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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:

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:

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

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:

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.

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