US Family Health Plan
BENEFITS OVERVIEW
- No deductibles or cost shares for in-network preventive services
- Annual physicals, eye exams, laboratory tests, prenatal and postnatal maternity care at no additional cost
- Emergency and urgent care available anywhere in the world
- Patient advocates who will make sure you’re getting the best care possible during hospital stays
See Active-Duty Summary of Benefits or Retiree Summary of Benefits document in right column for benefit information.
COSTS OVERVIEW
Your copays and out-of-pocket maximums are determined by the status of your sponsor:
- Group A: Sponsor’s initial enlistment or appointment occurred before January 1, 2018.
- Group B: Sponsor’s initial enlistment or appointment occurred on or after January 1, 2018.
See Active-Duty Summary of Benefits or Retiree Summary of Benefits document in right column for cost information.
Important notes: These fees might be different for survivors of a service member who died while on active duty or for medically retired service members and their families
MEDICARE PART B PARTICIPANTS
Applicants who show proof that they pay monthly Medicare Part B premiums are exempt from the enrollment fees.
- For Active-Duty and Retirees with Medicare Part B: See Active-Duty Summary of Benefits document in right column for copays, etc.
- For Retiree, Survivors, and Family Members: See Retiree Summary of Benefits document in right column for copays, etc.
The US Family Health Plan includes a comprehensive pharmacy benefit, which covers your prescription drugs.
WHAT DRUGS ARE COVERED?
The TRICARE formulary is a list of medications that are covered under the Martin’s Point US Family Health Plan benefit. The formulary is established by the Department of Defense Pharmacy and Therapeutics (P&T) Committee.
See if your prescriptions are covered
HOW COVERAGE WORKS
- One-time medications, or medications you need to begin taking immediately, can be filled at any participating retail pharmacy.
- Long-term, maintenance medications you take regularly must be filled through the Martin’s Point Mail-Order Pharmacy or at the Martin’s Point Health Care Center Pharmacies in Portland, Maine, and Portsmouth, New Hampshire.
COSTS
Prescription drug costs vary depending on what type of medication it is (generic, brand name, or nonformulary) and whether you are using a retail pharmacy or the mail-order pharmacy.
TRICARE® encourages the use of generic prescription drugs. Generics have the same high quality, potency, and reliability as brand name drugs at a much lower cost.
OVERVIEW
The Martin’s Point US Family Health Plan requires use of the Martin’s Point Mail-Order Pharmacy or Martin’s Point Health Care Center Pharmacies (on-site) for most maintenance medications.
With the mail-order pharmacy you get a 90-day supply for the same or lower price you would pay for a 30-day supply at a retail pharmacy, and your prescription is mailed directly to you at no charge.
Some restrictions apply. Some liquids, refrigerated items, and controlled substances cannot be mailed. Please refer to your Member Handbook (PDF) for more details.
WAYS TO REFILL MEDICATIONS
Please be sure the pharmacy has a method of payment on file to avoid delays in your prescription order: 1-800-707-9853
Online Refill Request (Preferred Method)
- Collect your prescription containers to identify your prescription number(s)
- Remember to use your primary Zip Code when entering information
- Use the comments section for any information that may be helpful in processing your prescription
- When you are ready, please fill out our Online Refill Request form.
Refill by Phone: 1-800-707-9853
- Collect your prescription containers and your credit card information
Refill by Mail:
- Mail to:
Martin’s Point Mail-Order Pharmacy
PO Box 9746
Portland, ME 04104
Please allow up to 14 days for mail order medications to reach you.
Our pharmacy staff is happy to answer your questions and provide the help you need to get started. Call 1-800-707-9853, 8:00 am–5 pm, Monday through Friday.
Download the Mail-Order Pharmacy Quick Start Guide (PDF)
Download an Alternate Address Form (PDF)
View All Pharmacy Notices Here
DRUGS NEWLY RELEASED TO MARKET
It is rare, but possible, to have differences in the search tool and coverage of your prescription drug. This will happen when your prescription medication is newly released to market, and the P&T committee has not yet made a coverage decision. The plan will make a formulary coverage decision based on clinical and financial determinations. When the DOD P&T committee makes a determination, the plan will then adjust the coverage, if needed, to match the P&T decision.
NONFORMULARY DRUG LIST
Nonformulary medications, as well as the criteria for medical necessity, are established by the DoD P&T Committee. If you meet the criteria for medical necessity, you may receive the nonformulary medication at a lower cost share. Have your provider call 1-888-732-7364 to start the authorization process. Please refer to the formulary search tool to check that your medication is on the formulary.
MEDICATIONS REQUIRING PRIOR-AUTHORIZATION
Some medications require a prior authorization before they can be dispensed. Obtaining this authorization is necessary before the prescription can be paid for by the US Family Health Plan. Please refer to the formulary search tool to check that your medication requires prior authorization.
Call Member Services at 1-888-674-8734 or talk to your doctor for more information.
MEDICATIONS REQUIRING STEP THERAPY
Step therapy is used to provide safe, clinically effective, and cost-effective medication in drug categories that have multiple agents with comparable therapeutic effectiveness. Generic drugs are commonly used as the preferred medication due to their established safety and effectiveness for treating a given condition. This means that medications requiring step therapy are only covered if you have already tried certain medications and those did not work. Please refer to the formulary search tool to check if your medication requires step therapy. Call Member Services at 1-888-674-8734 or talk to your doctor for more information.
- Excluded drugs listed in the Noncovered Category
- Drugs prescribed for cosmetic purposes
- Fluoride preparations
- Food supplements
- Homeopathic and herbal preparations
- Multivitamins (some prenatal vitamins are covered with a prescription)
- Over-the-counter products (except insulin and diabetic supplies)
Dental benefits ARE NOT offered through the US Family Health Plan. You may purchase dental coverage as a separate offering available through TRICARE.
Learn more and purchase/enroll in dental benefits through this separate TRICARE offering:
REFERRALS AND YOUR POINT-OF-SERVICE
The US Family Health Plan is a managed care program with two benefit levels: Your TRICARE®️ Prime benefit level and the Point-of-Service (POS) option. When seeking specialty care, the benefit level you use is determined by the type of referral on file. Except in emergencies, most specialty services require a referral.
Follow this link for more information: Point of Service Benefit for US Family Health Plan.
For information on the US Family Health Plan's Authorizations and Referrals, visit the Authorizations and Referrals section in the member portal.
OVERVIEW
The US Family Health Plan covers outpatient and inpatient care related to the treatment of diagnosed mental health or substance abuse conditions. The Behavioral Health Care Program (BHCP) and its affiliated providers provide all mental health services to members of the US Family Health Plan.
Referrals are not required for mental health and substance abuse visits with a participating network provider. However, you must arrange for this care through the Behavioral Health Care Program.
A BHCP Customer Service Representative can be reached at all times by calling, toll-free, 1-888-812-7335.
Because the US Family Health Plan is based on the TRICARE Prime universal benefits, there are some limitations to the mental health and substance abuse benefits.
For additional information about the mental health benefit or to obtain names of participating network mental health professionals, please contact the Behavioral Health Care Program, toll-free, at 1-888-812-7335.
ADDITIONAL HELPFUL RESOURCES
Mental Health
Substance Abuse
Talk to a trained nurse anytime, 24 hours a day, 7 days a week, to answer any questions about symptoms, injuries, or illness.
Call 1-800-574-8494 and choose option #2 if you need to know:
- What to do about your child’s fever
- If a cut requires stitches
- If you should head to the ER or wait until morning to see your doctor
- General information about a condition, medication, or other health concerns
Submit your question online. Send a secure message to the nurses. You will have the option to either receive an email response (within 24 hours) or have a nurse call you back directly (within an hour).
This service is provided by Carenet Healthcare Services in partnership with Martin's Point. This service is not intended to take the place of your primary care provider.
As a US Family Health Plan member, you and your family can call a Health Coach for information and guidance about your health. This service is provided at no additional charge to you.
Health Coaches are specially trained health care professionals such as nurses, dietitians, and respiratory therapists, who can work with you over the phone to:
- Manage a health condition like diabetes or heart disease
- Develop an exercise plan that fits your life
- Help you quit smoking
Call 1-800-574-8494 and choose option #1. 8 am–4:30 pm Monday through Friday. After hours, you can leave a voice message and we will call you back the next business day.
US Family Health Plan members receive eyewear discounts up to 35% off retail prices through our partnership with EyeMed Vision Care.
Use this discount program to save on your purchase of a new set of glasses or on additional eye care services that are over and above your free annual routine eye exam provided through the US Family Health Plan.
FIND YOUR DISCOUNT PLAN
2. Scroll toward the bottom of the page and click on "FIND MY DISCOUNT PLAN"
3. Click on the letter "U" and select "USFHP Martin's PT Discount (3021937)"
FIND AN EYE DOCTOR
2. Click on "Find an eye doctor" at the top of the page
3. Under "Network," click on "Choose your network" and select "Access Network"
4. Click on "USE MY LOCATION" or enter a ZIP code
Receive discounts of 10–30% off complementary and alternative medical treatments through our partnership with WholeHealth Living Choices through tivity health.
Access beneficial treatment options you may otherwise not be able to afford, or enjoy discounts on services you may already use such as:
- Acupuncture
- Chiropractic
- Massage Therapy
- Naturopathy
- Nutritional Counseling
- Tai Chi
- Yoga
See a list of participating providers.
NOTE: You will need to set up a user name and password to access the provider list. For assistance, please contact WholeHealth directly at 1-800-274-7526.
Members have access to substantial discounts on hearing aids and hearing aid batteries through our partnership with Amplifon.
The Amplifon program should be used only to purchase hearing aids and batteries.
Important note: Hearing tests and medical services should be through a US Family Health Plan network provider. Call Martin’s Point US Family Health Plan Member Services at 1-888-674-8734 for a network provider near you.