TRICARE Supplement Insurance

TRICARE Supplement Insurance Plans

Available to TRICARE Beneficiaries, regardless of Rank, Service or Duty Status

TRICARE, when used with the TRICARE Supplement, pays 100% of Doctor Visits, Pharmacy, and Hospital Co-Pays*.

If you are retired from the military, are a spouse of a retired military or an active duty service member, TRICARE eligible beneficiary, or a spouse, you or your eligible dependents may be eligible to participate in the GEA TRICARE SUPPLEMENTAL INSURANCE PLAN.

TRICARE is the Department of Defense’s health benefits program for the military community. The TRICARE Supplement wraps around your TRICARE coverage entitlement so that in most cases, you will obtain 100% reimbursement for TRICARE covered services. In addition, the TRICARE Supplement Insurance affords you the ability to seek care from any TRICARE authorized civilian facility or provider.

Why Choose TRICARE Select Supplemental Insurance Plan

100% coinsurance

100% out-of-pocket costs for covered services

100% excess charges to the legal limit**

Pays 100% of Doctors Visits, Pharmacy, and Hospital Co-pays

Guaranteed acceptance (subject to 6-month pre-existing condition limitation**)

Priced to fit Your Budget as Well as Your Needs

Retirees and Spouses Get the Same Rates

Smokers Pay the Same Price as Non-smokers

Coverage at Almost Any Hospital and Any doctor

Comprehensive coverage

Issuance of Insurance Policy and ID cards

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When You Use the TRICARE SUPPLEMENT

With a TRICARE supplement plan, a trip to the doctor means TRICARE Select covers 75% of doctor’s fee, while your TRICARE supplemental insurance picks up the remaining 25% – and you’re 100% covered. Once you reach the Supplement Plan deductible, there are simply no further costs while your supplemental insurance kicks in to cover your balances.

With TRICARE Select you are never required to get HMO approvals for seeing specialists; you never need permission before taking your children to see the doctor; no referrals from a primary health care manager are required, and you don’t have to go to a military treatment facility. It’s easy, just call the office of the doctor you prefer and use your TRICARE supplemental insurance.

Supplemental insurance always pays after TRICARE pays. So, after your TRICARE SUPPLEMENTAL INSURANCE PLAN pays its portion of the bill, the supplemental insurance pays your provider direct or reimburses you, the TRICARE beneficiary, for out-of-pocket medical expenses you will have paid to civilian providers to cover their charges.

You are eligible to enroll if you are a TRICARE eligible recipient, under age 65, and entitled to retired (Military), 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. If you are:

• Retirees of the uniformed services, their spouse, and unmarried dependent children (under age 21 or 23 if a full-time student)
• Spouse or surviving spouse of retired military personnel and dependent children under age 21 or 23 if a full-time student.
• Retired Reservists and National Guard members (gray area retirees) under age 60 and enrolled in TRICARE Retired Reserve (TRR)
• Spouse and unmarried eligible dependent children (under age 21 or 23 if a full-time student) who are eligible for CHAMPVA

Your coverage under the Policy will cease on the first to occur of:

1. The date the Policy terminates;
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 you cease to be a member of the Policyholder;
4. The first day of the month on or next following the date you cease to be eligible for the Plan under which you are covered;
5. The date we or the Policyholder cancel coverage for a Class of Eligible Person to which you belong;
6. The date you attain age 65;
7. The date you cease to be covered under TRICARE;
8. The date you become eligible for Medicare unless you reside in an area where Medicare is not available, in which case coverage will not terminate until you return to residency in an area where Medicare is available. Termination of coverage will be without prejudice to any claim which originated before the effective date of termination.

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
   Suicide or attempted suicide, whether sane or insane (in Colorado and Missouri, while sane)
3. 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 these services are covered when rendered to a Covered Child who is less than 6 years of age
4. Domiciliary or custodial care
5. Eye refractions and routine eye exams except when rendered to a child up to 6 years from his or her birth
6. Eyeglasses and contact lenses
7. Prosthetic devices, (except that artificial limbs and eyes and devices which must be implanted by surgery are covered)
8. Cosmetic procedures, except those resulting from Sickness or Injury while a Covered Person
9. Hearing aids
10. Orthopedic footwear
11. Care for the mentally incapacitated or physically handicapped if the care is required because of the mental incapacitation or physical handicap or the care is received by an Active Duty Member’s child who is covered by the “Program for the Handicapped” under TRICARE
12. Drugs which do not require a prescription, except insulin
    Dental care unless such care is covered by TRICARE, and then only to the extent that TRICARE covers such care
13. Any confinement, service, or supply that is not covered under TRICARE
    Hospital nursery charges for a well newborn, except as specifically provided under TRICARE
14. Any routine newborn care except Well Baby Care, as defined, for a child up to 6 years from his or her birth
15. TRICARE eligible cost-share and deductible amounts more than the TRICARE Cap
16. Expenses which are paid in full by TRICARE
17. Any expense or portion thereof applied to the TRICARE Outpatient Deductible
18. Treatment for the prevention or cure of alcoholism or drug addiction except as specifically provided under TRICARE
19. Any part of a covered expense which the Covered Person is not legally obligated to pay because of payment by a TRICARE alternative program
20. And 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, subject to the Pre-Existing Condition Limitation.

Your coverage and that of your covered dependents become 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.

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.

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 a dependent.

Rates are based on the attained age of the insured person and increases as you enter each new category. Rates and /or benefits may be changed based on a class basis.

Pre-Existing Conditions Limitation

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.

The Pre-existing condition limitation may be waived under the following conditions:

• For individuals who are newly retired from active duty military and who enroll in the plan within 63 days of the military retirement date. Application for coverage should include a copy of their DD-214.
• For individuals who were previously enrolled in a non-TRICARE Supplement Employer Group Plan and loses that coverage due to involuntary termination. Such individuals must enroll in the Supplement Plan within 31 days following the termination date of the prior insurance plan. Application for coverage under the Supplement Plan should include a copy of the Certificate of Creditable Coverage for the prior group insurance plan.