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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.
  • If both You and Your Spouse are members and are eligible for coverage, coverage may not be duplicated by applying as dependents of each other and both cannot enroll dependents. No Covered Person can be insured as a dependent of more than one member under the Policy.


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 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.

Termination
Insured Person: Coverage under the Policy will cease on the first to occur of: 1) the date the Policy terminates, or the date the Organization ceases to be a Participating Organization of the policyholder, 2) the date the required premium is not paid, subject to the Grace Period provision; 3) the first day of the month on or next following the date you cease to be a member of the Policyholder; 4) the first day of the month on or next following the date you cease to be eligible for the Plan under which you are covered; 5) the date we or the Policyholder cancel coverage for a Class of Eligible Person to which you belong; 6) the date you attain age 65 unless you are not eligible for Medicare and can provide documentation of such from the Social Security Administration; 7) the date you cease to be covered under TRICARE; or 8) the date you become eligible for Medicare unless you reside in an area where Medicare is not available, in which case coverage will not terminate until you return to residency in an area where Medicare is available. Termination of coverage will be without prejudice to any claim which originated before the effective date of termination.
Dependent: Dependent’s coverage under the Policy will cease on the first to occur of: 1) the date the Policy terminates or the Participating Organization ceases to participate in the Policy; 2) the date the required premium is not paid, subject to the Grace Period provision; 3) the first day of the month on or next following the date the dependent ceases to be an Eligible Spouse or an Eligible Child; 4) the first day of the month on or next following the date the dependent ceases to be eligible for the Plan under which the dependent is covered; 5) the date we or the Policyholder cancel coverage for a Class of Eligible Person to which the dependent belongs; 6) the first day of the month following the date you cease to be covered, subject to the Covered Dependent Continuation provision 7) the date the dependent becomes eligible for Medicare unless the dependent resides in an area where Medicare is not available, in which case coverage will not terminate until the dependent returns to residency in an area where Medicare is available; 8) if a child, the date the child attains age 21 or age 23 (if the child is enrolled full time at a school of higher learning); under 26 if covered by the TRICARE Young Adult Program; or 9) the date a dependent ceases to be covered under TRICARE; 10) the date a your Spouse attains age 65 unless he or she is not eligible for Medicare and can provide documentation of such from the Social Security Administration. Termination of coverage will be without prejudice to any claim which originated before the effective date of termination 11) the date Your Dependent’s coverage ends in accordance with the Newborn or Newly Adopted Child Coverage provision.

IMPORTANT NOTICE

Although the Plan works in all 50 States, the Plan is currently not available in CO, ME, NH, NY, OR, UT, 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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