TRICARE Supplemental Insurance Plan | Benefits

TRICARE Supplemental Insurance helps pay your out-of-pocket medical costs

TRICARE is like other health insurance plans that covers you for healthcare services from civilian providers, TRICARE Supplemental insurance covers your healthcare out-of-pocket

Q1: Is TRICARE Affordable Care Act (ACA)-compliant health insurance plans for active duty and retired military members and eligible family members?

A1: TRICARE is Affordable Care Act (ACA)-compliant

Q2: Who is eligible for TRICARE?

A2: Eligibility includes the following:

  • Uniformed service members, including active duty and retired members of the military.
  • Spouses and eligible children of uniformed service members.
  • Retired military members and their spouses and eligible children.
  • Former spouses, who have not remarried, and eligible unmarried children of active duty or retired service members who have died.
  • Spouses and unmarried children of reservists and National Guard who are on active duty for more than 30 consecutive days or have died on active duty.
  • Medal of Honor recipients and their families.


Q3: Do all TRICARE plans offer the same Essential Health Benefits as any other ACA-compliant plan.

A3: You are covered at a minimum for:

  • Outpatient care including chronic disease management
  • Emergency care
  • Hospitalization
  • Pregnancy and newborn care
  • Mental health and substance abuse services
  • Prescription drugs
  • Rehabilitation services and devices
  • Lab tests
  • Preventive and wellness services
  • Dental and vision care for children

Q4: Should I consider a TRICARE Supplement Plan?

A4: TRICARE pays for much of your healthcare costs, but there are often out-of-pocket, co-pays, co-insurance expenses and deductibles. TRICARE Supplement is a secondary payer that helps cover out-of-pocket costs like deductibles, copayments, and coinsurance. The TRICARE Supplement is like Medicare Supplemental plans. You can think of it as a safety net, so you won’t get whacked with unplanned out-of-pocket costs.

Here’s what TRICARE Supplemental insurance pays for:

  • Up to 100% of copayments and coinsurance for TRICARE
  • Up to 100% of outpatient deductibles
  • Up to 100% of out-of-pocket costs for covered services
  • Up to 100% of doctor visits, pharmacy, and hospital copays

Q5: What does the TRICARE Supplemental insurance Not cover?

A5: Supplements do not cover the following:

  • Any healthcare services not covered by TRICARE.
  • Any healthcare services rendered before enrolling in TRICARE and TRICARE Supplement.
  • TRICARE Prime enrollment fees.


Effective Date

Your coverage and that of your covered dependents becomes effective on the first day of the month following receipt of your enrollment form and first premium payment. If, on that day, you or a covered dependent are confined in a hospital, the effective date will be the day following discharge from the hospital.

Deferred Effective Date: If on the date that You are to become covered under the Policy you are confined in a Hospital, your coverage will be deferred until the first day after You are discharged.
Deferred Effective Date (Dependent): If on the date that an Eligible Dependent is to become covered under the Policy he or she is confined at home, in a Hospital or elsewhere because of injury or sickness, coverage of such person will be deferred until the first day after he or she is discharged from the Hospital or place of confinement.

Pre-Existing Conditions Limitation

Any injury or sickness whether diagnosed or undiagnosed, for which a covered person received medical care or treatment within the 6 month period preceding the effective date of his or her insurance will not be covered until the coverage has been in effect for 6 months. However, new conditions will be covered immediately.

The Pre-existing condition limitation may be waived under the following conditions:

For individuals who are newly retired from active duty military and who enroll in the plan within 63 days of the military retirement date. Application for coverage should include a copy of their DD-214. For individuals who were previously enrolled in a non-TRICARE Supplement Employer Group Plan and loses that coverage due to involuntary termination. Such individuals must enroll in the Supplement Plan within 31 days following the termination date of the prior insurance plan. Application for coverage under the Supplement Plan should include a copy of the Certificate of Creditable Coverage for the prior group insurance plan.

Limitations

Newborn children not named in your enrollment form are automatically covered from birth for injury or sickness, including treatment of congenital defects 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 retardation or physical disability- and who are unmarried and chiefly dependent on the insured member for support and maintenance—may continue coverage past policy age limits, with a dependent. Rates are based on the attained age of the insured person and increases as you enter each new category. Rates and /or benefits may be changed based on a class basis.

IMPORTANT NOTICE

Although the Plan works in all 50 States, the Plan is currently not available in CO, ME, NH, OR, WA. * Services are covered up to the legal limit maximum.

  • The Corporate Plan Sponsor: Government Employee Association (GEA)
  • Plan Administer: Selman and Company
  • Underwritten by: Harford Life and Accident Insurance Company, Harford, CT 06155
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