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Plan Details
Benefits Summary

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30-Day Right to Examine:
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

USBA CHAMPVA Supplement Plan

The USBA CHAMPVA Supplement Plan provides you with the protection you may need when a serious covered accident or sickness occurs. The USBA CHAMPVA Supplement Plan, when combined with your CHAMPVA benefits, is designed to provide you with the protection you need when you need it.

So why choose USBA’s CHAMPVA Supplement Plan?

  • Guaranteed Acceptance (subject to pre-existing condition limitation*)
  • 30-Day Right to Examine
  • Competitively Priced
  • Retirees and Spouses Get the Same Rates
  • Smokers Pay the Same Price As Non-smokers

Before you begin the application process, be sure to review the USBA CHAMPVA Suppplement Plan Features, Benefits Summary, FAQs and Rates.

If you have questions, please don’t hesitate to call one of our highly-trained product specialists at (877) 297-9235.

NOTE: Coverage may not be available in all states.

Notice: ASI, the administrator of USBA’s TRICARE/CHAMPVA Supplement products was recently acquired by Selman & Company of Cleveland, Ohio. This acquisition does not change the terms or conditions of your TRICARE/CHAMPVA Supplement products. The insurer stays the same, claims file the same, the customer service 1-800-638-2610 remains the same. USBA was not a party to the acquisition and continues to operate independently.

Underwritten by Transamerica Premier Life Insurance Company, Cedar Rapids, IA and for NY residents, Transamerica Financial Life Insurance Company, Harrison, NY.


Application Download
Choose the application that’s right for you:
Arrow CHAMPVA Supplement
Arrow Download Claim Form
Arrow Download Claim Form (NY Residents Only)

To qualify for this product, you must be:
  Arrow CHAMPVA-eligible recipient under age 65
CHAMPVA-eligible spouse under age 65, and dependent, unmarried children under age 18 (23 if in college)
CHAMPVA-eligible widow(er)s under age 65
Plan Details    
Benefits Summary

Here’s how the USBA CHAMPVA Supplement Plan works to help pay covered expenses after CHAMPVA pays.

Covered Care Required CHAMPVA Pays CHAMPVA Supplement Plan Pays
Inpatient Services
Confinement in civilian hospital or skilled nursing facility
DRG* rate, less the beneficiary cost share The lesser of (1) the standard DRG* amount per day, times number of inpatient days, or (2) 25% of the billed amount.
Inpatient Services
Non-DRG* based
75% of the Allowable Amount 25% of the Allowable Amount
Inpatient Physician Services
Visits, surgeons, anesthesiologists, etc.
75% of the Allowable Amount 25% of the Allowable Amount
Outpatient Services
Office visits, clinics, laboratory and pharmacy services, durable medical equipment (non-VA source)
75% of the Allowable Amount, after the CHAMPVA Annual Outpatient Deductible

25% of the Allowable Amount

We will pay the Inpatient and Outpatient covered medical expenses once the Calendar Year plan deductible of $250 per person and $500 family maximum has been satisfied. Expenses incurred to satisfy the CHAMPVA Calendar Year Outpatient deductible cannot be used to satisfy the CHAMPVA Supplement Plan deductible.

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Download the Application
That’s Right For You:
Download Claim Form
Arrow CHAMPVA Supplement Claim Form
Arrow CHAMPVA Supplement
(NY Residents Only)
Claim Form (NY Residents Only)

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