TRICARE Supplement Insurance Plan
Although your health benefits offer the high-quality coverage that you deserve, TRICARE leaves you responsible for some out-of-pocket costs. Costs that can really add up if you or a loved one suffer a serious or chronic medical problem. An MBA TRICARE Supplement Insurance Plan can help protect you by covering many of those costs.
Underwritten by The Hartford Financial Services Group, Inc., and its subsidiaries, a 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).
Take a minute to discover which might be best for you and your family.
Who Is Eligible To Enroll?
To be eligible, persons must be under age 65 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. A child who is covered by the TRICARE Young Adult Program and is under age 26 may also enroll.
What would be Covered?
The Supplement Plan pays eligible out-of-pocket expenses, after any applicable deductible, as follows:
- 100% of co-pays and Cost-shares for TRICARE (Standard, Extra, Prime, Reserve Select)
- 100% of covered Excess Charges above the TRICARE Standard Allowable Amount**
- 100% of the TRICARE (Standard, Extra) outpatient deductible, if elected
- 100% of Cost-shares and covered 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 or excluded by TRICARE
- Charges for which the insured is not legally obligated to pay, up to the legal limit
- 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, up to the legal limit
- 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.
How are claims processed?
- Present your Identification Card to your medical provider’s billing department for submission of your claim
- Your Explanation of Benefits and itemized bill or receipt must be submitted to Web TPA (P. O. Box 1868, Grapevine TX 76099; fax 469-417-1960)
- A claim form is not required
- To check your claim status call 1 855-688-1302
- You may create an account at webtpa.com
All benefits are subject to the terms and conditions of the policy. Policies underwritten by Hartford Life and Accident Insurance Company and Hartford Life Insurance Company detail exclusions, limitations, and terms under which the policies may be continued in force or discontinued.
The Hartford® is The Hartford Financial Services Group, Inc., and its subsidiaries, including issuing companies Hartford Life and Accident Insurance Company and Hartford Life Insurance Company.
Form SRP-1269 (HLA), Form SRP-1269 (HL)
Tricare supplement is not available in the following states: Alaska, Arizona, Idaho, Montana, New Mexico, Oregon, West Virginia