How It Works

Summary of Plan Benefits

Here’s How The Comprehensive Tricare Supplement Works To Pay After Tricare Has Paid

Care Required	TRICARE Standard / Extra Pays	Your TRICARE Extra/Standard Supplement Pays	TRICARE Prime or Point-Of-Service (POS Pays)	After TRICARE Prime / POS Pays, The Supplement Pays
INPATIENT FACILITY SERVICE in civilian hospitals for RETIREES and their dependent family members (room, board, supplies and staff services billed by the hospital).	The TRICARE Standard /DRG allowed amount (contracted rate for TRICARE Extra minus your cost share).	The lesser of $635/day or 25% of the billed amount, not to exceed the TRICARE Standard DRG amount (lesser of $250/day or 20% cost share of the contracted rate for TRICARE Extra) PLUS 100% of applicable excess charges.	PRIME – All but the Prime copayments. POS – 50% of the TRICARE allowed amount after the deductible has been met.	All Prime copayments. The 50% POS cost share half the POS deductible* ($ 150 per person or $300 per family) PLUS 100% of applicable excess charges.
INPATIENT PROFESSIONAL SERVICES 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.)	Your 20% Extra or 25% Standard cost share deductible* ($150 per person or $300 per family) PLUS 100% of charges in excess of the TRICARE Standard allowed amount if applicable.	PRIME – All but the Prime copayments. POS – 50% of the TRICARE allowed amount after the deductible has been met.	All Prime copayments. The 50% POS cost share half the POS deductible* ($ 150 per person or $300 per family) PLUS 100% of applicable excess charges.
Inpatient care in military hospitals	All but the daily subsistence fee.	The daily subsistence fee.	The daily subsistence fee.	The daily subsistence fee.
OUTPATIENT CARE for RETIREES and their dependent family members (office visits, clinics, lab, etc).	75% of the TRICARE Standard allowed amount (80% for TRICARE Extra) after you pay the TRICARE Outpatient Deductible.	Your 20% Extra or 25% Standard cost share deductible* ($150 per person or $300 per family) PLUS 100% of charges in excess of the TRICARE Standard allowed amount if applicable.	PRIME – All but the Prime copayments. POS – 50% of the TRICARE allowed amount after the deductible has been met.	All Prime copayments. The 50% POS cost share half the POS deductible* ($ 150 per person or $300 per family) PLUS 100% of applicable excess charges.
PRESCRIPTION DRUGS (civilian network up to a 30-day supply or TRICARE Mail Order Pharmacy up to a 90-day supply).	All but the $3 generic, $9 brand name or $22 non- formulary	All copayments.	PRIME – All but the Prime copayments. POS – 50% of the TRICARE allowed amount after the deductible has been met.	All copayments The 50% POS cost share half the POS deductible* ($ 150 per person or $300 per family).
PRESCRIPTION DRUGS (civilian non network Pharmacy up to a 30-day supply).	All but the deductible and $9/20% brand name or $22/20% non-formulary copayment, whichever is greater.	$9/20% or $22/20% Standard cost share PLUS the TRICARE deductible* ($150 per person or $300 per family).	Not Applicable.	The 50% POS cost share half the POS deductible* ($ 150 per person or $300 per family).

Reimbursement toward the fiscal year TRICARE Standard/Extra Outpatient Deductible the Comprehensive Plan is made only if the deductible is incurred after the effective date of coverage.

PORTABILITY

The TRICARE Supplement plan is portable. This means that when employment ends for any reason, you can take the coverage with you by paying the full monthly premium directly to ASI.

Eligibility

TRICARE

TRICARE eligible beneficiaries must be enrolled in the Defense Enrollment Eligibility Reporting System (DEERS). DEERS is a computerized database of beneficiaries, worldwide, who are entitled to TRICARE benefits. The following is a list of some of these TRICARE eligible beneficiaries:

Military retirees who are entitled to retiree, retainer or equivalent pay
Spouses, surviving spouses and some former spouses of military retirees, active duty service members and TRICARE eligible reservists
Retired reservists (usually eligible at age 60 after 20 creditable year of military service) and their eligible family members.
And unmarried dependent children up to age 21 or 23 if full time student

Military retirees and spouses must be under age 65, unless ineligible for Medicare. Unmarried dependent children must be under age 21 (or age 23 if fulltime student). Eligibility may extend past age 21 or 23 for some mentally or physically incapacitated children. (Contact your TRICARE Service Center for further eligibility requirements).

CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs) is a federal health benefit program administered by the Department of Veterans Affairs. CHAMPVA, like TRICARE Standard, is fee for service indemnity plan.

CHAMPVA provides reimbursement for medically necessary healthcare service (this includes inpatient, outpatient, mental health, prescription medication, skilled nursing care and durable medical equipment).

TRICARE for Life

When TRICARE beneficiaries attain age 65 and become eligible for Medicare Part A, eligibility for TRICARE Prime, Standard and Extra ends and eligibility for TRICARE for Life begins. TRICARE for Life does not require enrollment or payment of an enrollment fee. However, beneficiaries must first enroll in Medicare Part B and pay Part B premium (this applies even if the beneficiary is actively employed).

CHAMPVA
To be eligible for CHAMPVA you cannot br eligible for TRICARE and you must be in one of the following categories:

The spouse or child of a veteran who has been rated 100% permanently and totally disabled from a service connected disability by a VA regional office, or
The surviving spouse or child of a veteran who died from a VA-rated service connected disability, or who , at the time of death, was rated , was rated 100% permanently and totally disabled, or
The surviving spouse or child of a veteran who died in the line of duty, not due to misconduct (in most cases, these family members are eligible for TRICARE, not CHAMPVA).

Under CHAMPVA eligibility for an unmarried dependent child ends at age 18 or 23, if a full-time student. Eligibility continues for an unmarried dependent child who prior to age 18 became permanently incapable of self-support as rated by a VA regional office. Eligibility for a spouse ends at age 65. At age 65, the spouse becomes eligible for Medicare and CHAMPVA for Life.

CHAMPVA for Life
When the spouse of a disabled veteran turns 65 and becomes eligible to CHAMPVA for Life (CFL). CHAMPVA for Life is similar to TRICARE for Life. It pays the covered balance after Medicare pays.

Tricare Benefit Options

TRICARE is the military healthcare system for active duty and retired members of uniformed services and their eligible family members. TRICARE uses a combination of military hospitals and clinics and civilian professionals to treat uniformed service member, retirees and their eligible family members. TRICARE includes three healthcare insurance options, namely TRICARE Standard, TRICARE Extra and TRICARE Prime.

Prescription Drug Benefit
TRICARE implemented a fully integrated retail pharmacy program managed by Express Scripts, Inc. (ESI). Express Scripts manages both the TRICARE Mail Order and retail pharmacy contracts. Express Scripts Provides the customer service contact and processes the prescription drug claims

Where to get Prescriptions Filled
Eligible beneficiaries still have four sources to fill their prescriptions. They may fill prescriptions at:

Military treatment facility (MTF) pharmacies
The TRICARE Mail order Pharmacy (TMOP)

Civilian retail network pharmacies, and
Civilian non- network pharmacies

The TRICARE Supplement Plan
The TRICARE Supplement Plan is offered to TRICARE eligible employees who are insured by TRICARE Standard/Extra or are enrolled in Prime.

Plan Features of the TRICARE Supplement:

No pre-existing condition exclusion
No plan deductibles
Protection from excess charges
Guaranteed acceptance in the Supplement Plan
Freedom of choice – Employees and their families may utilize any TRICARE authorized civilian doctor or specialist
Comprehensive coverage
Prompt processing of claims
Portability – Employees may choose to continue Supplement Plan coverage if employment ends for any reason
No claim forms required – but if you choose to use claim forms, they are available from the ASI web site at www.asicorptricaresupp.com or by calling ASI’s toll free customer service number
Toll-free fax number for claim submission– 1-800-310-5514
No separate pre-certification or pre-authorization requirement
Virtually 100% coverage between TRICARE and the TRICARE Supplement for most eligible charges.