US Family Health Plan- A TRICARE Prime option

What US Family Health Plan- A TRICARE Prime option does

US Family Health Plan at SVCMC, Inc. is a not-for-profit TRICARE Prime Designated Provider sponsored by the U.S. Department of Defense, operating under the legal entity Saint Vincent's Catholic Medical Center affiliates and headquartered in New York City. Founded circa 1981/1989, the organization has served military families, uniformed services retirees under age 65, survivors, and certain former spouses for over 35 years across the Tri-State area (New York, New Jersey, Pennsylvania) and Connecticut. The core product is the TRICARE Prime health plan, delivered under a fixed-eligibility government contract through a network of contracted hospitals, physicians, pharmacies, and ancillary providers.

The operational platform consists of 24/7 Member and Provider web portals, a mobile app on iOS and Android, HEDIS-based quality reporting to the Defense Health Agency, and population health programs including Health Risk Assessments and Social Determinants of Health screening that feed a Care Management Team. USFHP runs dedicated Health Benefits Consultants (many themselves veterans or military family members) who conduct enrollment outreach at National Guard armories, VA facilities, libraries, and military bases. Vendor partners handle adjacent functions: VtylOne for mail-order pharmacy, Davis Vision and United Healthcare for enhanced vision and dental benefits, AdaptHealth for durable medical equipment, Toney Healthcare for mental health utilization review (effective January 1, 2026), and WellDoc for member-facing health apps.

Revenue mechanics are driven by the DoD/TRICARE Prime contract, with pharmacy and minor co-pays from members as a secondary stream. Active-duty family members carry no enrollment fees, co-pays, or deductibles (except prescriptions), while retirees pay modest annual enrollment fees and per-service co-pays. Pricing for pharmacy and enhanced benefits is published and standardized. The organization holds URAC health plan accreditation, maintains HIPAA and URAC-aligned compliance programs, and reports HEDIS/NCQA quality metrics annually. The business model is fundamentally a regional government-contracted managed care plan with no commercial payer exposure.

Name

US Family Health Plan- A TRICARE Prime option

Legal name

USFHP at SVCMC, INC.

Website

https://usfhp.net

Company type

Private

Founded year

1989

Operating status

Operating

Headcount range

101–250 employees

Short description

US Family Health Plan at SVCMC is a not-for-profit TRICARE Prime Designated Provider, sponsored by the U.S. Department of Defense, delivering comprehensive government-funded healthcare to military families, retirees under 65, survivors, and eligible former spouses across New York, New Jersey, Pennsylvania, and Connecticut.

Ownership category

akta.pro rank

Product category

Military Managed Healthcare Services

NAICS

Direct Health and Medical Insurance Carriers (524114), Direct Life, Health, and Medical Insurance Carriers (52411)

SIC

Hospital & Medical Service Plans (6324), Accident & Health Insurance (6321)

akta.pro primary industry

Veterans/Military Hospitals & Federal Health Systems (HLAFAAAH)

Keywords

• TRICARE Prime health
• Military family healthcare
• Managed care services
• Government health insurance
• Military health benefits

Headquarters

HQ city

New York

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2C

Offering type

Services

Cost components

Personnel, Operations, Infrastructure, Marketing or Sales, Others

Revenue model

1. TRICARE Prime Government Contract Revenue: USFHP operates as a TRICARE Prime Designated Provider under a Department of Defense sponsored contract. The plan receives government funding to provide healthcare to military beneficiaries. Active duty family members have no enrollment fees, copayments, or deductibles except for prescriptions. Retirees pay low annual enrollment fees and modest co-pays for medical services.
2. Pharmacy Services: Mail order pharmacy through VtylOne for maintenance medications, with cost-sharing through tiered copays for generic, brand-name, and non-formulary drugs. Local pharmacy prescriptions also available at participating pharmacies.

Pricing tiers

Go-to-market motion3 records

Distribution channels4 records

Marketing channels5 records

Core offering

USFHP operates a TRICARE Prime Designated Provider health plan under contract with the Department of Defense, delivering comprehensive healthcare benefits to military families, retirees, survivors, and qualifying former spouses across the Tri-State area (NY, NJ, PA) and Connecticut. The plan provides routine and specialty care, hospitalization, urgent/emergent care, preventive services, mental health, and prescription drug coverage, supported by an in-house care management team, population health programs, and a regional provider network.

Product overview

US Family Health Plan (USFHP) is a TRICARE Prime health plan sponsored by the Department of Defense that provides comprehensive healthcare to military families and retirees. The core offering is the TRICARE Prime Health Plan, which delivers the full TRICARE Prime benefit including routine doctor visits, specialty care, hospitalization, urgent/emergent care, preventive health services, mental health services, and prescription coverage through the TRICARE Uniform Formulary. USFHP offers multiple add-on modules including three Enhanced Benefits options (Vision through Davis Vision, Preventive Dental through United Healthcare, and Gym Reimbursement), an Integrative Health Benefits package (acupuncture, chiropractic, massage therapy), and Pharmacy Benefits via VtylOne mail order and local pharmacies. Supporting platforms include the Member Portal and Provider Portal for 24/7 web-based self-service, while care management is delivered through the Care Management Program, Population Health Program, and Mental Health Care Management team. The company also partners with AdaptHealth for medical equipment, Toney Healthcare for utilization management, and offers WellDoc health apps. USFHP's service delivery is supported by webinars, Q&A sessions, Health Risk Assessments, and wellness toolkits covering chronic disease and prevention topics.

Differentiator

Problem solved

Functional benefit

Products and services

• TRICARE Prime Health Plan A TRICARE Prime military health care option sponsored by the Department of Defense that delivers the full TRICARE Prime benefit including routine doctor visits, specialty care, hospitalization, urgent and emergent care, preventive health services, mental health, and prescription drug coverage. Available to active duty family members, military retirees under 65, survivors, and certain former spouses residing in the Tri-State area (NY, NJ, PA) and Connecticut.
• Care Management Program A nurse care management service providing personalized assistance to help members and caregivers understand healthcare decisions, access needed care, and develop individualized care plans. The program is composed of multiple healthcare professionals working collaboratively with members.
• Population Health Program A program addressing members' health and well-being through physical, mental, and social determinants of health, focusing on wellness, preventive health, and chronic disease management using Health Risk Assessments and Social Determinants of Health screening tools.
• Mental Health Care Management A team of licensed social workers providing personalized mental health care management services, assisting members with accessing care, understanding mental health options, and developing care plans to manage mental health needs.
• Mental Health Services Comprehensive mental health services including referrals, care management, crisis support, substance use disorder treatment, and an integrated wellness library covering physical, emotional, and social health topics. Effective January 1, 2026, services transition to the internal USFHP team and Toney Healthcare for authorizations.
• Integrative Health Benefits A combined package of 24 integrative health benefits annually available at a $20 copay per visit, including acupuncture (6 visits), chiropractic care (12 visits), and massage therapy (6 visits).

Quantifiable outcome

• Same-day urgent care appointments available
• +2 more outcomes

Named customers3 records

Segments4 records

Ideal customer profiles2 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration10 records

Feature4 records

Partnerships

Eight partnerships are on record, tiered core.

• AdaptHealthcoreTechnology or IntegrationAdaptHealth provides comprehensive home medical equipment including ventilation, oxygen therapy, sleep therapy (CPAP, Bilevel), walk-aids, wheelchairs, hospital beds, CPM devices, custom mobility/scooters, diabetes/CGM, urology supplies, breast pumps, orthotics, enteral nutrition, and wound care. Contact: 844-679-1577.
• Toney HealthcarecoreImplementation/ SI/ Consulting PartnerToney Healthcare serves as the utilization review partner for mental health services, processing prior authorization requests. Contact: 866-560-9069, Fax: 866-337-8690, Mon-Fri 8am-5pm. Effective January 1, 2026, all mental health referrals and authorizations route through this partner.
• Davis VisioncoreTechnology or IntegrationDavis Vision provides vision benefits as one of USFHP's three enhanced benefit options. Members choosing this benefit receive eyeglasses/frames and/or contact lenses at $0 cost. Access via client code 3258 at davisvision.com/clients/.
• United Healthcare (UHC)coreTechnology or IntegrationUnited Healthcare provides preventative dental services as one of USFHP's three enhanced benefit options. Members receive professional teeth cleaning, comprehensive examinations, emergency services, oral evaluation, cleaning, bitewings and X-rays at $0 cost.
• VtylOne (formerly MaxorPlus)coreTechnology or IntegrationVtylOne is the mail order pharmacy partner for maintenance medications. Members can order refills online at VytlOneMembers.com, or mail/fax/phone refills. Initial fills require paper form with doctor's prescription.
• LabCorpcoreTechnology or IntegrationLaboratory services partner for diagnostic testing.
• BioReferencecoreTechnology or IntegrationLaboratory services partner for diagnostic testing.
• Quest DiagnosticscoreTechnology or IntegrationLaboratory services partner for diagnostic testing.

Scale indicators2 records

Recent moves6 records

Expansion highlights5 records

Broad incumbents

• Kaiser Permanente: Integrated nonprofit managed care plan combining insurance, care delivery, and population health. Comparable in operating an integrated, regionally organized health plan model with strong care management and member portal/app capabilities, though serving a much broader civilian population.
• Health Net Federal Services: Managed care contractor for TRICARE and other federal health programs. Comparable as a large-scale administrator of DoD-sponsored health benefits with overlapping operational capabilities (claims, network, utilization management).
• Humana Military: TRICARE East region managed care support contractor and large government health programs operator. Comparable as a managed care organization administering DoD-sponsored military health benefits, though at larger scale and broader geographic scope than USFHP.
• TriWest Healthcare Alliance: TRICARE West region managed care support contractor administering military health benefits on behalf of the DoD. Comparable as a managed care organization serving military beneficiaries, though broader in scope and population than USFHP at SVCMC.

Direct peers

• Pacific Medical Centers (PacMed): Operates a TRICARE Prime US Family Health Plan designated provider in the Pacific Northwest (Washington State). Closely comparable nonprofit health system running the same designated-provider model for military families in its region.
• Johns Hopkins Medicine: Operates the Johns Hopkins US Family Health Plan designated provider serving military beneficiaries in Maryland and surrounding areas. Direct comparable as another nonprofit academic medical center running a TRICARE Prime designated-provider plan under the same DoD program.
• CHRISTUS Health: Operates a TRICARE Prime US Family Health Plan designated provider serving the South Texas region. Direct comparable nonprofit health system running the same DoD-sponsored USFHP program under identical regulatory and contract structure.
• Brighton Marine Health Center: Operates one of the six TRICARE Prime US Family Health Plan designated providers, serving military beneficiaries in the Boston/Massachusetts area. Directly comparable DoD-sponsored health plan for uniformed services families with the same community-based enrollment motion.
• Martin's Point Health Care: Operates one of the six TRICARE Prime US Family Health Plan designated providers, serving military families in the New England region. Closely comparable business model: government-contract managed care plan for uniformed services beneficiaries with similar benefit structure and community-led enrollment.

Others

• Anthem Blue Cross Blue Shield (Federal Employee Program): Administers the Federal Employee Health Benefits Program for federal civilian employees, including many federal/defense-affiliated workers. Adjacent comparable in administering government-sponsored health benefits at scale, though for civilian federal employees rather than uniformed services beneficiaries.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat4 records

Key risks6 records

Key highlights6 records

Customer concentration

• LinkedInlinkedin.com/company/us-family-health-plan--a-tricare-prime-option

Compliance6 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles2 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about US Family Health Plan- A TRICARE Prime option