Need to see a specialist? For dates of service 5/1/25 or after, make sure your referrals are in place to avoid higher cost shares.
Posted 06/25/25
Understand your referral requirements
As a valued plan member, please note that effective May 1, 2025, the US Family Health Plan requires an approved referral from your PCP for most specialty care. Without one, claims will be processed at the TRICARE® Point of Service (POS) benefit level—resulting in significantly higher costs, including a $300 individual deductible and 50% cost share.
The POS option offers flexibility to see TRICARE-authorized providers without a referral, but always confirm out-of-pocket costs before choosing this route.
IMPORTANT NOTE: Some services may also require prior authorization for coverage.
Take action today
- Check your Member Portal to confirm we have received and approved a referral that is valid for your date(s) of service before visiting a specialist.
- For any new or ongoing specialty care without an approved referral: Ask your PCP to submit a new electronic referral to the US Family Health Plan before you receive services.
How to check your referral status
You can view your referral status in the Online Member Portal, along with your claims and authorization information.
Need help or have questions? Call Member Services at 1-888-674-8734 (TTY: 711). Taking time to verify your referral can save you unexpected costs.
Sign up today: MartinsPoint.org/MemberPortal
