TRICARE Supplement Coverage
This Supplement Plan provides maximum protection for you at very affordable rates. TRICARE Options:
I. Prime
II. Extra
III. Standard
The MBA TRICARE Supplement Insurance Plan provides reimbursement of eligible out-of-pocket medical expenses for insured MBA members and their families who are covered by TRICARE (Standard, Extra or Prime).
I. Prime
TRICARE Prime is a voluntary "HMO-type" plan that emphasizes preventive care. All active duty service members are automatically enrolled in Prime. If you choose this option, you and your family will enroll for a year at a time, and will receive your care from a network of civilian and military providers.
II. Extra
TRICARE Extra is essentially a Preferred Provider Organization (PPO). With this option, you can choose to use a network of civilian doctors and military providers and get a discount on cost sharing. There is no enrollment fee, and you may use Extra when you elect to do so.
III. Standard
This is the same as the standard TRICARE program. TRICARE Standard pays a share of the cost of covered health care services that you obtain from a non-network civilian health care provider. There is no enrollment fee in TRICARE Standard. After the TRICARE deductible has been met, the TRICARE Standard will Cost-share 20% of the TRICARE allowable charge for outpatient services and supplies for active duty families and 25% of the allowable charge for all others.
Who Is Eligible To Apply?
To be eligible, persons must be under age 62 on their coverage effective date and authorized to enroll in or use TRICARE for medical care coverage. Unmarried dependent children from birth to age 21, or 23 if a full-time student, are also eligible.
The purchase of life insurance is not required; however, MBA Term 90 and Level Term II Life Insurance Plan provide security and benefits not offered by SGLI/VGLI.
What Is Covered?
The Supplement pays eligible out-of-pocket expenses, after any applicable deductible, as follows:
- 100% of co-pays and Cost-shares for TRICARE (Standard, Extra, Prime)
- 100% of Excess Charges above the TRICARE Standard Allowable Amount
- 100% of the TRICARE (Standard, Extra) outpatient deductible, if elected
- 100% of Cost-shares and Excess Charges for Prime Point of Service
- 100% of the daily subsistence fee the insured must pay in a government facility
- The daily inpatient charges from the first day.
What Is Not Covered?
- Charges incurred for services which are not covered by TRICARE
- Charges for which the insured is not legally obligated to pay
- Charges incurred prior to the individual's effective date of coverage under the Plan
- Charges incurred for pre-existing conditions, except as outlined in the Plan
- Enrollment fees under TRICARE Prime
- Deductible amounts for the TRICARE Prime Point of Service option
- Any TRICARE (Standard, Extra) deductible amount unless you have selected the Outpatient Deductible Reimbursement Option
- Charges for outpatient services, as defined under TRICARE, if the individual has not enrolled for outpatient coverage under this Plan.
