| |
Note:
Coverage is not available in
Nevada.
USBA
has three plans to Supplement TRICARE Standard and TRICARE Extra:
"If you're a military retiree or retiree spouse and you don't want
to pay a TRICARE deductible and excess medical charges . . ." Consider:
USBA's Comprehensive Plan.
"If
you're a military retiree, or spouse of a military retiree or dependent
of an active duty member and want to avoid most out-of-pocket health
care costs . . ." Consider: USBA's High Option
II Plan or the Active Duty Family Plan.
| Consider
USBA's High Option II Plan: It Pays... |
| |
| You
Pay: |
- The
plan's fiscal year deductible of $150 per person or $300
per family.
|
| Consider
USBA's Comprehensive Plan: It Pays... |
-
Daily subsistence fee for inpatient care in military hospitals.
- Your
cost share for inpatient care in civilian hospitals.
- Your
cost share for outpatient care.
- Reimburses
up to the TRICARE Standard/Extra Outpatient deductible ($300
maximum per family). Reimbursement of the fiscal year outpatient
deductible is made only if the deductible is incurred after
the effective date of coverage. It will be pro-rated if
you are insured less than a full year.
- Plan
has a new survivor benefit that pays the premium of the
surviving spouse and covered dependents up to one year.
- 100%
of covered excess charges up to the reasonable and customary
Community standard level.
- Eligibility
- Waiver of Premium for Surviving Spouse and Dependents
- Effective Date
- Renewability
- Exclusions
- Limitations
- Pre-Existing Condition Limitations
|
| You
Pay: |
- The
plan's fiscal year deductible of $75 per person or $150
per family.
|
| Consider
USBA's Active Duty Family Plan: It Pays... |
| |
BENEFITS
SUMMARY CHART
See how our USBA TRICARE Supplement plans work with your TRICARE
Standard/Extra coverage |
| Care
Required |
TRICARE
Standard/Extra Pays |
Your TRICARE Standard/Extra Supplement Pays |
| Inpatient
care 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. |
Comprehensive
Plan & High Option II Plan - The lesser of $441/day
or 25% of 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) PLUS 100% of covered excess charges
up to the reasonable and customary community standard level
(after you satisfy the fiscal year plan deductible.) |
| Inpatient
care 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)
for doctors and other professional services. |
Comprehensive
Plan & High Option II Plan - Your cost share**
PLUS 100% of covered excess charges up to the reasonable and
customary community standard level. |
| Inpatient
care in military hospitals |
All
but the daily subsistence fee. |
All
Plans - The daily subsistence fee. |
| Outpatient
care 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. |
Comprehensive
Plan –
After you satisfy the fiscal year plan deductible of $75 per
person, and $150 family maximum, the plan will reimburse you
(1) the Tricare fiscal year outpatient deductible of $150
per person and $300 family maximum, *(2) your cost share**
and (3) 100% of covered excess charges up to the reasonable
and customary community standard level.
High
Option II Plan - Your cost share** PLUS 100% of covered
excess charges up to the reasonable and customary community
standard level. AFTER you pay the fiscal year plan deductible
of $150 per person $300 family maximum.* |
| Inpatient
care 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 reasonable
and customary community standard level. |
Outpatient
care for ACTIVE DUTY dependents (office visits, clinics, lab,
prescription drugs, etc.)
|
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 reasonable and customary community
standard level, AFTER you pay the Tricare Extra Standard Outpatient
Deductible. |
* Expenses incurred to satisfy the fiscal year Tricare Standard/Extra
Outpatient Deductible cannot be used to satisfy the High Option
II and Comprehensive Plan deductibles. Also, reimbursement toward
the fiscal year Tricare Standard/Extra outpatient deductible under
the Comprehensive Plan is made only if the deductible is incurred
after the effective date of coverage. It will be prorated if you
are insured less than a full year.
**
Until the Tricare Cap is met.
Note:
Inpatient and outpatient expenses can be used to satisfy the fiscal
year plan deductible.
|
|
| Is
there a maximum limit on benefits (lifetime, annual, etc.)? |
| When
the Tricare cap of $3,000 is met, Tricare will pay 100%
of covered medical expenses. The supplement pays nothing.
However, the supplement will pay 100% of covered excess
charges over the cap. Additionally, 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 calendar
year. Outpatient benefits for mental, nervous or emotional
disorders, drug addiction or alcoholism are limited to
a maximum of $500 in a 12 month period. |
|
|
|
| Will
the plan cover amounts beyond what TRICARE allows? |
| The
Plan will pay 100% of covered excess charges up to the
reasonable and customary community standard level. |
|
|
|
| Does
the plan pay for services that aren't covered by TRICARE?
|
| No |
|
|
|
| Will the plan pay the TRICARE outpatient deductible? |
| The Comprehensive Plan reimburses the TRICARE fiscal year
outpatient deductible subject to a fiscal year plan
deductible of $75 per person and $150 per family. The
High Option plan has a fiscal year Plan deductible of
$150 per person and $300 family maximum. |
|
|
|
| How will the plan require premium payments? |
| Premiums may be paid monthly by deduction from Checking or Saving accounts (Checkomatic), Quarterly, Semi-annually or Annually. Credit cards may not be used to pay premiums. |
|
|
|
| Will
the plan cover the TRICARE Prime enrollment fees or co-payments?
|
| No,
as we no longer offer a Prime Supplement. |
|
|
|
| Does
the plan convert to a Medicare Supplement? If so, must
it be in force as a TRICARE supplement for any specified
length of time before conversion? |
| No,
the plan does not convert to a Medicare Supplement Plan.
At age 65, TRICARE FOR LIFE kicks in and benefits are
paid between Tricare and Medicare (providing the individual
has Part B of Medicare.) |
|
|
|
| Will
the plan cover you overseas? |
| Yes.
TRICARE coverage is worldwide. If TRICARE pays for covered
medical expenses overseas, the plan will pay its contractual
benefit. |
|
|
|
| How
will the plan require premium payments. |
| Premiums
may be paid monthly by deduction from Checking or Saving
accounts (Checkomatic), Quarterly, Semi-annually or
Annually. |
|
|
|
| Can
premium payments be increased? Under what conditions? |
| Premiums
increase as a person moves from one 5-year age bracket
to another (40, 45, 50, 55, 60). The company reserves
the right to change premiums on a group wide basis to
maintain the financial solvency of the plan. |
|
|
|
| What
are the membership fees (annual, lifetime, etc.), if any,
when you join the organization that sponsors the plan?
|
| USBA
has no membership fees. |
|
|
|
| Does
the plan cover the service member when he/she retires?
|
| Yes.
If the member enrolls within 63 days from the time he/she
retires from the military, providing his dependents had
already enrolled in our Tricare Supplement Plan, the retiree
will not be subject to the Pre-Existing Condition provision.
If the retiree waits beyond the 63 day period, he/she
is subject to the Pre-Existing Condition clause. |
|
|
|
| Does
coverage continue for surviving spouses at no charge? |
| Yes,
under the Comprehensive Plan, for four years providing
both Member and Spouse have coverage under the policy
on the date of member's death. |
|
|
|
| If
you're retired military and have a health care plan (which
pays before TRICARE) through a civilian job, do you still
need a TRICARE supplement if, between them, your employer's
plan and the TRICARE health care option you've chosen
will pay most or all of your civilian medical bills? |
| No |
|
| USBA
Tricare Supplements Economical Rates |
| Military Retirees |
High Option II Plan
|
Comprehensive
|
| Retiree & Spouse |
Month |
Quarter |
Month |
Quarter |
| Under 40 |
$18.33 |
$55.00 |
$30.67 |
$92.00 |
| 40-44 |
$19.67 |
$59.00 |
$33.33 |
$100.00 |
| 45-49 |
$22.67 |
$68.00 |
$35.67 |
$107.00 |
| 50-54 |
$29.33 |
$88.00 |
$44.67 |
$134.00 |
| 55-59 |
$34.67 |
$104.00 |
$52.33 |
$157.00 |
| 60+ |
$42.00 |
$126.00 |
$65.00 |
$195.00 |
| Each Child of Retiree |
$14.33 |
$43.00 |
$22.67 |
$68.00 |
| Active Duty Family Plan |
| Spouse |
$7.00 |
$21.00 |
N/A |
N/A |
| Each Child |
$6.00 |
$18.00 |
N/A |
N/A |
|
 |
