TRICARE Reserve Select Supplemental Insurance Plan | Benefits
The USBA TRICARE Supplement is Sponsored by NGAUS and EANGUS
Here's How the TRICARE Reserve Select Supplement Plan works to Pay After TRICARE Reserve Select Pays.
TRICARE Reserve Select ANNUAL DEDUCTIBLE
- E-4 and below Deductible is $50 member only coverage or a maximum of $100 per family per year
- E-5 and above Deductible is $150 member only coverage or a maximum of $300 per family per year
- No plan deductible
Inpatient Benefit: We will pay the benefits described below for a Covered Person's Period of Confinement in a Hospital or Skilled Nursing Facility. The Period of Confinement must: a) be due to Sickness or Injury; b) begin while he or she is covered under this benefit; c) be approved by TRICARE.
|Care Required||TRICARE Reserve Select Pays||Your TRICARE Reserve Select Supplement Pays|
|Benefits in a Government Hospital||All TRICARE Reserve Select Allowed Amount except the Current Daily Subsistence fee.||Current Daily Subsistence Charge.|
|Benefits in a Civilian Hospital or Skilled Nursing Facility||All TRICARE Reserve Select allowable amounts except the first $25.00 or current daily subsistence charges (whichever is greater).||For the Covered Member, Spouse or
Child, we will pay:
a) The greater of:
|Outpatient Benefit||TRICARE Network
85% of the TRICARE allowable charge after the annual deductible is met.
80% of the TRICARE allowable charge after annual deductible is met.
Your 15% cost share for covered expenses until the TRICARE cap is met TRICARE Authorized, Non-Network Provider
Your 20% cost share PLUS 100% of the Covered Excess Charges up to Legal Limit.
|Prescription Drug Charges
Mail Order (up to 90-day supply) Network Retail (up to 30-day supply) Non-Network Retail (up to 30-day supply)
|All but the copyaments of $3 generic, $9
brand name or $22 non-formulary
All but the copyaments of $5 generic, $12 brand name or $25 non-formulary Retail Non Network
All but $12 or 20% of the total cost for generic/brand name or $25 or 20% for non-formulary (whichever is greater) after the fiscal year deductible is met.
Copayments of $5 generic, $12 brand name or $25 non-formulary Retail network
Copayments of $5 generic, $12 brand name or $25 non-formulary Retail non-network
$12 or 20% of the total cost for generic/brand name or $25 or 20% for non-formulary (whichever is greater) after the fiscal year deductible.
It's So Easy To Enroll in the TRICARE RESERVE SELECT SUPPLEMENT Enrollment Form
The Supplemental Insurance Plan is not available in ME, MT, NH and VT.