National Guard and Reserve retirees in the “gray area,” may be eligible to purchase the DoD’s TRICARE Retired Reserve coverage. This means, as an ROA member, you also qualify for ROA’s ReserveCare TRICARE Retired Reserve Supplement.
ReserveCare Includes These Competitive Advantages:
Choice of plan options to fit your lifestyle and budget.
ReserveCare TRICARE Retired Reserve Basic Supplement:
This plan is ideal if you are looking for a little help paying for your medical expenses TRICARE doesn’t fully cover – at an affordable price. Once you meet your TRICARE deductible ($300), this plan pays 25% of the TRICARE-allowed amount until the TRICARE Catastrophic Cap is met. This plan does not pay excess charges.
ReserveCare TRICARE Retired Reserve High-Option Supplement:
The High-Option Supplement plan helps cover medical expenses including covered excess charges, after you meet the annual plan deductible ($300). If your covered medical bills are more than what TRICARE allows (also known as excess charges), ReserveCare helps pick up the rest of the bill for you. That’s right, ReserveCare helps pay the difference between your eligible medical bills and what TRICARE pays for those bills. Once TRICARE makes its payment, ReserveCare takes over. Remember, doctors and medical providers are prohibited from charging you more than 115% of the amount TRICARE allows.
You’re guaranteed acceptance.
This means that you will not be asked to take a medical exam or answer medical questions at the time of enrollment, however, insurance benefits payable are subject to the policy’s Pre-Existing Conditions Limitation.
TRICARE Retired Reserve Officers Supplement Monthly Premiums
|TRICARE Retired Reserve Supplement Monthly Premiums*
||Basic In- & Outpatient
||High Option In- & Outpatient
||Member or Spouse
||Member or Spouse
*You will be billed just four times a year. If applicable, an additional $2.00 billing fee will be included on your billing notice payable to the administrator. To save the fee, select Electronic Funds Transfer (EFT) as a safe and secure payment option. Rates and/or benefits may be changed on a class basis. Rates are based on the attained age of the Insured Person and increase as you enter each new age category. If you wish to be billed monthly, this will be done through EFT.
Seamless transition to other ReserveCare coverage.
When your military status changes and you are no longer eligible for TRICARE Retired Reserve, you can continue your supplement with TRICARE Standard coverage. And if you switch to TRICARE Prime for retirees, you can also switch to a TRICARE Prime Supplement by notifying the Plan Administrator of this change.
How ReserveCare Helps Pay the Difference Between Your Actual Covered Medical Bills and What TRICARE Retired Reserve Pays
TRICARE Retired Reserve sets a limit on how much certain medical procedures should cost. Then, this DoD program pays only about 75% of the set “allowed” amount for each procedure.
- You are responsible for the approximate 25% of “allowed’ charges that TRICARE Retired Reserve doesn’t pay. ReserveCare helps pay this amount for you.
- When your doctor or Hospital charges more than the amount TRICARE Retired Reserve “allows,” you must pay the difference yourself. The difference is called “excess charges.”
The ReserveCare High-Option Plan helps you pay all these expenses (not to exceed the TRICARE 115% legal limit). PLUS—there are some medical procedures TRICARE Retired Reserve won’t pay for at all. You must pay the cost of these procedures yourself.
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 addicts or alcoholics, 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 Conditions Limitation
During the first 6 months of coverage, losses incurred for Pre-Existing Conditions are not covered. A Pre-Existing Condition means any Injury or Sickness including pregnancy, diagnosed or undiagnosed, for which you have received medical care within the 6-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.
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 expense or portion thereof which is in excess of the Legal Limit; any expense or portion thereof applied to the TRICARE Outpatient Deductible, treatment for the prevention or cure of alcoholism or drug addiction except as specifically provided under TRICARE and this Policy; 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 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.
You and your spouse are eligible for coverage if you are a Member of the Reserve Officers Association. If you are over age 65, you must be ineligible for Medicare benefits. Your unmarried dependent children up to age 21 (23 if full-time students) are eligible for coverage.
The only way your ReserveCare Plan can be canceled is: if in the unlikely event the Master Policy is canceled for everybody, if you wish to end coverage, if you stop paying your premiums, if you are no longer covered by TRICARE, the first premium due on or next following the date you became eligible for Medicare, or if you are no longer a Member of ROA. Your dependent's coverage will remain in effect as long as your coverage is active, premiums are paid, and dependents meet the eligibility requirements. In the event of your death, their coverage continues as long as premiums are paid.
Your ReserveCare protection begins on the first day of the month after your enrollment form and first premium are received, as long as you’re an ROA Member in good standing. If on that date you are Confined in a Hospital, your coverage will become effective on the first day after your discharge.
|Important Information About this Coverage
|Type of Insurance
||ReserveCare TRICARE Retired Reserve Supplement
||Reserve Officers Association (ROA)
members and dependents
||Hartford Life and Accident Insurance Company Simsbury, CT 06089.
The Hartford is The Hartford Financial Services Group, Inc., and its subsidiaries, including issuing company Hartford Life and Accident Insurance Co.
||SRP-1269 ASN (5367)
|Group Policy Number