FRA-ENDORSED TRICARE SUPPLEMENT INSURANCE PLANS (MILICAREPLUS)
Benefits Exclusively for Shipmates in Good Standing
- Affordable group rates for your entire family
- The MilicarePlus Silver and Gold plans pay the difference between your actual covered medical bills and what Tricare standard pays
- The Gold plan has no plan deductible
- Guaranteed acceptance
This policy is guaranteed acceptance, but it does contain a Pre-Existing Conditions Limitation. Please refer to the website for more information on exclusions and limitations, such as Pre-Existing Conditions.
- Surviving dependents' benefit
- 30 day, no-hassle guarantee
To qualify for TRICARE Standard, a Hospital must operate within the laws of the jurisdiction in which it is located and be engaged primarily in providing diagnostic and therapeutic facilities for surgical and medical diagnosis, treatment and care of injured or sick persons by or under the supervision of one or more staff physicians or surgeons, and continuously provide 24-hour nursing service by registered graduate nurses. Hospital does not include a nursing or convalescent home, a place for drug addiction or alcoholism, or a place for rest, custodial care, or care of the aged. Confined or confinement means being an Inpatient in a hospital due to Sickness or Injury.
Pre-Existing Condition Limitation
During the first two years of coverage (one year if choosing the Gold Plan), losses incurred for Pre-Existing Conditions are not covered (unless you are treatment free for 12 months from the effective date). A Pre-Existing Condition means any injury or sickness including pregnancy; diagnosed or undiagnosed, for which you have received medical care within the 12-month period prior to your coverage effective date or the date of an increase in coverage. During that time, benefits for all other accidents or illnesses will be paid under the policy provisions. You are urged to consider this limitation before dropping any coverage you may have until the waiting period is over. If your dependents are currently insured under the Active Duty Supplement with FRA and you join the MilicarePLUS Retired Plan within 63 days of your discharge from active duty, we will credit you with continuity of coverage from your dependents' prior effective date.
Exclusions and Limitations
The Policy does not cover: injury or sickness resulting from war or act of war, whether war is declared or undeclared; intentionally self-inflicted injury; suicide or attempted suicide, whether sane or insane (in Missouri, while sane); routine physical exams and immunizations, except when: a) rendered to a child up to 6 years from his or her birth; or b) ordered by a Uniformed Service: (1) for a Covered Spouse or Child of an Active Duty Member; (2) for such spouse or child's travel out of the United States due to the Member's assignment; domiciliary or custodial care; eye refractions and routine eye exams except when rendered to a child up to 6 years from his or her birth; eyeglasses and contact lenses; prosthetic devices, except those covered by TRICARE; cosmetic procedures, except those resulting from a covered Sickness or Injury; hearing aids; orthopedic footwear; care for the mentally incapacitated or physically handicapped if: a) the care is required because of the mental incapacitation or physical handicap; or b) the care is received by an Active Duty Member's child who is covered by the Program for the Handicapped under TRICARE; drugs which do not require a prescription, except insulin; dental care unless such care is covered by TRICARE, and then only to the extent that TRICARE covers such care; any confinement, service, or supply that is not covered under TRICARE; Hospital nursery charges for a well newborn, except as specifically provided under TRICARE; any routine newborn care except Well Baby Care, as defined, for a child up to 6 years from his or her birth; expenses in excess of the TRICARE Cap; expenses which are paid in full by TRICARE; any expenses or portion thereof which is in excess of the Legal Limit; any expense or portion thereof applied to the TRICARE Outpatient Deductible, except as otherwise provided under the High Deductible plans; treatment for the prevention or cure of alcoholism or drug addiction except as specifically provided under TRICARE and this policy; and any part of a covered expense which the Covered Person is not legally obligated to pay because of payment by a TRICARE alternative program.
Nervous, Mental, Emotional Disorder, Alcoholism, and Drug Addiction Limitations
Your coverage provided under the inpatient benefits of the TRICARE supplement for nervous, mental and emotional disorders, including alcoholism and drug addiction, is limited to: 30 inpatient treatment days for a covered person age 19 or older; or 45 inpatient treatment days for a covered person under age 19; per fiscal year. Outpatient benefits for such disorders are limited to $500 during any period of 12 consecutive months.
Your coverage will never terminate because of medical history as long as the Master Policy remains in force, you keep paying your premium, you remain an FRA member, you remain ineligible for Medicare, or you reach age 65 (please refer to your Certificate of Insurance for details regarding Medicare eligibility). Dependents' coverage ceases when your coverage terminates; premiums are not paid; or they cease to be eligible dependents.
|MilicarePLUS TRICARE Standard Supplement Inpatient and Outpatient Plans
||Retired Bronze Plan
||Retired Silver Plan
||Retired Gold Plan
||For All Ages
||Each child $16.48
||Each child $23.04
||Each child $101.29
||Active Duty Bronze Plan
||Active Duty Silver Plan
||Active Duty Gold Plan
||Each Child $10.61
||Each Child $12.70
||Each Child $32.75
*You'll be billed four times a year. All billing modes except annual will include a $2.00 billing fee.
You are eligible for coverage if you are a member or auxiliary member of Fleet Reserve Association. If you are over age 65, you must be ineligible for Medicare benefits.
Your MilicarePLUS rates will not increase unless rates increase for all in your classification. Rates are based on attained age and increase as you enter a new age bracket. Plan deductible is $250/person or $500/family for Silver Retired and $300/person or $600/family for Bronze Retired. The Active Duty Plan Deductible is $250/person or $500/family for the Bronze or Silver Plans.
*This is a listing of highlights for the above Insurance Plan. Be sure to review the entire website for a detailed plan description.
This website explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this website and the policy, the terms of the policy apply. All benefits are subject to the terms and conditions of the policy. Policies underwritten by Hartford Life and Accident Insurance Company detail exclusions, limitations, reduction of benefits and terms under which the policies may be continued in full or discontinued. Complete details are in the Certificate of Insurance issued to each insured individual and the Master Policy issued to the policyholder. This program may vary and may not be available to residents of all states. This program is currently not available to residents of Montana.
Policy Form #SRP-1269 (HLA)(5191)