TRICARE Supplemental Insurance Plan | Benefits

Available to TRICARE Beneficiaries, regardless of Rank, Service or Duty Status

How the TRICARE Supplement Plan works to pay after TRICARE Standard/Extra Pays

Care RequiredTRICARE Standard/Extra PaysYour TRICARE Standard/Extra Supplement High Option II Plan Pays
Inpatient confinement in civilian hospitals for RETIREES and dependent family members (room, board, supplies and staff services billed by the hospital)The TRICARE Standard/DRG amount (contracted rate for TRICARE Extra)minus your cost share.The lesser of $535/day or 25% of billed amount, not to exceed the TRICARE Standard DRG amount (lesser of $250/day or 25% cost share of the contracted rate for TRICARE Extra) AFTER you satisfy the fiscal year plan deductible PLUS 100% of covered excess charges up to the Legal Limit.)
Inpatient confinement in civilian hospitals for RETIREES and dependent family members (doctors, and other inpatient services not billed by the hospital)75% of the TRICARE Standard allowed amount (80% for TRICARE Extra) for doctors and other professional services.Your cost share AFTER you satisfy the **fiscal year plan deductible PLUS 100% of covered excess charges up to the Legal Limit.
Inpatient confinement in military hospitals.All but the daily subsistence fee.The daily subsistence fee.
Outpatient care for RETIREES and dependent family members (office visits, clinics, lab, prescription drugs, etc.)75% of the TRICARE Standard allowed amount (80% for TRICARE Extra)after you pay the TRICARE Outpatient Deductible.Your cost share AFTER you satisfy the fiscal year plan deductible PLUS 100% of covered excess charges up to the Legal Limit. For prescription drugs - the plan pays your copayment amounts.
Inpatient confinement in civilian hospitals for ACTIVE DUTY dependents

Outpatient care for ACTIVE DUTY dependents (office visits, clinics, labs, prescription drugs, etc.)
All allowable charges except daily subsistence fee or $25, whichever is greater.

80% of the TRICARE Standard allowed amount (85% for TRICARE Extra) after you pay the TRICARE Outpatient Deductible.
Active Duty Plan - $25 or the daily subsistence fee, whichever is greater.

Active Duty Plan - Your cost share PLUS 100% of covered excess charges up to the reasonable and customary community standard level, AFTER you pay the Tricare Extra/Standard Outpatient Deductible.*

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**Legal Limit means the maximum amount that a non-participating provider can legally charge. This amount is up to the 115% of the TRICARE Allowed Amount.

It’s So Easy To Enroll in the TRICARE Select Supplement

Eligibility

Eligibility – TRICARE SUPPLEMENT

You are eligible to enroll if you are a TRICARE eligible recipient, under age 65, and entitled to retired (Military), retainer, or equivalent pay. If you are age 65 or over and ineligible for Medicare, you may apply for the plan by attaching a copy of your Social Security Notice of Disallowance of Benefits to your Enrollment Form. If you are:

  • Retirees of the uniformed services, their spouse and unmarried dependent children (under age 21 or 23 if a full-time student)
  • Spouse or surviving spouse of retired military personnel and dependent children under age 21 or 23 if a full-time student.
  • Retired Reservists and National Guard members (gray area retirees) under age 60 and enrolled in TRICARE Retired Reserve (TRR)
  • Spouse and unmarried eligible dependent children (under age 21 or 23 if a full-time student) who are eligible for CHAMPVA

Termination

Termination

Your coverage under the Policy will cease on the first to occur of:

  1. The date the Policy terminates;
  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;
  7. The date you cease to be covered under TRICARE;
  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.

Exclusions

Exclusions

The Policy does not cover:

  1. Injury or sickness resulting from war or act of war, whether war is declared or undeclared
  2. Intentionally self inflicted injury
  3. Suicide or attempted suicide, whether sane or insane (in Colorado and Missouri, while sane)
    the following services: a) routine physical exams, unless required for school enrollment (but not sports physicals) by a Covered Child aged 5 through 11; and b) immunizations; except that these services are covered when rendered to a Covered Child who is less than 6 years of age
  4. Domiciliary or custodial care
  5. Eye refractions and routine eye exams except when rendered to a child up to 6 years from his or her birth
  6. Eyeglasses and contact lenses
  7. Prosthetic devices, (except that artificial limbs and eyes and devices which must be implanted by surgery are covered)
  8. Cosmetic procedures, except those resulting from Sickness or Injury while a Covered Person
  9. Hearing aids
  10. Orthopedic footwear
  11. Care for the mentally incapacitated or physically handicapped if the care is required because of the mental incapacitation or physical handicap or the care is received by an Active Duty Member’s child who is covered by the “Program for the Handicapped” under TRICARE
  12. Drugs which do not require a prescription, except insulin
  13. Dental care unless such care is covered by TRICARE, and then only to the extent that TRICARE covers such care
  14. Any confinement, service, or supply that is not covered under TRICARE
  15. Hospital nursery charges for a well newborn, except as specifically provided under TRICARE
  16. Any routine newborn care except Well Baby Care, as defined, for a child up to 6 years from his or her birth
  17. TRICARE eligible cost-share and deductible amounts in excess of the TRICARE Cap
  18. Expenses which are paid in full by TRICARE
  19. Any expense or portion thereof applied to the TRICARE Outpatient Deductible
  20. Treatment for the prevention or cure of alcoholism or drug addiction except as specifically provided under TRICARE
  21. Any part of a covered expense which the Covered Person is not legally obligated to pay because of payment by a TRICARE alternative program
  22. And any claim under more than one of the TRICARE Supplement Plans, or under more than one Inpatient Benefit or more than one Outpatient Benefit of the TRICARE Supplement Plans. If a claim is payable under more than one of the stated Plans or Benefits, payment will only be made under the one that provides the highest coverage, subject to the Pre Existing Condition Limitation.

Effective Date

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.

Limitations

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.

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.

IMPORTANT NOTICE:

The Plan is currently not available in CO, ME, NH, NV, OR, WA.

  • The Corporate Plan Sponsor: Government Employee Association (GEA)
  • Plan Administer: Selman and Company
  • Underwritten by: Transamerica Premier Life Insurance Company, Cedar Rapids, IA Transamerica Financial Life Insurance Company, Harrison, NY (NY residents only)
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