USFHP Forms, Provider Directory & Resources

TRICARE Costs

• 2026 TRICARE Costs

Member Resources

• 2026 USFHP Member Handbook (PDF)
• USFHP Grievance, Reconsideration, and Appeal Request Form (PDF)
• Member Advisory Committee (MAC) Meeting Information

US Family Health Plan beneficiaries have access to a toll-free 24-hour nurse line. Call the number 800-455-9355 to speak with a registered nurse at any time, day or night. If you are experiencing a medical emergency, please dial 911.

Claims & Reimbursement Forms 

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

Enrollment Applications

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

Legal Documents

• Authorization to Disclose Personal Information (PDF)
• DD Form 2870, Authorization for Disclosure of Medical or Dental Information (PDF)
• LA Physician Orders for Scope of Treatment (PDF)
• LA Advance Directive for Mental Health Treatment (PDF)
• LA Durable Financial Power of Attorney (PDF)
• TX Out-of-Hospital DNR (PDF)
• TX Statutory Advance Medical Directive (PDF)
• TX Statutory Durable Power of Attorney (PDF)

Pharmacy Resources

• VytlOne Prescription Mail Order Form (PDF)
• VytlOne Pharmacy Benefits Booklet (PDF)

Provider & Pharmacy Directory

While you can choose to go to an out-of-network provider or specialist, your care will be subject to a higher cost and will not count toward your annual out-of-pocket max. Your handbook contains more details about this option, known as Point-of-Service (POS).

• 2026 USFHP Provider & Pharmacy Directory - Texas (PDF)
• 2026 USFHP Provider & Pharmacy Directory - Louisiana (PDF)

Provider Search Tools

• Online Searchable Provider Directory

TRICARE® is a registered trademark of the Department of Defense, Defense Health Agency. All rights reserved.
Last Updated 9/9/2026