TRICARE Supplement Plan
A Supplement Program Designed for TRICARE Eligible Members of
American Military Retirees Association
Note: These entities are not affiliated with the TRICARE Supplement in any way.





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About TRICARE

About Our Plans

How the Standard/ Extra Supplement Works

High Option II

Young Adult

Eligibility

Rate Schedule

How To Enroll

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DEERS Info



Do You Need a CHAMPVA Supplement ?



Eligibility | Effective Date | Termination |
Exclusions | Limitations | Pre-Existing Conditions Limitation |
| Non-Duplication of Coverage |
| Nervous,Mental,Emotional Disorder, Alcoholism and Drug Addiction Limits |
| Change of Policy Premium |




Eligibility

You are eligible to enroll provided you are an eligible TRICARE/CHAMPVA recipient, under age 65, and entitled to retired, 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.

Coverage is also available for your TRICARE-eligible spouse under age 65, and dependent, unmarried children under age 21 (23 if in college). Eligible spouses and children of active-duty service members may enroll; TRICARE-eligible widow(er)s and ex-spouses may also enroll.

CHAMPVA - ChampVASupplement.com for CHAMPVA Supplement information.




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.




Termination

Insured Person Termination: The Insured Person's 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 he or she ceases to be a Member;
4. the first day of the month on or next following the date he or she ceases to be eligible for the Plan under which he or she is covered;
5. the date we or the group cancel coverage for a Class of Eligible Person to which he or she belongs;
6. the date the Member attains age 65;
7. the date he or she becomes eligible for Medicare, if under age 65 at time of Medicare eligibility, you must notify ASI in writing.

Termination of an Insured Person's insurance will not prejudice any claim which occurred before the effective date of termination.

Dependent Termination: The dependent's 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 he or she ceases to be an Eligible Spouse or an Eligible Child;
4. the first day of the month on or next following the date he or she ceases to be eligible for the Plan under which he or she is covered;
5. the date we or the group cancel coverage for a Class of Eligible Person to which he or she belongs;
6. the date he or she ceases to be covered under TRICARE;
7. the date he or she becomes eligible for Medicare (must notify ASI in writing);
8. the date the Member ceases to be covered, subject to the Covered Dependent's Continuation Provision; (this will not apply to the Spouse or Child of an Active Duty Memeber or a Service Disabled Member.);
9. if a Spouse, the date he or she attains age 65.

Termination of a Covered Dependent's insurance will not prejudice any claim which occurred before the effective date of termination.




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 Missouri, while sane);
4. 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 thes services are covered when rendered to a Covered Child who is less than 6 years of age;
5. domiciliary or custodial care;
6. eye refractions and routine eye exams except when rendered to a child up to 6 years from his or her birth;
7. eyeglasses and contact lenses;
8. prosthetic devices, except those covered by TRICARE;
9. cosmetic procedures, except those resulting from covered Sickness or Injury;
10. hearing aids;
11. orthopedic footwear;
12. care for the mentally incapacitated or physically handicapped if the care is required because of the mental incapacitation or physical handicap;
13. drugs which do not require a prescription, except insulin;
14. dental care unless such care is covered by TRICARE, and then only to the extent that TRICARE covers such care
15. any confinement, service, or supply that is not covered under TRICARE;
16. Hospital nursery charges for a well newborn, except as specifically provided under TRICARE;
17. any routine newborn care except Well Baby Care, as defined, for a child up to 6 years from his or her birth;
18. TRICARE eligible cost-share and deductible amounts in excess of the TRICARE Cap;
19. expenses which are paid in full by TRICARE;
20. treatment for the prevention or cure of alcoholism or drug addiction except as specifically provided under TRICARE and the policy;
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. 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.




Nervous, Mental, Emotional Disorder,
Alcoholism, and Drug Addiction Limits


The coverage provided under the Inpatient Benefit of the TRICARE Supplement Plan for nervous, mental and emotional disorders, including alcoholism and drug addiction, is limited to:
a) 30 Inpatient treatment days for a covered Person age 19 or older; or
b) 45 Inpatient treatment days for a Covered Person under age 19;
per Fiscal Year.

This Inpatient limit is based on the number of days TRICARE normally provides each Fiscal Year for such confinements.

In rare instances, TRICARE extends these daily limits.

If this occurs,we will limit the number of days that we provide for such confinement to the lesser of:
a) the number of days TRICARE pays for such Inpatient treatment during the Fiscal Year; or
b) 90 Inpatient days per Fiscal Year.

The coverage provided under the Outpatient Benefit of the TRICARE Supplement Plan for:
a) nervous, mental, and emotional disorders; and
b) alcoholism and drug addiction;
is limited to $500 during any Fiscal Year for all such disorders.




Limitations

Routine newborn and well baby care, hospital nursery charges for a well newborn, dental care, treatment for prevention or cure of alcoholism or drug addiction, and prosthetic devices are limited to expenses covered by TRICARE. See coverage information below for mental, nervous, or emotional disorders.




Pre-Existing Conditions Limitations *

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.

* (If you are newly retired from active duty, the pre-existing condition limitation clause will be waived if you enroll in the supplement plan within 63 days of your retirement date. For waiver of the pre-existing clause, please submit a copy of your DD-214 showing your retirement date.)

* (The pre-existing condition limitation is also waived for applicants who enroll in the plan within 30 days of an involuntary termination from a non-Tricare Supplement employer group plan. For waiver of the pre-existing condition limitation, please submit your Certificate of Group Coverage showing evidence of your prior coverage and the termination date.)




Non-Duplication of Coverage under Employer Health Program

If a claim payable under the Policy is also payable under an Employer Health Program with TRICARE as the secondary payor, we will limit our payment to an amount which, when added to the amounts paid by the Employer Health Program and TRICARE, will not exceed 100% of TRICARE Covered Expenses.



Change of Policy Premium

We have 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.








Click on the following links to learn more!
About TRICARE | About Our Plans | How the Standard/Extra Supplement Works
High Option II | Young Adult | Eligibility | Rate Schedule | How to Enroll | Return to Index