How It Works

Here’s How The Tricare Extra/Standard Supplement Works
To Pay What Tricare Extra/Standard Doesn’t Pay

Care Required	Tricare Extra/Standard Pays	Your Tricare Extra/Standard Supplement Pays
Inpatient care 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.	Comprehensive Plan & High Option II Plan - The lesser of $535/day or 25% of 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) PLUS 100% of covered excess charges up to the reasonable and customary community standard level. (After you satisfy the fiscal year plan deductible.)
Inpatient care in civilian hospitals for RETIREES and dependent family members (doctors, and 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.	Comprehensive Plan & High Option II Plan - Your cost share** PLUS 100% of covered excess charges up to the reasonable and customary community standard level.
Inpatient care in military hospitals. Outpatient care for RETIREES and dependent family members (office visits, clinics, lab, prescription drugs, etc.)	All but the daily subsistence fee. 75% of the Tricare Standard allowed amount (80% for Tricare Extra) after you pay the Tricare Outpatient Deductible.	All Plans - The daily subsistence fee. Comprehensive Plan - After you satisfy the fiscal year plan deductible of $75 per person, and $150 family maximum, the plan will reimburse you (1) the Tricare fiscal year outpatient deductible of $150 per person and $300 family maximum,* (2) your cost share and (3) 100% of covered excess charges up to the reasonable and customary community standard level. High Option II Plan - Your cost share PLUS 100% of covered excess charges up to the reasonable and customary community level, AFTER you pay the fiscal year plan deductible of $150 per person, $300 family maximum.*
Inpatient care in civilian hospitals for ACTIVE DUTY dependents Outpatient care for ACTIVE DUTY dependents (office visits, clinics, labs, prescription drugs, etc.)	All allowable charges except daily subsistence fee or $25, whichever is greater. 80% of the Tricare Standard allowed amount (85% for Tricare Extra) after you pay the Tricare Outpatient Deductible.	Active Duty Plan - $25 or the daily subsistence fee, whichever is greater, PLUS 100% of covered excess charges up to the reasonable and customary community standard level. Active Duty Plan - Your cost share** PLUS 100% of covered excess charges up to the reasonable and customary community standard level, AFTER you pay the Tricare Extra/Standard Outpatient Deductible.*

* Expenses incurred to satisfy the fiscal year Tricare Extra/Standard Outpatient Deductible cannot be used to satisfy the High Option II and Comprehensive Plan deductibles. Also, reimbursement toward the fiscal year Tricare Extra/Standard Outpatient Deductible under the Comprehensive Plan is made only if the deductible is incurred after the effective date of coverage. It will be prorated if you are insured less than a year.

** Until the Tricare Cap is met.

NOTE: Inpatient and outpatient expenses can be used to satisfy the fiscal year plan deductible.

Guaranteed Acceptance - Satisfaction Guarantee

It's easy to enroll in the Tricare Extra Standard Supplement Plan. Just complete the Enrollment Form (Supplement Application) - making sure to provide all information requested - and return it with your check for the first premium payment. That's all there is to it! 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 (Supplement Application) and first premium payment have been processed, you'll recieve a certificate of insurance which you can examine for 30 days risk-free. Return it for a full refund if you are not completely satisfied (less any claims paid).

Eligibility

You are eligible to enroll provided you are an eligible TRICARE/CHAMPVA 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 apply 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). Eligible spouses and children of active-duty service members may enroll; Tricare-eligible widow(er)s and ex-spouses may also enroll.

Waiver of Premium for Surviving Spouse and Dependents

The Comprehensive Plan features a special benefit that provides additional financial protection to your surviving spouse and dependents. If you die while insured under the Plan, your insured spouse's premiums will be waived for up to four full years unless your spouse remarries, reaches age 65, or dependents no longer remain in an eligible status. After four years, he or she will need to begin paying the appropriate premium to continue 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.

Renewability

Your 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, children are under age 21 or age 23 if a full-time student); and the Master Policy and your class of insured persons remain 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. Under the Comprehensive Plan, your insured dependent's premium will be waived for up to one year, if you die while insured. To continue coverage beyond one year, your surviving spouse must pay the appropriate premium.

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 acts 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; cosmetic procedures, except those resulting from sickness or injury occurring while a covered person; drugs (other than insulin) which do not 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 Standard/Extra fiscal year outpatient deductible, except as specifically provided under the Comprehensive Plan; 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.

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 devices 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 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.

Pre-Existing Conditions Limitations

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 will not be covered until the coverage has been in effect for 6 months. However, new conditions will be covered immediately.