Tricare Supplement
TRICARE Supplement Plan for Active Employees
- Non-Medicare eligible retiree group members, please click here -
The TRICARE Supplement Plan is administered by ASI and underwritten by Monumental Life Insurance Company and Transamerica Financial Life Insurance Company (NY residents only).
TRICARE-eligible employees who are also eligible for the State Health Benefits Program and are in one of the following categories may voluntarily enroll in the supplement plan:
- 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 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).
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 clause
- No supplement plan deductibles, but TRICARE deductibles apply
- Full reimbursement of the TRICARE Standard/Extra Outpatient Deductible and
50% reimbursement of the POS deductible
- Full reimbursement of the TRICARE cost shares
- Full reimbursement of the excess charge benefit (difference between the
TRICARE allowed amount and the provider’s billed charge) when a nonparticipating
provider is utilized
- Flexibility and freedom to see any TRICARE-authorized civilian providers
- Full portability if your enrollment with the Commonwealth of Virginia ends
- Guaranteed Issue
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
MONTHLY PREMIUM SCHEDULE
| Employee Only |
$60 |
| Employee plus One |
$119 |
| Employee plus Two/More |
$160 |
The enclosed TRICARE Supplement Plan communication materials provide more detailed
information on the coverage and benefits provided.
MAKING PREMIUM PAYMENTS: Monthly premiums will be payroll deducted on a pre-tax
basis.
SPECIAL ENROLLMENT OPTIONS: During the special enrollment period from August
22 – September 6, you may:
- Change to the TRICARE supplement from your current COVA Care, COVA Connect,
COVA HDHP or Kaiser Permanente HMO health plan,
- Elect the TRICARE supplement from waived status, or
- Take no action and remain in your current health plan.
If you elect the TRICARE supplement, your coverage will be effective on October 1, 2011.
Remember that you cannot change plans again unless you have a consistent qualifying midyear
event or until the next annual Open Enrollment in spring 2012.
TO ENROLL OR FOR QUESTIONS: Call ASI’s toll-free number at 1-866-637-9911 for an enrollment package, questions about Open Enrollment or other questions about the TRICARE supplement.
