The USBA CHAMPVA Supplement Plan will pay your cost share for both covered inpatient and outpatient medical expenses after you satisfy the calendar year plan deductible of $250 per person, $500 family maximum. Take a moment to read the details below. Then enroll today to give your family the additional protection of the USBA CHAMPVA Supplement Plan that complements your CHAMPVA benefits.
Eligibility - Eligible Spouse: “Spouse” means your spouse who is under age 65 and a CHAMPVA benefits recipient, but not a spouse from whom you are legally separated or divorced. “Spouse” also means widow(er) if he or she is a member of the Participating Organization.
Spouses over age 65 are also eligible if documentation from the Social Security Administration certifying their non-entitlement to Medicare Part A benefits is submitted with their enrollment form. Eligible dependents and unmarried children under 18 (23 if a full-time college student) may also enroll.
Effective Date - Coverage for dependents becomes effective on the first day of the month following receipt of your Enrollment Form and first premium payment.
Covered Dependent Effective Date - Subject to the Deferred Effective Date provision, an Eligible Dependent will become covered by the Policy on the Certificate Effective Date that first shows coverage for him or her. Your coverage is shown on your Schedule of Insurance.
Deferred Effective Date - If on the date that an Eligible Dependent is to become covered under the Policy he or she is confined in a Hospital, coverage of such person will be deferred until the first day after he or she is discharged.
Renewability - Your coverage is renewable to age 65. As long as premiums are paid on time, everyone remains eligible, and the Master Policy remains in effect, no one can be individually canceled. So even if you or a covered dependent develops a serious health condition in the future, the coverage will not terminate, provided these three conditions are met.
Change of Policy Premiums - We have the right on each Premium Due Date to change the rate at which premiums will be calculated. This includes the right to change premium rates for a benefit that applies to all individuals of the same class, age, plan and effective date. Rates may be changed based on claims experience of the Policy. We will give the Policyholder or Organization notice of any change at least 45 days before the Premium Due Date on which it is to become effective.
Termination - A Covered Person’s coverage under the Policy will cease on the first to occur of: (1) the date the Policy terminates, or the date USBA ceases to be a Participating Organization of the Policyholder; (2) the date the required premium is not paid, subject to the Grace Period provisions; (3) the date you or your widow(er) terminates membership in the Participating Organization; (4) the first premium due date on or next following the date a dependent ceases to be an Eligible Spouse or an Eligible Child; (5) the date we or the group cancel coverage for a class of Eligible Person to which he or she belongs; (6) the first premium due date on or next following the date he or she ceases to be covered by CHAMPVA; (7) the date he or she becomes eligible for Medicare unless the covered person resides in an area where Medicare is not available, in which case coverage will not terminate until the covered person returns to residency in an area where Medicare is available; (8) if a child, the date he or she attains age 18, or 23 if enrolled full-time in a school of higher learning; (9) if a spouse, the date he or she attains age 65. Termination of insurance will not prejudice any claim which occurred before the effective date of termination. Limitations and exclusions may vary by state. Please see Certificate for details.
Exclusions - The Policy does not cover - (1) injury or sickness resulting from war or act of war, whether war is declared or undeclared; (2) treatment or confinement not ordered by a Physician or necessary for medical care; (3) intentionally self-inflicted injury; (4) suicide or attempted suicide, whether sane or insane (in Colorado and Missouri while sane); (5) routine physical exams and immunizations, except when considered Well Baby Care covered by CHAMPVA; (6) domiciliary or custodial care, care received in a retirement home, rest home or halfway house; (7) rest cures; (8) eye refractions and routine eye exams except when considered Well Baby Care covered by CHAMPVA; (9) eyeglasses and contact lenses; (10) cosmetic procedures, except those resulting from Sickness or Injury while a Covered Person; (11) hearing aids or hearing exams except when considered Well Baby Care covered by CHAMPVA; (12) orthopedic footwear; (13) care for the mentally incapacitated or physically handicapped if the care is required because of the mental incapacitation or physical handicap; (14) drugs which do not require a prescription, except insulin and other diabetic supplies; (15) any confinement, service, or supply that is not covered under CHAMPVA; (16) expenses in excess of the CHAMPVA Cap; (17) expenses in excess of the CHAMPVA Allowed Amount; (18) expenses which are paid in full by CHAMPVA; (19) any expenses or portion thereof applied to the CHAMPVA Deductible; (20) any part of a covered expense which the Covered Person is not legally obligated to pay; (21) care received as part of a grant, study or research program; (22) care considered experimental or investigational.
Limitations - The coverage provided under the Inpatient Benefit of the CHAMPVA Supplement Plan for nervous, mental and emotional disorders, including alcoholism and drug addictions, is limited to: (a) 30 Inpatient treatment days for a Covered Person age 19 or older; or (b) 45 Inpatient treatment days for a Covered Person under age 19; or (c) 150 Inpatient treatment days in a CHAMPVA authorized Residential Treatment Center for a Covered Person under age 21 per Calendar Year. This Inpatient limit is based on the number of days CHAMPVA normally provides each Calendar Year for such confinements. In rare instances, CHAMPVA extends these daily limits. If this occurs, we will limit the number of days that we provide for such confinement to the lesser of: (a) the number of days CHAMPVA pays for such Inpatient treatment during the Calendar Year; or (b) 90 Inpatient days per Calendar Year.
The coverage provided under the Outpatient Benefit of the CHAMPVA Supplement Plan for: (a) nervous, mental, and emotional disorders; and (b) alcoholism and drug addition; is limited to $500 during any Calendar Year for all such disorders.
Coverage provided under the CHAMPVA Supplement Plan for: (1) routine newborn and Well Baby Care; (2) hospital nursery charges for a well newborn; (3) dental care; (4) treatment for the prevention or cure of alcoholism or drug addition; (5) and prosthetic devices; will be limited to those expenses covered by CHAMPVA for such care or service.
Pre-Existing Condition Limitations - 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 will not be covered until the coverage has been in effect for 6 months. However, new conditions will be covered immediately.
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.