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Military Life Insurance, TRICARE, CHAMPVA
Supplements for Armed Forces & Services:
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Veterans, Retired Military, Reserve &
National Guard, Federal Employees
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Home > Insurance Help & Plans Overview > TRICARE Standard/Extra Supplement
USBA TRICARE Standard/Extra Supplement Plan Family Photo
 
     
 
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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 TRICARE Standard/Extra Supplement Plan

SELECTED RESERVE
or READY RESERVE?

If you’re an eligible TRICARE beneficiary, we invite you to compare our TRICARE Standard or TRICARE Extra Supplemental insurance plan to other providers. 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 Right to Examine
  • Your Choice of 2 Specially-designed Plans to Custom Fit Your Needs
  • Competitively Priced
  • Retirees and Spouses Get the Same Rates
  • 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: 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.

To qualify for this product, you must be:
  Arrow TRICARE-eligible recipient under age 65 and entitled to retired, retainer, or equivalent pay
  Arrow
TRICARE-eligible spouse under age 65, and dependent, unmarried children under age 21 (23 if in college)
  Arrow
TRICARE-eligible widow(er)s and ex-spouses
Arrow
Eligible Spouses and Children of active-duty service members
  Arrow
Must not be enrolled in Medicare
Check your eligibility for TRICARE by visiting here.
Plan Details    
Benefits Summary

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.)

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.

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Arrow TRICARE Standard/Extra Supplement Claim Form
Arrow TRICARE Standard/Extra Supplement
(NY Residents Only)
Claim Form (NY Residents Only)



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