Network Copayments
Active duty family members and their families pay nothing out-of-pocket for any type of care. Retired service members, their families and all others pay the following copayments for care.
| Type of Care | Network Copayment |
| Ambulance Services | $20 per occurrence |
| Ambulatory (same day) Surgery | $25 per visit |
| Behavioral Health |
Outpatient:
Hospitalization:
|
| Clinical Preventive Services | $0 per visit |
| Durable Medical Equipment, Prosthetics, Orthotics, and Supplies | 20% of the negotiated fee |
| Emergency Room Visit |
$30 per visit |
| Home Health Care | $0 |
| Hospice Care | $0 |
| Hospitalization | $11 per day ($25 minimum) |
| Lab & X-Ray Services | $12 per visit (unless billed as a clinical preventive service) |
| Maternity Care |
Office visits & hospitalization for delivery planned in a hospital in an inpatient setting. This is one global fee.
Office visits for delivery planned in a TRICARE-authorized birthing center.
Office visits for delivery planned at home or another setting.
|
| Newborn Care | $11 per day ($25 minimum) |
| Outpatient Visit | $12 per visit |
| Skilled Nursing Care |
$11 per day ($25 minimum) |
Last Modified:May 29, 2012
PrintContact
US Family Health Plan
1-800-74-USFHP
(1-800-748-7347)
www.usfhp.com
