TRICARE Supplement for Retirees

Tricare Supplement

resources

TRICARE Supplement Plan Brochure

TRICARE Supplement Plan Summary of Benefits

Understanding TRICARE and Your TRICARE Supplement Plan

AMRA Information

Dept. of Defense Certificate

TRICARE Supplement Plan for Retirees

The TRICARE Supplement Plan is underwritten by Monumental Life Insurance Company and Transamerica Financial Life Insurance Company (NY residents only) administered by Association & Society Insurance Corporation (ASI). Monumental Life and Transamerica Financial are rated A+ by A.M. Best.

The Commonwealth has contracted with ASI to administer this voluntary benefit for TRICARE-eligible retiree group enrollees in the State Retiree Health Benefits Program and their eligible dependents who are not eligible for Medicare. You may also add dependents as long as they are eligible for the state program, eligible for TRICARE, and not eligible for Medicare.

TRICARE eligibility includes:

Military retirees with 20 years of creditable military service and entitled to retired pay and their spouses/surviving spouses who are not eligible for Medicare.
Retired Reservists and National Guardsmen between the ages of 60 and 65 with 20 years of creditable service and their spouses/surviving spouses who are not eligible for Medicare.
Retired Reservists and National Guardsmen under age 60 and enrolled in TRICARE Retired Reserves (TRR) and their spouses/surviving spouses who are not eligible for Medicare.
Military retirees and their spouses/surviving spouses, even if they are Medicare eligible, who reside outside the U.S. or its territories (all who are eligible for Medicare must be enrolled in Medicare).
Military retirees and their spouses/surviving spouses age 65 or older but ineligible for Medicare (all must have received a Statement of Disallowance from Social Security Administration).

If you are in one of the above categories and are enrolled in the State Retiree Health Benefits Program, you may terminate your current coverage and enroll in this TRICARE Supplement Plan.

WHAT IS THE TRICARE SUPPLEMENT PLAN?

The TRICARE Supplement plan provides secondary benefits after TRICARE pays; in most cases, providing the Enrollee and family members with 100 percent coverage for covered services. The supplement plan pays the portion for which the Enrollee is responsible.

The TRICARE Supplement Plan works with all three TRICARE options (Standard, Extra and Prime) to pay the following benefits.

Under the TRICARE Standard/Extra option, the supplement plan pays:

100% of the TRICARE Standard Outpatient Deductible of $150 individual (maximum $300 family)
100% TRICARE Standard/Extra cost share
100% applicable Excess Charges (when non-network providers are used)

Under the TRICARE Prime or Point of Service (POS) option, the supplement plan pays:

100% of the TRICARE Prime copayments or cost shares
50% of the POS deductible of $300 individual (maximum $600 family)
100% TRICARE Prime POS cost share
100% applicable Excess Charges

The link to the TRICARE Supplement Plan brochure will provide you with more detailed information on the coverage and benefits provided under the plan.

Advantages of the TRICARE Supplement Plan:

Available to all TRICARE participants regardless of rank or service
No medical examination required for enrollment
No pre-existing condition exclusions
No supplement plan deductibles (but TRICARE deductibles apply)
Full reimbursement of TRICARE Standard/Extra Outpatient Deductible and 50% reimbursement of the POS deductible
Full reimbursement of the TRICARE cost shares and copayments
Full reimbursement of Excess Charges
Flexibility and freedom to see any TRICARE-authorized civilian provider
Full portability if your enrollment with the Commonwealth of Virginia ends
Guaranteed issue

MONTHLY PREMIUM SCHEDULE

Retiree Group Enrollee Only	$61
Retiree Group Enrollee Plus One	$120
Retiree Group Enrollee Plus Two/More	$161

MAKING PREMIUM PAYMENTS:

Monthly premium payments should be made directly to ASI.

You may:

Be billed directly by ASI, or
Have your payment made by electronic fund transfer (EFT) from your checking account. EFT payments will be deducted on the first business day of each month.

For information on direct billing or to request a Checkomatic form for EFT, contact ASI.

RETURNING TO OTHER STATE PROGRAM OPTIONS:

As long as the Enrollee remains eligible for the State Retiree Health Benefits Program (state program), he/she and family members may return to other available state program plans at Open Enrollment or with certain qualifying events such as Medicare eligibility or loss of TRICARE eligibility for a child. However, if eligibility for the supplement is lost due to failure to pay the premium, failure to move back to the state program upon Medicare eligibility of the Enrollee, or any other event that causes loss of eligibility for the state program, the retiree, survivor or LTD participant may not return to other state program options. Having a family group split between the TRICARE supplement and other state program plan options is not allowed. Your Benefits Administrator can assist you with specific program provisions.

MORE INFORMATION:Contact ASI directly at 1-866-637-9911.