CHAMPVA Supplement Insurance

ENROLL TODAY

Fill in the forms, include payment, mail to the address on the Instructions. Enrollments received by end of the month are made effective the First of the Following Month.

If you would like assistance completing the forms, give us a call at 888-654-3129 ext. 3

Print Enrollment Form





GEA CHAMPVA SUPPLEMENT INSURANCE

The CHAMPVA Supplemental Insurance Plan may provide you with the protection you may nred when a serious covered accident or sickness occurs.

CHAMPVA Insurance Features

The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a health benefits program in which the Department of Veterans Affairs (VA) shares the cost of certain health care services and supplies with eligible beneficiaries. In general, the CHAMPVA program covers most health care services and supplies that are medically and psychologically necessary.

GEA CHAMPVA Supplemental Insurance Plan
  • 100% coinsurance
  • 100% out-of-pocket costs for covered services
  • Pays 100% of Doctors Visits, Pharmacy, and Hospital Co-pays
  • Issuance of ID cards
  • Priced to fit Your Budget As well As Your Needs •Smokers Pay Same Price As Non-smokers
  • Coverage at Almost Any Hospital and Any doctor
  • Guaranteed acceptance (subject to 6-month pre-existing condition limitation**)
CHAMPVA when used with the Supplement

Pays 100% of Doctors’ Visits and Hospital Co-Pays*

CHAMPVA Primary Coverage Pays
CHAMPVA SUPPLEMENT Pays
You Pay
75% of Doctor Visits
25% of Doctor Visits
$0.00
75% of Hospitalization Impatient / Outpatient
25% of Hospitalization
$0.00
 Rx Co-Pay Pharmacy
Supplement Pays Rx Co-Pay
 
75% of Prescriptions
25% of Prescriptions
$0.00

* After the CHAMPVA Deductible and CHAMPVA Supplement Insurance Plan Deductible have been met.

CHAMPVA SUPPLEMENTAL INSURANCE PLAN | RATES 2018

The CHAMPVA deductible is applied to the first medical or pharmacy claims processed in 2018 until the deductible is met.

  • Annual CHAMPVA Deductible is $50 per beneficiary or a maximum of $100 per family per year.
  • Annual Supplement Deductible is $250 per beneficiary or a maximum of $500 per family per year.
Economical Premiums to Fit Your Budget

Economical Premiums to Fit Your Budget are Per Person. Includes first year discount of 11%.

Age of Spouse, Widow/er
Monthly
Quarterly
Annual
Under 40
$32.04 $96.12 $384.48
40 - 44
$35.60 $106.80 $427.20
45 - 49
$40.94 $122.82
$491.20
50 - 54
$52.51
$157.53
$630.12
55 - 59
$62.30
$186.90
$747.60
60 - 64
$74.76
$224.28
$897.12
65+ $94.34
$283.02
$1,132.08
Each Child
$24.92
$74.76
$299.04
It's So Easy To Enroll in the CHAMPVA SUPPLEMENT
Click Here to Download The Enrollment Form
How the CHAMPVA Supplement works with CHAMPVA

The CHAMPVA Supplemental Insurance Plan, when combined with your CHAMPVA benefits, is designed to provide you with the protection you need when you need it. The plan will pay your cost share for both covered inpatient and outpatient medical expenses after you satisfy the calendar year plan deductible of $250 per person, $500 family maximum. Take a moment now to read the details inside. Then enroll today to give your family the additional protection of the GEA CHAMPVA Supplement Insurance Plan that complements your CHAMPVA benefits.

Eligibility

Eligible Spouse: “Spouse” means your spouse who is under age 65 and a CHAMPVA benefits recipient, but not a spouse from whom you are legally separated or divorced. “Spouse” also means widow(er) if he or she is a member of the Participating Organization.

Spouses over age 65 are also eligible if documentation from the Social Security Administration certifying their non-entitlement to Medicare Part A benefits is submitted with their enrollment form.

Eligible dependent and unmarried children under age 18 (23 if a full-time college student) may also enroll.

Supplement Rates and GEA Membership

Rates illustrated are Per Person. Includes first year discount of 11%. Premiums increase as a person moves from one 5-year age bracket to another (40, 45, 50, 55, 60). The company reserves the right to change premiums on a group wide basis to maintain the financial solvency of the plan. This coverage is available to GEA members and their dependents only. If you are not a member of GEA, it is easy to become one. A membership application is included with the CHAMPVA SUPPLEMENT.

Plan Deductibles

The CHAMPVA $50 individual/$100 family outpatient deductible are not covered by the CHAMPVA Supplement Plan. The CHAMPVA Supplement plan has an annual year Plan deductible of $250 per person and $500 family maximum. We will pay the Inpatient and Outpatient covered medical expenses once the Calendar Year plan deductible of $250 per person and $500 family maximum has been satisfied. Expenses incurred to satisfy the CHAMPVA Calendar Year Outpatient deductible cannot be used to satisfy the CHAMPVA Supplement Plan deductible.

Pre-Existing Conditions Limitation

All new sickness or injury covered from day one, and the Supplement has a 6-month pre-existing period. 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 were previously enrolled in a non-TRICARE Supplement Employer Group Plan and loses their 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. For more information regarding the Waiver of Pre-Existing give us a call.

How claims are filed with the Supplement EOB

All claims are filed first with CHAMPVA. After CHAMPVA has processed your claim, they will send you an Explanation of Benefit Statement (EOB). You will need to file a claim with the Supplement Plan only if the provider has not agreed to file one on your behalf. To file a supplement claim, simply write your certificate (member ID) number on the EOB and also, write “Pay Provider” if you would like the benefits paid directly to the provider, otherwise the benefits will be paid to you. Claims may be mailed to:

GEA Administrator
6110 Parkland Blvd.
Cleveland, OH 44124

FAX: 800-311-3124

Additional Information

Additional plan information available by clicking GEA CHAMPVA Supplement Enrollment Form Take a moment to review and click the tabs, Eligibility, Termination, Exclusion, Effective Date, limitations and FAQ’s on the below.

GOVERNMENT EMPLOYEES ASSOCIATION (GEA)

The thousands of government employees who belong to the association give GEA a strong voice to advocate for issues that impact current and former government employees. This strong voice enables GEA to foster support for those issues that matter to government employees and their families, and offer valuable member benefits at an affordable cost, including TRICARE Supplement and CHAMPVA Supplement. You must be a GEA member to enroll in the TRICARE Supplement and CHAMPVA Supplement plan. The GEA membership form is included with Enrollment Form and can be added to your premium option.

CHAMPVA SUPPLEMENT INSURANCE PLAN | BENEFITS
Eligibility

Eligibility

Eligible Spouse: “Spouse” means your spouse who is under age 65 and a CHAMPVA benefits recipient, but not a spouse from whom you are legally separated or divorced. “Spouse” also means widow(er) if he or she is a member of the Participating Organization.

Spouses over age 65 are also eligible if documentation from the Social Security Administration certifying their non-entitlement to Medicare Part A benefits is submitted with their enrollment form.

Eligible dependent and unmarried children under age 18 (23 if a full-time college student) may also enroll.

Termination

Termination

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


1. The date the Policy terminates, or the date the GEA ceases to be a Participating Organization of the Policyholder;


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 date you or your widow(er) terminates membership in the Participating Organization;


5. The date you or your widow(er) terminates membership in the Participating Organization;


6. The date we or the group cancel coverage for a class of Eligible Person to which he or she belongs;


7. The first premium due date on or next following the date he or she ceases to be covered by CHAMPVA;


8. If a spouse, the date he or she attains age 65;


9. If a child, the date he or she attains age 18, or age 23 if enrolled full-time in a school of higher learning.


10. 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.

Exclusions

Exclusions

The Policy does not cover:

1. Treatment or confinement not ordered by a physician or necessary for medical care;


2. Intentionally self-inflicted injury;


3. Suicide or attempted suicide, whether sane or insane;


4. Sickness or injury resulting from acts of war, whether declared or undeclared;


5. Routine physical exams, eye exams, hearing exams and immunizations, except when considered Well Baby Care covered by CHAMPVA;


6. Eye refractions;


7. Custodial care, care received in a retirement home, rest home or halfway house, or domiciliary care;


8. Rest cures;


9. Hearing aids;


10. Orthopedic footwear;


11. Eyeglasses or contact lenses;


12. Cosmetic procedures except those resulting from sickness or injury occurring while a Covered Person under the Policy;


13. Drugs (other than insulin and other diabetic supplies) which do not require a prescription;


14. Any confinement, service or supply not covered by CHAMPVA as contained in Regulations 38 CFR17.272;


15. Expenses paid in full by CHAMPVA;


16. Expenses in excess of the CHAMPVA Allowed Amount;


17. Expenses in excess of the CHAMPVA Cap;


18. Care for the mentally or physically incapacitated if the care is required because of the mental or physical incapacitation;


19. Any part of a covered expense which the Covered Person is not legally obligated to pay;


20. Care received as part of a grant, study or research program;


21. Care considered experimental or investigational.

Effective Date

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.

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.

Limitations

Limitations

Nervous, Mental, Emotional Disorder, Alcoholism, and Drug Addiction Limits The coverage provided under the Inpatient Benefit of the CHAMPVA Supplement plan for nervous, mental and emotional disorders, including alcoholism and drug addiction, is limited to:

  • 30 Inpatient treatment days for a Covered Person age 19 or older; or
  • 45 Inpatient treatment days for a Covered Person under age 19; or
  • 150 Inpatient treatment days in a CHAMPVA authorized Residential Treatment Center for a Covered Person under age 21; per Calendar Year.

This Inpatient limit is based on the number of days CHAMPVA normally provides each Calendar Year for such confinements. In rare instances, CHAMPVA extends these daily limits.

If this occurs, we will limit the number of days that we provide for such confinement to the lesser of:

  • The number of days CHAMPVA pays for such Inpatient treatment during the Calendar Year; or
  • 90 Inpatient days per Calendar Year.
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 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.

FAQ's

Q1.Is there a maximum limit on benefits (lifetime, annual, etc.)?

No maximum limit.


Q2.Will the plan cover amounts beyond what CHAMPVA allows?

The CHAMPVA Supplement does pay cost share amounts, however; it does not pay additional charges above CHAMPVA’s allowed amount.


Q3.Does the plan pay for services that aren’t covered by CHAMPVA?

No.


Q4.Will the plan pay the CHAMPVA outpatient deductible?

The CHAMPVA outpatient deductible is not covered by the CHAMPVA Supplement Plan. The CHAMPVA Supplement plan has a calendar year Plan deductible of $250 per person and $500 family maximum.


Q5.How will the plan require premium payments?

Premiums may be paid monthly by deduction from checking account (Check-o-matic) or direct bill - quarterly, semi-annually or annually. Credit cards may not be used to pay premiums.


Q6.Does my Medicare status impact eligibility for CHAMPVA benefits?

Yes, your Medicare status has an impact on your eligibility for CHAMPVA benefits. Medicare automatically enrolls the vast majority of eligible beneficiaries 90 days prior to their 65th birthday. When you receive your initial information from Medicare, you also receive a Medicare card indicating both Medicare Part A and Medicare Part B coverage. To continue your CHAMPVA eligibility, you MUST enroll in, and remain enrolled in, Medicare Part B. Upon enrollment in Medicare Part B, CHAMPVA changes to CHAMPVA for Life and becomes the secondary payor to Medicare. As a result, the CHAMPVA Supplement Plan will automatically end.


Q7.Will the plan cover you overseas?

Yes, if you live or travel overseas (excluding Iraq, North Korea and Cuba), the supplement provides the same benefits as if you were in the U.S. Reimbursement for health care claims in foreign countries is based on reasonable and customary billed amounts. Your deductible and cost share will be the same as if you were in the U.S. Medicare does not provide benefits for services provided overseas. However, if you are 65 or over, you must enroll in Medicare Part B. CHAMPVA will continue as your primary benefit option for the period of time you are overseas. As a result, the CHAMPVA Supplement Plan will also continue. You will receive the same level of benefits provided to those under age 65.


Q8.Can premium payments be increased? Under what conditions?

Premiums increase as a person moves from one 5-year age bracket to another (40, 45, 50, 55, 60). The company reserves the right to change premiums on a group wide basis to maintain the financial solvency of the plan.


Q9.What are the membership fees (annual, lifetime, etc.), if any, when you join the organization that sponsors the plan?

GEA $24 annual membership fees.


Q10.Does the plan cover the service member when he/she retires?

The service member is not covered by CHAMPVA.


Q11.If you’re retired military and have a health care plan (which pays before CHAMPVA) through a civilian job, do you still need a CHAMPVA supplement if, between them, your employer’s plan and the CHAMPVA health care option you’ve chosen will pay most or all of your civilian medical bills?

You will need to look at your individual situation and review your primary health plan benefits to determine if the CHAMPVA Supplement Plan will be necessary. In most cases, an individual with a primary health plan, CHAMPVA and a CHAMPVA Supplement Plan will be over insured.


Q12.When does a spouse lose eligibility?

When there is a divorce or annulment from the qualifying Veteran sponsor. Eligibility for CHAMPVA ends at midnight of the effective date of the divorce decree or annulment.


Q13.When does a child lose eligibility?

At age 18, unless enrolled in an accredited school as a full-time student. At age 23 or loses full-time student status whichever comes first. He/she marries. A stepchild no longer lives in the household of the sponsor. An incapacitated dependent will continue coverage past age 18 or 23 as long as incapacity occurred while enrolled in the plan.


Q14.How are claims filed with the Supplement?

All claims are filed first with CHAMPVA. After CHAMPVA has processed your claim, they will send you an Explanation of Benefit Statement (EOB). You will need to file a claim with the Supplement Plan only if the provider has not agreed to file one on your behalf. To file a supplement claim, simply write your certificate (member ID) number on the EOB and also, write "Pay Provider" if you would like the benefits paid directly to the provider, otherwise the benefits will be paid to you. Claims may be mailed to: GEA Administrator, 6110 Parkland Blvd., Cleveland, OH 44124


Q15.What happens when I reach age 65?

At age 65, eligibility under the CHAMPVA Supplement ends for members and their spouses. If at age 65, you are eligible for Medicare Part A and enrolled in Medicare Part B your CHAMPVA eligibility will continue. Medicare will be your primary carrier and you will have supplemental coverage under CHAMPVA for Life.


Here’s How The CHAMPVA Supplement Insurance Plan Works to Help Pay After CHAMPVA Pays
Covered Care Required
CHAMPVA Pays
CHAMPVA Supplement Insurance Plan Pays
Inpatient Services Confinement in civilian hospital or skilled nursing facility DRG* rate, less the beneficiary cost share The lesser of (1) $635 per day, times number of inpatient days (2) 25% of the billed amount, or (3) the DRG* rate
Inpatient Services Non-DRG* based 75% of the Allowable Amount 25% of the Allowable Amount
Inpatient Physician Services Visits, surgeons, anesthesiologist, etc 75% of the Allowable Amount 25% of the Allowable Amount
Outpatient Services Office visits, clinics, laboratory and pharmacy services, durable medical equipment (non-VA source) 75% of the Allowable Amount, after the CHAMPVA Annual Outpatient Deductible 25% of the Allowable Amount

We will pay the Inpatient and Outpatient covered medical expenses once the Calendar Year plan deductible of $250 per person and $500 family maximum has been satisfied. Expenses incurred to satisfy the CHAMPVA Calendar Year Outpatient deductible cannot be used to satisfy the CHAMPVA Supplement Plan deductible.

Important Notice

The CHAMPVA Supplement Plan works in all 50 States, but not sold in CO, ME, NH, NV, OR, WA.

  • The Corporate Plan Sponsor: Government Employee Association (GEA)
  • Plan Administer: Selman and Company
  • Underwritten by: Transamerica Premier Life Insurance Company, Cedar Rapids, IA Transamerica Financial Life Insurance Company, Harrison, NY (NY residents only)
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