Click Below to Learn More
About Tricare
About Our Plans
How the Standard/ Extra
Supplement Works
Plan Options
Eligibility
Rate Schedule
How To Enroll
Return to Index
Links
Tricare Official Site
DEERS Info
|
|
|
Eligibility | Waiver of Premium | Effective Date | Renewability | Exclusions | Limitations | Pre-Existing Conditions Limitation
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.
|
Waiver of Premium for Surviving Spouse and Dependents
The Comprehensive Plan features a special benefit that provides additional financial protection to your surviving spouse and dependents. If you die while insured under the Plan, your insured spouse's premiums will be waived for up to four full years unless your spouse remarries, reaches age 65, or dependents no longer remain in an eligible status. After four years, he or she will need to begin paying the appropriate premium to continue coverage.
|
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.
|
Renewability
Your coverage is renewable to age 65. As long as premiums are paid on time; you remain a member of the sponsoring organization; you, your spouse and dependents remain in an eligible status (you are covered by TRICARE, children are under age 21 or age 23 if a full-time student); and the Master Policy and your class of insured persons remain in effect. So even if you or a covered dependent develops a serious health condition in the future, their coverage will not terminate, provided these conditions are met. Under the Comprehensive Plan, your insured dependent's premium will be waived for up to one year, if you die while insured. To continue coverage beyond one year, your surviving spouse must pay the appropriate premium.
|
Exclusions
Treatment or confinement not ordered by a physician or necessary for medical care; intentionally self-inflicted injury; suicide or attempted suicide, whether sane or insane; sickness or injury resulting from acts of war; whether declared or undeclared; routine physical exams, eye exams, eye refractions and immunizations, except for well baby care covered by Tricare; custodial care, hearing aids, orthopedic footwear, eyeglasses or contact lenses; cosmetic procedures, except those resulting from sickness or injury occurring while a covered person; drugs (other than insulin) which do not require a prescription; any confinement, service or supply not covered under Tricare, or for expenses paid in full by Tricare; expenses in excess of the Tricare Cap; the Tricare Standard/Extra fiscal year outpatient deductible, except as specifically provided under the Comprehensive Plan; care of the mentally retarded or physically handicapped which is required due to the mental retardation or physical handicap; any part of a covered expense which the covered person is not legally obligated to pay because of payment by a Tricare alternative program.
|
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. INPATIENT treatment for mental, nervous, or emotional disorders in excess of 45 days if under age 19, or 30 days if age 19 or older, is limited to 90 days (if approved by Tricare) in a calendar year. OUTPATIENT benefits for mental, nervous or emotional disorders, drug addiction or alcoholism are limited to a maximum of $500 in a 12-month period.
|
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.
CLICK HERE to view the Pre-Existing Condition Plan Enhancements, effective October 1, 2004.
(This is in PDF format. To download the Adobe Reader needed, click on the following link.)
|
|