4037. Information about covered medications, medication prior authorization requirements and related prior authorization forms are available here.

Your USFHP member ID card will be your prescription drug card. Just take it to the nearest Walgreens Phar­macy or use our convenient mail order program. Find the Pharmacy Home Delivery forms in Plan Documents. When you travel you may use any Walgreens nationwide.

No. Since the DoD will be paying the USFHP for all your care, including prescription drugs, you must agree to use the USFHP’s contracted pharmacy, Walgreens, and network providers while enrolled in the Plan — otherwise, the government would be paying twice. If you decide at some point to disenroll, you can resume full use of the military treatment facility, if available.

Emergency care is covered wherever you are. In the area, out of state, even outside of the country, you’ll have the security of knowing you are covered. Simply obtain the care you need and let us know as soon as possible. Emergencies that do not result in a hospital admission require a copay (for retirees only).

Non-emergency medical care requiring prompt attention but may not require life-saving care from a hospital emergency room physician. Urgent Care is available after hours, weekends and holidays for minor health concerns, such as but not limited to: ear infections, sprained ankles, rashes, pinkeye, allergic reactions, respiratory infections, and cold, flu, and sinus symptoms.

• Walk-in primary care – call your PCM before seeking care. Most PCM offices have evening or extended hours.
• Johns Hopkins OnDemand Virtual Care for no-appointment after-hours telehealth care.

All TRICARE Prime benefits are covered, but some require prior authorization or have certain restrictions that are listed with the benefits chart.

The TRICARE manual contains comprehensive information about TRICARE Prime benefits. The manual is available at www.TRICARE.mil.

The Plan provides language and American sign language interpreters for medical appointments when your physician cannot provide this service.

Care management is a free service that provides members with complex or chronic illnesses with ongoing support,
monitoring, and even health coaches to help them understand and better manage their conditions. To speak to someone about this service, call a customer service representative at 410-424-4528 or toll-free 800-808-7347.