TRICARE Supplemental Insurance | FAQ's
Q1. Is there a maximum limit on benefits (lifetime, annual, etc.)?
When the TRICARE cap of $3,000 is met, TRICARE will pay 100% of covered medical expenses. The supplement pays nothing. However, the supplement will pay
100% of covered excess charges over the cap. Additionally, Inpatient treatment for mental, nervous or emotional disorders in excess of 45 days if under
age 19, or 30 days if age 19 or older, is limited to 90 days (if approved by TRICARE)in a calendar year. Outpatient benefits for mental, nervous or
emotional disorders, drug addiction or alcoholism are limited to a maximum of $500 in a 12 month period.
Q2. Will the plan cover amounts beyond what TRICARE allows?
The Plan will pay 100% of covered excess charges up to the legal limit.
Q3. Does the plan pay for services that aren’t covered by TRICARE?
Q4. Will the plan pay the TRICARE outpatient deductible?
The High Option II plan has a fiscal 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. What happens when I reach age 65?
At age 65, eligibility under the TRICARE Supplement or CHAMPVA Supplement ends for members and their spouses. Coverage may be continued under the Supplement
Plan if you are ineligible for Medicare or reside overseas. If ineligible for Medicare, you must submit a copy of your Social Security Disallowance
Notice to ASI in order for coverage to be continued.
If at age 65, you are eligible for Medicare Part A and enrolled in Medicare Part B your TRICARE or CHAMPVA eligibility will continue. Medicare will be
your primary carrier and you will have supplemental coverage under TRICARE for Life (or CHAMPVA for Life if you are a CHAMPVA beneficiary).
Q7. Does the plan convert to a Medicare Supplement? If so, must it be in force as a TRICARE supplement for any specified length of time before conversion?
No, the plan does not convert to a Medicare Supplement Plan. At age 65, TRICARE FOR LIFE kicks in and benefits are paid between TRICARE and Medicare (providing
the individual has Part B of Medicare.)
Q8. Will the plan cover you overseas?
Yes. TRICARE coverage is worldwide. If TRICARE pays for covered medical expenses overseas, the plan will pay its contractual benefit.
Q9. 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.
Q10. What are the membership fees (annual, lifetime, etc.), if any, when you join the organization that sponsors the plan?
GEA $24 annual membership fees.
Q11. Does the plan cover the service member when he/she retires?
Yes. If the member enrolls within 63 days from the time he/she retires from the military, providing his dependents had already enrolled in our TRICARE
Supplement Plan, the retiree will not be subject to the Pre-Existing Condition provision. If the retiree waits beyond the 63 day period, he/she is
subject to the Pre-Existing Condition clause.
Q12. If you’re retired military and have a health care plan (which pays before TRICARE) through a civilian job, do you still need a TRICARE supplement if, between them, your employer’s plan and the TRICARE health care option you’ve chosen will pay most or all of your civilian medical bills?
Q13. How are claims filed with the Supplement?
All claims are filed first with TRICARE or CHAMPVA. After TRICARE/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. According to TRICARE, 98% of providers submit claims directly to TRICARE. Most providers will
also submit claims directly to ASI for the Supplemental coverage. You should always ask your provider to file your supplemental claim for you.
Claims may be mailed to: ASI, P.O. Box 2510, Rockville, MD 20847
Q14. How are prescription drugs covered under the Supplement?
When you visit a pharmacy, show your military ID card (or CHAMPVA ID card if you are a CHAMPVA beneficiary) and pay the copayment (cost share) amount.
Your prescription drug co-pay receipt (showing the name of the drug, date filled, and copayment (cost share) amount) should be submitted to Association
& Society Insurance Corporation (ASI) for reimbursement.
Q15. Up to what age are dependents eligible?
For TRICARE, unmarried dependent children are eligible up to age 21, and up to age 23 if a full-time student. For CHAMPVA, unmarried dependent children
are eligible up to age 18, and up to age 23 if a full-time student.
Q16. Are incapacitated dependents eligible for coverage?
If an incapacitated unmarried child who is covered under the policy reaches age 21 or 23, his/her coverage will not terminate due to age if he/she continues
TRICARE eligibility due to the incapacity. Coverage will continue as long as the unmarried child qualifies as an incapacitated child and the required
premium is paid.
Q17. How does the TRICARE Extra/Standard Supplement Plan coordinate with TRICARE?
Unless also enrolled under another Group Insurance Plan, TRICARE is the primary payer and the Supplement Plan is secondary. Thus, you are able to take
full advantage of your military benefits. Your claims are filed first with TRICARE, then the TRICARE Explanation of Benefit (EOB) Statement is sent
to the Supplement Plan. The Supplement Plan will pay for your TRICARE cost share, (TRICARE Standard deductible if enrolled in the Comprehensive Plan
option) and covered excess charges after you meet the Supplement Plan deductible.
Q18. Under what circumstance would a member, age 65 or older, be eligible for the TRICARE Supplement?
There are two circumstances that would allow continuing eligibilty for members who are 65 or older:
The TRICARE beneficiaries who live/work out of the United States of America. They must be eligible for Medicare Part A and enrolled in Medicare Part B,
and TRICARE must have the information on file with the Defense Enrollment Eligibility Reporting Systems (DEERS). You may contact DEERS at:
1-800-538-9552 (in the continental United States)
Fax address changes to: 1-831-655-8317
Write to: DEERS Support Office, 400 Gigling Road, Seaside, CA 93955-6771
Beneficiaries who are ineligible for Medicare. These members must have received a Statement of Disallowance from Social Security Administration.