USBA: TRICARE Reserve Select Insurance Plan

Eligibility
To qualify for TRICARE Reserve Select (TRS) supplement, you must be a member of the Selected Reserve of the Ready Reserve, and you cannot be eligible for or enrolled under FEHBP (either under their own eligibility or through a family member with FEHBP).

TRICARE Reserve Select 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 Plan Wizard

Additionally, as part of the transition to the new TRS health plan, all enrollments in the three-tiered TRS were terminated on September 30, 2007 and you will need to re-enroll in the new plan to certify eligibility.
You can learn more here.

Class

Members — Members who are eligible for TRS
Spouses — Spouses who are eligible for TRS
Member must also be covered in order to enroll Spouse
Child — A child who is eligible for TRS and is
1. under 21; or
2. 21 or over, but under 23 if enrolled as full-time student
Member must be covered in order to enroll Child(ren)

Effective Date
Your coverage begins on the first day of the first or second month (whichever you select on the 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 age 23 if a full-time student); and the Master Policy and your class of insured persons remains 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; 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; not cosmetic procedures, except those resulting from sickness or injury occurring while a covered person; drugs (other than insulin) which do 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 devises 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 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.

Pre-Existing Conditions Limitation
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.

BENEFITS SUMMARY CHART Here's How The TRICARE Reserve Select Supplement Works To Pay What Tricare Reserve Select Doesn't Pay. Inpatient Benefit: We will pay the benefits described below for a Covered Person's Period of Confinement in a Hospital or Skilled Nursing Facility.
CARE REQUIRED	TRICARE Reserve Select Pays	Your TRICARE Reserve Select Supplement Pays
Benefits in a Government Hospital	Nominal charges may apply. Check with your local facility for details.	Current Daily Subsistence Charge.
Benefits in a Civilian Hospital or Skilled Nursing Facility	All Tricare Reserve Select allowable amounts except the first $25.00 or current daily subsistence charges (whichever is greater).	For the Covered Member, Spouse or Child, we will pay: a) The greater of: Current Daily Subsistence Charge for each day of Confinement; or $25.00 for all Confinements which are due to the same or related Sickness or Injury and separated by less than 60 days; until the TRICARE Cap* is met; and b) 100% of all Covered Expenses in Excess of the Tricare allowed amount, not to exceed the legal limit - after the TRICARE deductibles are met.
Same Day Surgery Benefit	Military Treatment Facility No Charge Tricare Network Provider 85% of the negotiated rate after the annual deductible is met. Non-Network Provider 80% of the TRICARE allowable charge after annual deductible is met.	*Until the TRICARE Cap is met, we will pay the $25.00 not paid by TRICARE for Covered Expenses which are incurred in connection with a Same-Day Surgery performed:** a) In a facility licensed as an ambulatory surgical center approved by TRICARE; or b) In a Hospital, provided the Hospital charges less than a full day's room and board.
Outpatient Benefit	Military Treatment Facility No Charge Tricare Network Provider 85% of the TRICARE allowable charge after the annual deductible is met. Non-Network Provider 80% of the TRICARE allowable charge after annual deductible is met.	When a Covered Person incurs Covered Expenses while he or she is not Confined in a Hospital or Skilled Nursing Facility, we will pay the benefits described below provided that the expenses are: a) Due to Sickness or Injury; b) Incurred while he or she is covered under this benefit; c) Approved by TRICARE; and d) Incurred after he or she has satisfied the Outpatient Deductible charged by TRICARE. For the Covered Member, Spouse or Child, we will pay: a) Your cost share* of the TRICARE Allowed Amount for the covered expenses until the TRICARE cap* is met; and b) 100% of all Covered Expenses in Excess of the Tricare allowed amount, not to exceed the legal limit — after the TRICARE deductibles are met.

* Tricare Catastrophic Cap — Maximum out-of-pocket expense = $1,000 per family, per fiscal year. Monthly premium payments do not apply toward meeting the catastrophic cap.
**Tricare Annual Outpatient Deductible	Member-Only Plan E-4 and Below - $50.00 E-5 and Above - $150.00	Family Plan $100.00 $300.00
***Your cost share is 20% for care received from any non-network TRICARE-authorized provider or 15% for care received from a TRICARE network provider.
We will not pay for expenses which are used to satisfy the Outpatient Deductible charged by TRICARE.
All outpatient Covered Expenses will be deemed incurred on the date the Covered Person received the treatment, service or supply that gave rise to the expense.
Confined or Confinement means being an inpatient in a Hospital (or Skilled Nursing Facility) due to Sickness or Injury. Skilled Nursing Facility does not mean: a) a hospital; or b) a place for rest, custodial care or the aged; or c) a place for the treatment of mental disease, drug addicts or alcoholics.

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?

Will the plan pay the TRICARE outpatient deductible?

The Comprehensive Plan reimburses the TRICARE fiscal year outpatient deductible subject to a modes 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. question 8 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?

Choose from two payment plans featuring attractive rates!
Economic Quarterly Premiums to Fit Your Budget

As a member, you benefit from our mass purchasing power, making the rates for this valuable coverage surprisingly affordable. What’s more … the insurance company guarantees you’ll never be singled out for a rate increase, no matter how many claims you file!

Quarterly Premium Rates
Under Age 65	Member Spouse Each Child		$21.00 $21.00 $18.00

Premiums shown are per person.

Budget Your Payments with
CHECKOMATIC …
The Direct Monthly Payment Plan

Your TRICARE Supplement Plan premiums can be deducted directly from your checking account every month … with no worries about missing a payment and losing your valuable insurance protection. Simply complete the Request and Authorization form that accompanies this Plan Application and mail it, along with your enrollment form and first month’s premium payment.

Enclose a blank check (marked VOID) to be kept of file. All future premiums will be deducted from your checking account automatically on the first business day of each month. Completed form and voided check must be received by the 15th of the month prior to the month of deduction.

Monthly Premium Rates
Under Age 65	Member Spouse Each Child		$7.00 $7.00 $6.00

Premiums shown are per person.

You can purchase the TRICARE Reserve Select Supplement plan at any time throughout the year as long as you are eligible for the TRICARE Reserve Select program

There is no specific period of coverage — coverage is effective unless terminated or you are not eligible for TRICARE Reserve Select program.

		USBA's Group Life Insurance Plans are Underwritten By New York Life Insurance Company.
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