Why do I need a TRICARE Prime
Insurance Supplement?
The two TRICARE Prime Supplement Insurance Plans available to you are designed to help pay your cost
share and copayments under TRICARE (In-Network and Out-of-Network expenses). Enrollment in the
TRICARE Prime Supplement Insurance Plan provides you and your eligible family members with
flexibility in converting your coverage should you move out of a TRICARE Prime area and then apply for a
TRICARE Select Insurance Supplement. When this happens, under the TRICARE Select Supplement
Insurance Plan, you receive credit towards the PreExisting Condition Provision for the time spent in the TRICARE Prime Supplement Insurance Plan.
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
Retired Government Employees Association members and spouses, under age 65, who are currently
enrolled in TRICARE PRIME, are eligible to apply for any one of the two supplemental insurance plans
described in this brochure. Unmarried dependent children under age 21 (23 if in college) are also eligible to
enroll. Coverage is extended to adult dependent children who are under age 26 and enrolled in TRICARE
Young Adult (TYA) program. Enrollment for these dependents must include a copy of the TYA enrollment
card. Coverage is also available to eligible surviving spouses, who are enrolled in TRICARE PRIME.
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.
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 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
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 PRIME. INPATIENT treatments for mental, nervous or emotional disorders, drug
addiction or alcoholism are limited to a maximum of $500 per fiscal year.
Conversion
If you end your participation in TRICARE Prime because you leave the network area, you may convert you
TRICARE Prime insurance supplement to a TRICARE Select Supplement Insurance Plan within 60 days of
disenrollment. Premiums for the TRICARE Select Supplement
Insurance Plan will be those then in effect at time of conversion and the Pre-Existing Condition
Limitation will be credited for the period of time covered by the TRICARE Prime insurance supplement.
Conversion from the TRICARE Prime insurance supplement to a TRICARE Select insurance supplement
is available following disenrollment for any other reason from TRICARE Prime (after a minimum of one
year enrollment in TRICARE Prime) and is subject to satisfaction of the TRICARE Supplement
Insurance Plan Pre-Existing Conditions Limitation.
