US Family Health Plan provides the full TRICARE Prime benefit, including doctor visits, hospitalizations, emergency care, and prescription medications to nearly 15,000 members in southern New England. Tufts Health Plan, our third-party administrator, provides claims processing, referral management, and member-relations services.

The Plan is available to families of active-duty service members and to retired service members and their families.

Important Updates

April 2024. Please remember that referrals to specialists expire at the end of every year (December 31). We ask members to request their Primary Care Provider to submit a new referral at the beginning of every Plan Year for specialty services, including physical therapy, occupational therapy, and speech therapy.

Network specialty providers should provide clearly legible specialty care consultation or referral reports, operative reports, and discharge summaries to the beneficiary’s Primary Care Provider.  All consultation or referral reports, operative reports, and discharge summaries should be provided to the Primary Care Provider within 30 calendar days.

January 2024.  Information for providers related to COVID-19, including therapeutics, who may benefit from them, guidance as to locations, and more, is continually updated at Mass.gov.

January 2024. VA/DoD Clinical Practice Guidelines are used in health care to improve patient care as a potential solution to reduce inappropriate variations in care. Go to healthquality.va.gov to understand the guidelines and be aware when they're new. 

May 2020. Because of the COVID-19 pandemic, we’ve been receiving questions about Telehealth/Telemedicine services and how they should be billed with US Family Health Plan.  

Please note that we are accepting GQ, GT, and 95 modifiers.

We now also provide codes for coverage of audio-only telephonic office visits by our network providers: (1) Evaluation and management visits represented by CPT 99441-3; 98966-8; HCPCS G2012; (2) other services such as psychotherapy when reported by the appropriate CPT and/or HCPS codes, and other appropriate coding such as place of service or modifiers; and (3) subsequent, new, or re-numbered codes as appropriate for medically or psychologically necessary care and treatment eligible for reimbursement and cost-sharing.

Administrative services (for example, making appointments or verifying prescriptions) are not separately reimbursed services.  

These measures are effective as of May 12, 2020 and expire upon the expiration of the President’s national emergency for the COVID-19 outbreak.

If you have any questions, please call us at 1.800.818.8589.