{"id":488,"date":"2018-02-13T14:57:40","date_gmt":"2018-02-13T19:57:40","guid":{"rendered":"https:\/\/sandbox0.foxtrotdev.com\/?page_id=488"},"modified":"2026-06-22T10:26:14","modified_gmt":"2026-06-22T14:26:14","slug":"plan-documents","status":"publish","type":"page","link":"https:\/\/sandbox0.foxtrotdev.com\/?page_id=488","title":{"rendered":"Plan Documents"},"content":{"rendered":"

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<\/a>

Member Handbook<\/h2>

Refer to your member handbook to understand the best way to take advantage of the services and benefits of Johns Hopkins USFHP.<\/p><\/div>

Download Handbook<\/a><\/p><\/div><\/div>[\/vc_column][\/vc_row][vc_row mobile_padding_top=”mobile-padding-top-40″][vc_column][vc_column_text css=””]<\/p>\n

Information Authorizations:<\/h2>\n

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Appointment of Representative and Authorization to Disclosure Information:<\/h4>\n

Use this form to authorize someone you trust to act on your behalf in a TRICARE appeals or hearing process. It also allows Johns Hopkins USFHP to share your health information with that person. You can revoke this authorization at any time.[\/vc_column_text]

Download<\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div>
[vc_column_text]<\/p>\n

Authorization for Release of Health Information\u2014Specific Request:<\/h4>\n

Like the \u201cstanding\u201d version of this form, you can choose someone you trust to have \u201cone-time\u201d access to a specific part of your personal health information. Don\u2019t worry, if you don\u2019t fill out this form, Johns Hopkins USFHP will continue to keep your health information protected and private.[\/vc_column_text]

Download<\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div>
[vc_column_text css=””]<\/p>\n

Authorization for Release of Health Information\u2014Standing:<\/h4>\n

This form lets you choose someone you trust to have access to your health information. You can also decide how much of your personal health information you want that person to know. Don\u2019t worry, if you don\u2019t fill out this form, Johns Hopkins USFHP will continue to keep your health information protected and private.[\/vc_column_text]

Download<\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div>[\/vc_column][\/vc_row][vc_row][vc_column][vc_empty_space][vc_column_text css=””]<\/p>\n

Reimbursements and Allotments<\/h2>\n

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Medical Reimbursement:<\/h4>\n

If you are ever required to pay a provider, you can submit this form, along with a copy of your receipt, for reimbursement.[\/vc_column_text]

Download<\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div>
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Travel Reimbursement Guidelines:<\/h4>\n

This document explains how you can qualify for travel reimbursement, what expenses are covered and how to submit your request.[\/vc_column_text]

Download<\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div>
[vc_column_text css=””]<\/p>\n

Enrollment Fee Allotment Authorization:<\/h4>\n

Fill out this form to authorize an allotment to be taken from your military retirement pay in order to cover the USFHP enrollment fee.[\/vc_column_text]

Download<\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div>[\/vc_column][\/vc_row][vc_row][vc_column][vc_empty_space][vc_column_text css=””]<\/p>\n

Pharmacy<\/h2>\n

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Compound Drug Prior Authorization Form:<\/h4>\n

Compound Drug Prior Authorization Form is utilized to request prior authorization for a compounded drug that rejects at the pharmacy.[\/vc_column_text]

Download<\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div>
[vc_column_text css=””]<\/p>\n

Pharmacy Mail Service:<\/h4>\n

Fill out this form if you would like to have your prescriptions mailed to your home. Mail Service is available for up to a 90-day supply of approved medications through Walgreens Mail Service (formerly AllianceRx Walgreens Prime Pharmacy)<\/span>. Mail Service is best suited for medications you take on a regular basis.[\/vc_column_text]

Download<\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div>
[vc_column_text]<\/p>\n

Pharmacy Prescription Reimbursement Claim Form:<\/h4>\n

In the event that you fill a prescription at a non-network pharmacy due to an emergent situation, you may seek reimbursement for incurred cost.[\/vc_column_text]

Download<\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div>
[vc_column_text css=””]<\/p>\n

Pharmacy Prior Authorization:<\/h4>\n

In order to ensure certain prescribed medications (i.e. brand-name drugs with generic equivalents; drugs not listed in the formulary; drugs that require prior authorization, step therapy, or medical necessity) will be covered, your doctor must request and receive approval from our plan.[\/vc_column_text]

Download<\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div>[\/vc_column][\/vc_row][vc_row][vc_column][vc_empty_space][vc_column_text css=””]<\/p>\n

Other<\/h2>\n

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DD 2527 Third-Party Liability Form:<\/h4>\n

USFHP partners with the Department of Defense Recoveries to investigate third-party claims. DHA requires a third-party liability form to be completed when you or a family member is injured due to another party\u2019s actions and TRICARE has received the claim from you or your medical care provider for medical services required. Please complete the form when applicable.[\/vc_column_text]

Download<\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div>
[vc_column_text]<\/p>\n

Representation for Legal Responsibility of a Minor Child:<\/h4>\n

If you are over 18 years old, filling out this form will give you the right to represent and make health care information-related decisions about a minor child who is 17 years old or younger. The adult representative can only be the minor\u2019s parent, step-parent, legal guardian, or kinship caregiver.[\/vc_column_text]

Download<\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div>
[vc_column_text]<\/p>\n

Other Health Insurance (OHI) Form<\/h4>\n

USFHP members are required to submit information about other health insurance policies by which they are covered. If you have not reported this already, please complete and mail this form to us. Call 800-808-7347<\/a> if you have any questions.[\/vc_column_text]

Download<\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div>
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Transition to Plan Form<\/h4>\n

New members and their dependents who are transitioning from another plan and have health care services scheduled, are renting any durable medical equipment or are managing a complex condition are advised to complete a Transition to Plan Form. USFHP will make sure you have the authorizations and support you need while you transition to the plan.<\/p>\n

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Download<\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div>[\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"

[vc_row el_class=”gutters-0″][vc_column width=”2\/3″][\/vc_column][vc_column width=”1\/3″ el_class=”col-absolute”][\/vc_column][\/vc_row][vc_row mobile_padding_top=”mobile-padding-top-40″][vc_column][vc_column_text css=””] Information Authorizations: [\/vc_column_text][\/vc_column][\/vc_row][vc_row el_class=”gutters-0″][vc_column width=”2\/3″ el_class=”columns-2″][\/vc_column][\/vc_row][vc_row][vc_column][vc_empty_space][vc_column_text css=””] Reimbursements and Allotments [\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column width=”2\/3″ el_class=”columns-2″][\/vc_column][\/vc_row][vc_row][vc_column][vc_empty_space][vc_column_text css=””] Pharmacy [\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column width=”2\/3″ el_class=”columns-2″][\/vc_column][\/vc_row][vc_row][vc_column][vc_empty_space][vc_column_text css=””] Other [\/vc_column_text][\/vc_column][\/vc_row][vc_row mobile_padding_bottom=”mobile-padding-bottom-40″][vc_column 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