TRICARE Select Supplement Insurance Plan - How The TRICARE Select Supplement Insurance Plan Works

TRICARE Select Supplement
Insurance Plan

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How the TRICARE Select Supplement Insurance Plan Works

Covered Care Required	TRICARE Select Pays(1)	TRICARE Select Supplement Plan Pays
Inpatient confinement(2) in civilian hospitals for RETIREES and dependent family members (room, board, supplies and staff services billed by the hospital)	The TRICARE Select DRG(3) amount (contracted rate for TRICARE Extra)minus your cost share.	The lesser of the DRG/day or 25% of billed amount, not to exceed the TRICARE Select 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.)
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 Select allowed amount (80% for TRICARE Extra) for doctors and other professional services.	Your cost share AFTER you satisfy the fiscal year plan deductible.
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 Select 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 TRICARE Legal Limit. For prescription drugs - the plan pays your copayment amounts.
Inpatient confinement in civilian hospitals for ACTIVE DUTY dependents.	All allowable charges except daily subsistence fee or $25, whichever is greater.	Active Duty Plan - $25 or the daily subsistence fee, whichever is greater.
Outpatient care for ACTIVE DUTY dependents (office visits, clinics, lab, prescription drugs, etc.).	80% of the TRICARE Select allowed amount (85%) for TRICARE Extra) after you pay the TRICARE Outpatient Deductible.	Active Duty Plan - Your cost share PLUS 100% of covered excess charges up to the TRICARE Legal Limit.For prescription drugs - the plan pays your copayment amounts.

The High Option II Supplement Plan pays the Inpatient and Outpatient covered medical expenses once the fiscal year Plan Deductible of $250 per person , $500 per family maximum has been satisfied. Expenses incurred to satisfy the fiscal year TRICARE Select Outpatient Deductible cannot be used to satisfy the High Option II Plan Deductible.

Definitions

(1) Check with TRICARE to confirm your actual copay portion. TRICARE’s portion of coverage is provided here for your convenience, but is subject to change by DHA (Defense Health Agency). The Supplement Insurance reimburses for copay costs for covered services after deductibles have been met.

(2) Confinement or Confined means being an inpatient in a hospital (or skilled nursing facility) due to sickness or injury.And skilled nursing facility does not mean: a) a hospital; or b) a place for rest, custodial care, or the aged; or c) a place forthe treatment of mental disease, drug addicts or alcoholics.

(3) Diagnosis-Related Groups (DRG): An agreement between most hospitals and TRICARE to accept a fixed rate for inpatient careregardless of the billed amount.