Additional Protection
at a
Competitive Price
The TRICARE Select Supplement Insurance Plan provides benefits to help pay your TRICARE
Select cost share for inpatient and outpatient care including doctor visits, emergency room care
and prescription medications. (Note: TRICARE Select was formerly known as TRICARE
Standard/Extra.) The Select Supplement Insurance Plan also pays 100% of Covered Excess
Charges up to the TRICARE Legal Limit. The Select Supplement Insurance Plan has a fiscal year
plan deductible of $250 per person or $500 per family maximum. If you are an Active Duty
Member, there is also a plan for your Dependents. See Benefit Chart.
Plan Sponsor: Government Employees Association
The Government Employees Association is a non-profit, tax-exempt organization; incorporated in
1965 in Washington, D.C. GEA was established to provide active and retired federal, state and
local government employees (including members of the military and National Guard services) with
a network of resources.
Important Notice
This coverage is available to Government Employees Association members and their dependents. If
you are not already a member of Government Employees Association, please complete the enclosed
Government Employees Association membership application or contact Government Employees Association
to apply. Your membership dues can be added to your insurance premium depending on the payment option
you select. Continued membership and benefit enjoyment requires renewal of membership upon expiration
of the initial period. For additional inquiries, call Selman & Company, the plan administrator,
toll‐free at: 1.800.638.2610.
Eligibility
You are eligible to enroll provided you are an eligible TRICARE 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
enroll 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). Coverage is extended to adult dependent
children who are under age 26 and enrolled in TRICARE Young Adult (TYA) program. Eligible spouses and
children of active-duty service members may enroll; TRICARE-eligible widow(er)s and ex-spouses may also
enroll.
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. 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 requested proof. Otherwise, each dependent child's coverage
terminates on the premium due date following the date he or she is no longer a dependent.
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.
Limitations (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: 1) 30 Inpatient treatment days
for a Covered Person age 19 or older; or 2) 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: 1) the number of days TRICARE
pays for such Inpatient treatment during the Fiscal Year; or 2) 90 Inpatient days per Fiscal Year. The coverage
provided under the Outpatient Benefit of the TRICARE Supplement plan for: 1) nervous, mental, and emotional
disorders; and 2) alcoholism and drug addiction; is limited to $500 during any Fiscal Year for all such disorders.
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.
