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Home > Insurance Help & Plans Overview > TRICARE Select Supplement
USBA TRICARE Select Supplement Plan Family Photo
 
     
 
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30-Day Right to Examine:
You cannot be turned down for coverage, although a pre-existing condition may initially limit the extent of your coverage. After your completed Enrollment Form and first premium payment have been processed, you’ll receive a Certificate of Insurance which you can examine for a 30 day free look. Return it for a full refund if you are not completely satisfied.
 

USBA TRICARE Select Supplement Plan

SELECTED RESERVE
or READY RESERVE?

If you’re an eligible TRICARE beneficiary, we invite you to compare our TRICARE Select 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 Select 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”: If you are enrolled in the TRICARE Retired Reserve (TRR) health plan, you are eligible to enroll in our TRICARE Select High Option II Supplement Plan.

Before you begin the application process, be sure to review the USBA TRICARE Select 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.

Plan Administered by: Selman & Company, based in Cleveland, Ohio, has marketed and administered life and health insurance products to members of associations and affinity groups, customers of financial institutions, and employees for over 30 years. Selman & Company is among the largest privately held firms in the nation with focus on the markets in which it serves.

Underwritten by: Transamerica Premier Life Insurance Company (TPLIC), Cedar Rapids, IA, Group Policy MLTRC1000GP. Transamerica Financial Life Insurance Company (TFLIC), Harrison, NY, Group Policy TFTRC1000GP. TFLIC is authorized to conduct business in New York. TPLIC is authorized to conduct business in all other states.

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

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    
Features

USBA High Option II Plan - USBA’s Supplement to TRICARE Select.

You Pay:

  • The TRICARE Select Supplement Plan’s fiscal year deductible of:
    • $250 per person or $500 per family.
    • Active duty military do not have an annual deductible.
  • The TRICARE Select Fiscal year outpatient deductible.

USBA High Option II pays:

  • Your daily subsistence for inpatient confinement in military hospitals.
  • Your cost share for inpatient confinement in civilian hospitals.
  • Your cost share for outpatient confinement after the TRICARE outpatient deductible has been met (25% of TRICARE Select allowed amount).
  • 100% of covered excess charges up to the legal limit.

Eligibility - You are eligible to enroll provided you are an eligible TRICARE recipient, under age 65, and entitled to retired, retainer, or equivalent pay. If you are age 65 or over and ineligible for Medicare, you may enroll for the plan by attaching a copy of your Social Security Notice of Disallowance of Benefits to your Enrollment Form. Coverage is also available for your TRICARE eligible spouse under age 65, and dependent, unmarried children under age 21 (23 if in college). Coverage is extended to adult dependent children who are under age 26 and enrolled in TRICARE Young Adult (TYA) program. Eligible spouses and children of active-duty service members may enroll; TRICARE-eligible widow(er)s and ex-spouses may also enroll.

TRICARE Young Adult (TYA) Program - Coverage is extended to qualified adult dependent children who are under age 26 and enrolled in TRICARE Young Adult (TYA) program. For further information on TRICARE Young Adult, please visit the TRICARE web site.

To enroll your adult dependent child in the TRICARE Supplement Plan, complete the enrollment form and mail along with a copy of his/her TYA enrollment card. Your adult dependent child must be enrolled in TRICARE Young Adult before enrolling in the TRICARE Supplement Plan. TYA coverage ends if any of the following occurs:

- Dependent attains age 26
- Gets married
- Becomes eligible for an employer-sponsored plan
- Gains other TRICARE coverage
- Sponsor ends TRICARE coverage

Effective Date - Your coverage and that of your covered dependents becomes effective on the first day of the month following receipt of your Enrollment Form and first premium payment. If, on that day, you or a covered dependent are confined in a hospital, the effective date will be the day following discharge from the hospital. Newborn children not named in your enrollment form are automatically covered from birth for injury or sickness, including treatment of congenital defects and birth abnormalities, for 31 days. You must notify the Plan Administrator in writing and pay the additional premium due within 31 days of birth for coverage to continue beyond this period. Insured children who are incapable of self-sustaining employment because of mental retardation or physical disability – and who are unmarried and chiefly dependent on the insured member for support and maintenance – may continue coverage past policy age limits, with requested proof. Otherwise, each dependent child’s coverage terminates on the premium due date following the date he or she is no longer a dependent.

Termination - Insured Person: Coverage under the Policy will cease on the first to occur of: 1) the date the Policy terminates, or the date the Organization ceases to be a Participating Organization of the policyholder, 2) the date the required premium is not paid, subject to the Grace Period provision; 3) the first day of the month on or next following the date you cease to be a member of the Policyholder; 4) the first day of the month on or next following the date you cease to be eligible for the Plan under which you are covered; 5) the date we or the Policyholder cancel coverage for a Class of Eligible Person to which you belong; 6) the date you attain age 65; 7) the date you cease to be covered under TRICARE; 8) the date you become eligible for Medicare unless you reside in an area where Medicare is not available, in which case coverage will not terminate until you return to residency in an area where Medicare is available. Termination of coverage will be without prejudice to any claim which originated before the effective date of termination. Dependent: Dependent’s coverage under the Policy will cease on the first to occur of: 1) the date the Policy terminates; 2) the date the required premium is not paid, subject to the Grace Period provision; 3) the first day of the month on or next following the date the dependent ceases to be an Eligible Spouse or an Eligible Child; 4) the first day of the month on or next following the date the dependent ceases to be eligible for the Plan under which the dependent is covered; 5) the date we or the Policyholder cancel coverage for a Class of Eligible Person to which the dependent belongs; 6) the date you cease to be covered, subject to the Covered Dependent Continuation provision (this will not apply to the Spouse or Child of an Active Duty Member or a Service Disabled Member); 7) the date the dependent becomes eligible for Medicare unless the dependent resides in an area where Medicare is not available, in which case coverage will not terminate until the dependent returns to residency in an area where Medicare is available; 8) if a child, the date the child attains age 21 or age 23 (if the child is enrolled full time at a school of higher learning); under 26 if covered by the TRICARE Young Adult Program; 9) the date a dependent ceases to be covered under TRICARE; 10) the date a dependent attains age 65. Termination of coverage will be without prejudice to any claim which originated before the effective date of termination.

Exclusions - This Policy does not cover 1) injury or sickness resulting from war or act of war, whether war is declared or undeclared; 2) intentionally self-inflicted injury; 3) suicide or attempted suicide, whether sane or insane (in Colorado and Missouri while sane); 4) routine physical exams and immunizations, except when: a) rendered to a child up to 6 years from the child’s birth; or b) ordered by a Uniform Service: i) for a Covered Spouse or Child of an Active Duty Member; ii) for such spouse or child’s travel out of the United States due to your assignment; 5) domiciliary or custodial care; 6) eye refractions and routine eye exams except when rendered to a child up to 6 years from the child’s birth; 7) eyeglasses and contact lenses; 8) prosthetic devices (except that artificial limbs and eyes and devices which must be implanted by surgery are covered); 9) cosmetic procedures, except those resulting from Sickness or Injury; 10) hearing aids; 11) orthopedic footwear; 12) care for the mentally incapacitated or physically handicapped if the care is required because of the mental incapacitation or physical handicap or the care is received by an Active Duty Member’s child who is covered by the “Program for the Handicapped” under TRICARE; 13) drugs which do not require a prescription, except insulin; 14) dental care unless such care is covered by TRICARE, and then only to the extent that TRICARE covers such care; 15) any confinement, service, or supply that is not covered under TRICARE; 16) Hospital nursery charges for well newborn, except as specifically provided under TRICARE; 17) any routine newborn care except Well Baby Care, as defined, for a child up to 6 years from the child’s birth; 18) expenses in excess of the TRICARE Cap; 19) expenses which are paid in full by TRICARE; 20) any expense or portion thereof, applied to the TRICARE Outpatient Deductible; 21) treatment for the prevention or cure of alcoholism or drug addiction except as specifically provided under TRICARE; 22) any part of a covered expense which the Covered Person is not legally obligated to pay because of payment by a TRICARE alternative program; 23) any claim under more than one of the TRICARE Supplement Plans, or under more than one Inpatient Benefit or more than one Outpatient Benefit of the TRICARE Supplement Plans. If a claim is payable under more than one of the stated Plans or Benefits, payment will only be made under the one that provides the highest coverage, subject to the Pre-Existing Condition Limitation.

Exclusions for the State of New York
The Policy does not cover: 1) injury or sickness resulting from war or act of war, whether war is declared or undeclared; 2) intentionally self-inflicted injury; 3) suicide or attempted suicide; 4)custodial care; 5) eye refractions and routine eye exams except when rendered to a child up to 6 years from the child’s birth; 6) eyeglasses; 7) cosmetic surgery, except that cosmetic surgery shall not include reconstructive surgery when such surgery is incidental to or follows surgery resulting from trauma, infection, or other diseases of the involved part, and reconstructive surgery because of a congenital disease or anomaly of a covered dependent child which has resulted in a functional defect; 8) hearing aids; 9) dental care or treatment, except for such care or treatment due to accidental injury to sound natural teeth within 12 months of the accident and except for dental care or treatment necessary due to congenital disease or anomaly; 10) any confinement, service, or supply that is not covered under TRICARE; 11) expenses in excess of the TRICARE Cap; 12) expenses which are paid in full by TRICARE; 13) any expense or portion thereof, applied to the TRICARE Outpatient Deductible; 14) treatment for the prevention or cure of alcoholism or drug addiction except as specifically provided under TRICARE; 15) any part of a covered expense which the Covered Person is not legally obligated to pay because of payment by a TRICARE alternative program; 16) any claim under more than one of the TRICARE Supplement Plans, or under more than one Inpatient Benefit or more than one Outpatient Benefit of the TRICARE Supplement Plans. If a claim is payable under more than one of the stated Plans or Benefits, payment will only be made under the one that provides the highest coverage, subject to the Pre-Existing Condition Limitation.

Limitations (Nervous, Mental, Emotional Disorder, Alcoholism, and Drug Addiction Limits) - The coverage provided under the Inpatient Benefit of the TRICARE Supplement Plan for nervous, mental and emotional disorders, including alcoholism and drug addiction, is limited to: 1) 30 Inpatient treatment days for a Covered Person age 19 or older; or 2) 45 Inpatient treatment days for a Covered Person under age 19 per Fiscal Year. This Inpatient limit is based on the number of days TRICARE normally provides each Fiscal Year for such confinements. In rare instances, TRICARE extends these daily limits. If this occurs, we will limit the number of days that we provide for such confinement to the lesser of: 1) the number of days TRICARE pays for such Inpatient treatment during the Fiscal Year; or 2) 90 Inpatient days per Fiscal Year. The coverage provided under the Outpatient Benefit of the TRICARE Supplement plan for: 1) nervous, mental, and emotional disorders; and 2) alcoholism and drug addiction; is limited to $500 during any Fiscal Year for all such disorders.

*Pre-Existing Condition Limitations - Pre-Existing Condition, as used in this limitation, means any injury or sickness including pregnancy, diagnosed or undiagnosed, for which Medical Care is received by a Covered Person; within the 6 month period prior to the Covered Person’s effective date of insurance; or with respect to the limitation for increase in coverage, within the 6 month period prior to the effective date of the Covered Person’s increase in coverage. For the purposes of this limitation, we will consider; (a) Medical Care received when: a Physician is consulted or medical advice is given; or Treatment is recommended or prescribed by, or received from, a Physician; (b) Treatment to include, but not limited to, any; medical examination, test, attendance, or observation; medical services, supplies, or equipment, including their prescription or use; or prescribed drugs or medicines, including their prescription or use. All manifestations, symptoms, or findings which result; from the same or related accidents or Sickness; or from any aggravations of accident or Sickness; are considered to be the same accident or Sickness for the purpose of determining a Pre-Existing Condition.

Waiver for Conditions Prior to Effective Date of Coverage: Under the following conditions, the period of time required to satisfy the Pre-Existing Condition exclusion will be reduced or waived as stated:

If you retire from Active Duty and become eligible for TRICARE Retiree Supplement coverage as provided under “Plan Conversions” and Requests such coverage within 63 days of the date you first becomes eligible for coverage, we will credit you with continuity of coverage from your prior effective date under the TRICARE Supplement Plan.

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Right For You:
Download Claim Form
Arrow TRICARE Select Supplement Claim Form
Arrow TRICARE Select Supplement
(NY Residents Only)
Claim Form (NY Residents Only)



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