Eligibility - TRICARE Reserve Select Supplement
is available to all members of the Selected Reserve regardless of any active duty
served, with one exception: If you are eligible for the Federal Employees Health
Benefits Program (FEHBP) or currently covered under FEHBP, you are excluded from
purchasing the restructured TRS plan.For more information, visit the TRICARE website
and use their interactive
TRICARE Young Adult (TYA) Program
- TRICARE Young Adult (TYA) is
a “premium-based health care plan available for purchase” by qualified
adult children, under age 26, after their eligibility for regular TRICARE ends.
TYA offers TRICARE Standard coverage and includes medical and pharmacy benefits
For further information on TRICARE Young Adult, please visit the TRICARE web site
Effective May 1, 2011, the TRICARE Supplement Plan will provide supplemental coverage
for dependent enrolled in TYA. These young adult dependents will have the same supplement
plan premium rates, benefits and coverage limitations as dependent children under
the age of 21 or 23 if full-time student.
To enroll your adult dependent child in the TRICARE Supplement Plan, complete the
enrollment form and mail to ASI along with a copy of his/her TYA enrollment card.
Your adult dependent child must be enrolled in TRICARE Young Adult before enrolling
in the TRICARE Supplement Plan. TYA coverage ends if any of the following occurs:
- Dependent attains age 26
- Gets married – Becomes eligible for an employer-sponsored plan
- Gains other TRICARE coverage
- Sponsor ends TRICARE coverage
Effective Date - Your coverage begins on the first day of the first
or second month (whichever you select on the TRS Supplement Request Form) following
the postmark of your TRS Supplement Request Form. For example, if your form is postmarked
in July, you may choose for your coverage to begin of the first day of the next
month, August, or on the first day of the second month, September.
Renewability - The TRICARE Reserve Select Supplement
coverage is renewable to age 65. As long as premiums are paid on time; you remain
a member of the sponsoring organization; you, your spouse and dependents remain
in an eligible status (you are covered by TRICARE Reserve Select, children are under
age 21 or 23 if a full-time student); and the Master Policy and your class of insured
persons remain in effect. So, even if you or a covered dependent develops a serious
health condition in the future, their coverage will not terminate, provided these
conditions are met.
Exclusions - Treatment or confinement not ordered by a physician
or necessary for medical care; intentionally self-inflicted injury; suicide or attempted
suicide, whether sane or insane (while sane in MO and CO); sickness or injury resulting
from act of war, whether declared or undeclared; routine physical exams, eye exams,
eye refractions and immunizations, except for well baby care covered by TRICARE;
custodial care, hearing aids, orthopedic footwear, eyeglasses or contact lenses;
cosmetic procedures, except those resulting from sickness or injury occurring while
a covered person; drugs (other than insulin) which do not require a prescription;
any confinement, service or supply not covered under TRICARE, or for expenses paid
in full by TRICARE; expenses in excess of the TRICARE Cap; the TRICARE Reserve Select
fiscal year outpatient deductible, care of the mentally retarded or physically handicapped
which is required due to the mental retardation or physical handicap; any part of
a covered expense which the covered person is not legally obligated to pay because
of payment by a TRICARE alternative program. Check your regional contractor’s
web site or your Certificate of Insurance for additional information.
Limitations - Routine newborn and well baby care, hospital nursery
charges for a well newborn, dental care, treatment for prevention or cure of alcoholism
or drug addiction, and prosthetic devices are limited to expenses covered by TRICARE.
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 fiscal year. OUTPATIENT benefits for mental, nervous or emotional
disorders, drug addiction or alcoholism are limited to a maximum of $500 in a fiscal
*Pre-Existing Condition Limitations - If a member enrolls in TRICARE
Reserve Select and requests coverage under the TRICARE Reserve Select Supplement
within 30 days of the date his or her TRICARE Reserve Select coverage begins, we
will waive the Pre-Existing Conditions Limitation. A pre-existing condition provision
means 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 and will not be covered until the coverage
has been in effect for 6 months. However, new conditions will be covered immediately.
Insured Person Termination - Your coverage under the Policy will
cease on the first to occur of: the date the Policy terminates; the date the required
premium is not paid, subject to the Grace Period provisions; the first day of the
month on or next following the date you cease to be a member of the Policyholder;
the first day of the month on or next following the date you cease to be eligible
for the Plan under which you are covered; the date we or the Policyholder cancel
coverage for a Class of Eligible Person to which you belong; the date you attain
age 65; the date you cease to be covered under TRICARE Reserve Select; 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.
This site explains the general purpose of the insurance described, but in no way
changes or affects the policy as actually issued. In the event of any discrepancy
between this site and the contract, the terms of the contract will apply. Complete
details are found in the certificate of insurance issued to each insured individual.
This program may not be available to residents of all states. You will be notified
by the Administrator if you are ineligible for coverage.