TRICARE Prime Supplemental Insurance | Rates 2014

Economical Rates
Premiums illustrated are Per Person.
PLAN A Monthly
Check-O-Matic
Quarterly Semi-Annual Annual
Under 40 $12.00 $36.00 $72.00 $144.00
40 - 44 $12.33 $36.99 $73.99 $147.96
45 - 49 $14.67 $44.01 $88.02 $176.04
50 - 54 $18.33 $54.99 $109.98 $219.96
55 - 59 $22.33 $66.99 $133.98 $267.96
60 - 65 $25.33 $75.99 $151.98 $303.96
Each Child* $10.67 $32.01 $64.02 $128.04

PLAN B Monthly
Check-O-Matic
Quarterly Semi-Annual Annual
Under 40 $14.00 $42.00 $84.00 $168.00
40 - 44 $14.67 $44.01 $88.02 $176.04
45 - 49 $17.67 $53.01 $106.02 $212.04
50 - 54 $22.67 $68.01 $136.02 $272.04
55 - 59 $27.67 $83.01 $166.02 $332.04
60 - 65 $31.67 $95.01 $190.02 $380.04
Each Child* $13.00 $39.00 $78.00 $156.00

Change of Policy Premiums: The Plan Underwriter has the right on each Premium Due Date to change the rate at which premiums will be calculated. This includes the right to change premium rates for a benefit that applies to all individuals of the same class, age, plan and effective date. Rates may be changed based on claims experience of the Policy. We will give the Policyholder or Organization notice of any change at least 45 days before the Premium Due Date on which it is to become effective

Premiums increase based on your effective date of coverage and as you move from one age bracket to another. The insurance company reserves the right to change premiums on a group wide basis.

*Newborn children not named in your enrollment form are automatically covered from birth for injury or sickness, including treatment of congenital defects, prematurity and birth abnormalities, for 31 days. YOU MUST NOTIFY THE PLAN ADMINISTRATOR IN WRITING AND PAY THE ADDITIONAL PREMIUM DUE WITHIN 31 DAYS OF BIRTH FOR COVERAGE TO CONTINUE BEYOND THIS PERIOD.

Insured children who are incapable of self-sustaining employment because of mental incapacitation or physical disability-and who are unmarried and chiefly dependent on the insured member for support and mainte-nance–may continue coverage past policy age limits, with requested proof. Otherwise, each dependent child's insurance terminates on the premium due date following the date he or she is no longer a dependent.

Before you begin enrollment,review TRICARE PRIME Features, Benefits Summary and Rates .

It's So Easy To Enroll in the TRICARE PRIME SUPPLEMENT Enrollment Form

If you have questions, please don't hesitate to call us at (866) 919-6572.

IMPORTANT NOTICE:


PRIME Plan A not available in: NC, ND and FL.

PRIME Plan B not available in: NC, ND, IA, VT and FL.

The Plan is currently not available in ME, MT, NH, NV, WA, VT.