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30-Day Unconditional Promise:
Upon approval of your Application, you’ll be
issued a Certificate of Insurance. If you are
not completely satisfied with the provisions
of your Certificate, you can return it within 30
days, without claim, for a prompt, full refund. Important
Plan Information |
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Introduction |
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If you are an eligible TRICARE beneficiary, you may be eligible to consider a TRICARE Supplement. USBA understands how confusing the health care choices are today for military families and retirees. We also understand how important choosing the right health care supplement is … because your family will still have medical expenses even after TRICARE pays. And even though your costs may be small, in many cases they can be huge.
So why choose USBA’s TRICARE Standard/Extra Supplement Plan?
- Guaranteed Acceptance (subject to pre-existing condition limitation)
- 30-Day Satisfaction Guarantee
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No Medical Exam Required
- Your Choice of 2 Specially-designed Plans to Custom Fit Your Needs
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Priced to Fit Your Budget As Well As Your Needs
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Retirees and Spouses Get the Same Rates
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Smokers Pay the Same Price As Non-smokers
Attention “Gray Area Reservists and Survivors”, effective September 1, 2010, TRICARE has a new health benefit program for Retired National Guard and Reservists who are under the age of 60, not qualified for non-regular retirement and not eligible for, or enrolled in, the Federal Employees Health Benefits (FEHB) program. You now have the option to purchase the TRICARE Retired Reserve (TRR) health benefits plan. If you are enrolled in TRR you are eligible to enroll in our High Option II Supplement Plan.
Before you begin the application process, be sure to review the USBA TRICARE Standard/Extra Supplement Plan Features, Benefits Summary, FAQs and Rates.
If you have questions, please don’t hesitate to call one of our highly-trained TRICARE specialists at (877) 297-9235.
NOTE: Do Not Request MEDICARE SUPPLEMENT Information. Coverage is not available in Nevada.
ASI, the plan administrator of the TRICARE Supplement Plan, is exercising its contractual right to change the plan underwriter effective October 1, 2010. The plan underwriter will be changed from Hartford Life and Accident Insurance Company to Monumental Life Insurance Company and Transamerica Financial Life Insurance Company (NY residents only).
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Benefits Summary |
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BENEFITS SUMMARY CHART
See how our USBA TRICARE Supplement plans work with your TRICARE Standard/Extra coverage. |
| Confinement
Required |
TRICARE
Standard/Extra Pays |
Your TRICARE Standard/Extra Supplement Pays |
| Inpatient
confinement in civilian hospitals for RETIREES and dependent family
members (room, board, supplies, and staff services billed by
the hospital) |
The
TRICARE Standard/DRG amount (contracted rate for TRICARE Extra)
minus your cost share. |
High Option II Plan – The lesser of the Standard DRG amount or 25% of the billed amount, not to exceed the TRICARE Standard DRG amount (lesser of $250/day or 25% cost share* of the contracted rate for TRICARE Extra) AFTER you satisfy the fiscal year Plan Deductible PLUS 100% of Covered Excess Charges up to the Legal Limit**. |
| Inpatient
confinement in civilian hospitals for RETIREES and dependent family
members (doctors & other inpatient services not billed by the
hospital) |
75%
of the TRICARE Standard allowed amount (80% for TRICARE Extra)
after you pay the TRICARE Outpatient Deductible. |
High Option II Plan - Your cost share* AFTER you satisfy the fiscal
year Plan Deductible PLUS 100% of Covered Excess Charges up to the Legal Limit**. |
| Inpatient
confinement in military hospitals |
All
but the daily subsistence fee. |
Both
Plans - The daily subsistence fee. |
| Outpatient confinement for RETIREES and dependent family members (office visits,
clinics, lab, prescription drugs, etc.) |
75%
of the TRICARE Standard allowed amount (80% for TRICARE Extra)
after you pay the TRICARE outpatient deductible. |
High Option II Plan - Your cost share* AFTER you satisfy the Plan Deductible PLUS 100% of Covered Excess Charges up to the Legal Limit**.
For prescription drugs - the plan pays your copayment amounts. |
| Inpatient
confinement in civilian hospitals for ACTIVE DUTY dependents |
All
allowable charges except daily subsistence fee or $25, whichever
is greater. |
Active
Duty Plan - $25 or the daily subsistence fee, whichever
is greater, PLUS 100% of Covered Excess Charges up to the Legal Limit. |
Outpatient
confinement for ACTIVE DUTY dependents (office visits, clinics, lab,
prescription drugs, etc.)
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80% of the TRICARE Standard Allowed amount (85% for TRICARE Extra)
after you pay the TRICARE Outpatient Deductible. |
Active Duty Plan – Your cost share* Plus 100% of Covered Excess Charges up to the Legal Limit**.
For prescription drugs – the plan pays your copayment amounts. |
Confined or Confinement means being an Inpatient in a hospital (or Skilled Nursing Facility) due to Sickness or Injury.
A Skilled Nursing Facility does not mean: a hospital; or a place for rest, custodial care or aged; or a place for the treatment of mental disease, drug addiction or alcoholics.
The High Option II Supplement Plan pays the Inpatient and Outpatient covered medical expenses once the fiscal year
plan deductible of $250 per person, $500 per family maximum has been satisfied. Expenses incurred to satisfy the fiscal year TRICARE Standard Outpatient Deductible cannot be used to satisfy the High Option II Plan deductible.
* Until the TRICARE Cap is met.
** Legal Limit means the maximum amount that a non-participating provider can legally
charge. The amount is up to 115% of the TRICARE allowed amount.
NOTE: Inpatient and outpatient expenses can be used to satisfy the fiscal year Plan Deductible.
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USBA Group Life Insurance plans are underwritten by New York Life Insurance Company
