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US Family Health Plan

Summary of Benefits

  • 2022 USFHP Summary of Benefits

Claims & Reimbursement Forms 

  • USFHP Medical Reimbursement Form
  • USFHP OOA and RX Reimbursement Form

Enrollment Applications

  • USFHP TRICARE Prime East Enroll/Disenroll PCM Change Form (PDF)
  • USFHP TRICARE TYA Enrollment Application (PDF)

Legal Documents

  • Form 2001: Notification of Appointment of Personal Representative (PDF)
  • TX Out-of-hospital DNR (PDF)
  • TX Statutory Advance Medical Directive (PDF)
  • TX Statutory Durable Power of Attorney (PDF)
  • US Family Health Plan Privacy Notice (PDF)

Member Resources

  • Child Well-care and Immunization Recommendations (PDF)
  • 2022 USFHP Member Handbook (PDF)
  • USFHP Appeals and Processing Form (PDF)

Pharmacy Resources

  • USFHP MaxorPlus DoD Mail Order Form (PDF)
  • Maxor Pharmacy Benefits Booklet 

Provider & Pharmacy Directory

Provider Search Tools

  • Online Searchable Provider Directory

 

2022

Southeast Texas and Louisiana

  • 2022 USFHP Provider & Pharmacy Directory (PDF)

Houston Texas

  • 2022 USFHP Provider & Pharmacy Directory (PDF)

South Texas

  • 2022 USFHP Provider & Pharmacy Directory (PDF)

Northeast Texas

  • 2022 USFHP Provider & Pharmacy Directory (PDF)

Other

  • 2022 USFHP Provider & Pharmacy Directory (PDF)

If you don’t see what you’re looking for, contact us or call 1-844-282-3100. We can help you find the plans, forms and resources you need.

Last Updated: 05/25/2022

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