TRICARE provides comprehensive health coverage to active-duty and retired service members and their families. However, even with TRICARE, beneficiaries may still face out-of-pocket healthcare expenses. This is where the TRICARE Supplemental Health Care Program comes into play. Designed as a secondary payer to TRICARE, this supplemental plan is available to members of the military community who are not eligible for Medicare, offering a robust financial safety net against medical costs. For eligible individuals, particularly state health plan members, it presents a compelling alternative for enhanced healthcare coverage. Administered by Selman & Company, the TRICARE Supplement Plan is structured to cover the subscriber’s share of covered medical expenses under TRICARE Prime (in-network), TRICARE Extra, and TRICARE Standard options.
Key Benefits and Features of the TRICARE Supplement Plan
The primary advantage of the TRICARE Supplement Plan is its ability to significantly reduce, and often eliminate, out-of-pocket medical expenses when used in conjunction with your TRICARE coverage. This dual-coverage approach is designed to provide near-complete financial protection against healthcare costs. Here are some of the standout features:
- No Deductibles or Coinsurance: For services covered under TRICARE and the supplemental plan, you generally won’t encounter deductibles or coinsurance. This means you pay little to nothing out-of-pocket for covered medical care.
- Freedom to Choose Providers: You retain the flexibility to seek care from any TRICARE-authorized provider. This includes network, non-network, and participating providers, ensuring broad access to healthcare services.
- Prescription Drug Coverage: The plan includes reimbursement for prescription drug copayments, further lowering your healthcare costs.
- Portability of Coverage: Should you leave your current employment, your TRICARE Supplement Plan coverage is portable. By paying premiums directly to Selman & Company, you can maintain your supplemental coverage without interruption, providing continuous financial protection.
TRICARE Supplement Plan Eligibility
It’s important to understand the eligibility criteria for the TRICARE Supplement Plan. While PEBA (South Carolina Public Employee Benefit Authority) does not handle eligibility confirmation for this specific supplemental plan, the general requirements are clear. To be eligible, individuals must be registered in the Defense Enrollment Eligibility Reporting System (DEERS) and must not be eligible for Medicare. Furthermore, for those who are currently enrolled in a State Health Plan and wish to switch to the TRICARE Supplement Plan, it’s necessary to drop the existing State Health Plan coverage to enroll.
Enrollment in the TRICARE Supplement Plan
If you meet the TRICARE eligibility requirements and are also eligible for your state health insurance program (like South Carolina’s), you can enroll in the TRICARE Supplement Plan. Enrollment is available for yourself and your eligible dependents. The initial enrollment window is within 31 days of your hire date or when you first become TRICARE-eligible. You can also enroll during the annual open enrollment period, with coverage becoming effective on January 1st of the following year if you enroll during this time.
A key requirement for enrollment is membership in the Government Employees Association (GEUSA). You can find more information about GEUSA and membership details at www.geausa.org. To finalize your enrollment, you will need to provide a copy of your military ID or TRICARE ID card. If you were previously enrolled in a State Health Plan, you may also need to complete the TRICARE Other Health Insurance form, which can be found on the TRICARE website at www.tricare.mil.
In conclusion, the TRICARE Supplemental Health Care Program offers a valuable layer of financial protection for military families by filling in the gaps in TRICARE coverage. By understanding its benefits, eligibility, and enrollment process, you can determine if this supplemental plan is right for you and take steps to secure more comprehensive and affordable healthcare coverage.
