TRICARE Supplement Insurance Plan (ReserveCare)

TRICARE Supplement Insurance Plan (ReserveCare)  

Overview

ROA offers ReserveCare TRICARE Supplement Insurance Plans to pair with TRICARE Select, TRICARE Prime, TRICARE Retired Reserve and TRICARE Reserve Select. It works hand-in-hand with your TRICARE coverage to help pay more of your covered medical bills and gives you protection for everything from hospital stays to doctor visits and prescription drugs.

 

ReserveCare TRICARE Active Duty Family Supplement:

This option available for your spouse and children helps pick up where their TRICARE plan leaves off and helps pay for covered doctor visits, outpatient treatment, prescription drugs and hospital stays. It also pays 100% of all excess charges — which is the difference between what your actual medical bills are and what TRICARE pays for those bills (not to exceed the TRICARE 115% legal limit). These costs could add up to hundreds of dollars a year out of your own pocket without a supplement.

 

ReserveCare TRICARE Retiree Basic Supplement:

This plan may be ideal if you're looking for a little help paying for your medical expenses TRICARE Select doesn't fully cover — at an affordable price. Once you meet your TRICARE and Plan deductible, this plan pays a specific percentage of the TRICARE-allowed amount until the TRICARE Catastrophic Cap is met. This plan does not pay excess charges.

 

ReserveCare TRICARE Retiree High-Option Supplement:

This plan covers almost everything, including excess charges, after you meet the TRICARE and Plan deductibles. It pays 100% of the allowed charges TRICARE Select leaves behind and pays 100% of all covered excess charges (not to exceed the TRICARE 115% legal limit).

 

ReserveCare TRICARE Retiree Prime Supplement:

This plan may be your best option if you like participating within a network. TRICARE Prime is an HMO and requires you to use a network physician. The ReserveCare Supplement greatly reduces your out of pocket expenses, such as copayments on doctor visits, hospital care, and prescription drugs.

 

ReserveCare TRICARE Retired Reserve Supplement:

National Guard and Reserve retirees 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. You have a choice of plan options to help fit your lifestyle and budget.

 

  • ReserveCare TRICARE Retired Reserve Basic Supplement:
    This plan may be 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.
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  • 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.
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ReserveCare TRICARE Reserve Select Supplement:

Eligible drilling members of the National Guard and Reserves qualify for DoD's TRICARE Reserve Select health coverage plan. That means those that are ROA members also qualify for ROA ReserveCare TRICARE Reserve Select Supplement. ReserveCare, teamed with TRICARE, helps pay your copays and cost-shares for your family’s covered medical expenses — doctor visits, lab tests, prescription drugs, outpatient treatments, and Hospital stays.

Print a Free Information Packet

These form(s) are in Adobe Acrobat Reader (PDF) format and are available for downloading and printing.

TRICARE Select & Prime Supplement

ENROLLMENT FORM & BROCHURE

 

TRICARE Retired Reserve Supplement

ENROLLMENT FORM & BROCHURE

 

TRICARE Reserve Select Supplement

ENROLLMENT FORM & BROCHURE

 

Print Forms

TRICARE Supplement Claim Form

 

HIPAA Privacy Notice

HIPAA PRIVACY NOTICE

Tell Me More

Guaranteed Acceptance For You And Your Family

You and your family are guaranteed acceptance. However, insurance benefits payable are subject to the Pre–Existing Conditions Limitation.

 

Pays Covered Excess Charges

If your doctor charges you more than what TRICARE allows, you’re left to pay the rest of the bill. Not with ReserveCare, because it covers 100% of covered excess charges even if they’re above the reasonable and customary charges for your area after the TRICARE deductibles are met. Remember, however, that doctors and medical providers are prohibited from charging you more than 115% of the amount TRICARE allows. (Excess charges are not covered under the "Basic" supplement plans.)

 

Guaranteed Satisfaction

Your satisfaction is guaranteed with ReserveCare. Take 30 days after you receive your Certificate of Insurance to examine the coverage. Pay for it only after you determine it’s the right protection for you. If you’re not completely satisfied with ReserveCare after the 30–day free look, return your Certificate to cancel your request for coverage. You’re under no obligation.

 

Change In Military Status? ReserveCare Has Other Options For You

If you go back to Active Duty: If you are covered by this ReserveCare TRICARE Reserve Select Supplement and then are reactivated to active duty, your family will then qualify for Active Duty Family Supplement.

 

If you decide to stay with TRICARE Select, your family may still need a supplement. ReserveCare Active Duty Family TRICARE Select Supplement would be available to you. This supplement has similar benefits as the TRICARE Reserve Select Supplement.

 

If you are Deactivated: If you go back on active duty and purchase TRICARE Reserve Select when you are deactivated, you can switch back to the ReserveCare TRICARE Reserve Select Supplement without any waiting period as long as you let us know within 30 days of the date your TRICARE Reserve Select coverage begins.

 

Should any of these situations occur, please call the Plan Administrator immediately to discuss the best options for you and your family. You must inform the administrator of any changes to your primary TRICARE coverage as you are their only source for that information.

  • Rates

    ReserveCare Retired TRICARE Select Supplement Premiums with $300 plan Deductible (Monthly Rates)

     

    Basic In- & Outpatient

    High Option In- & Outpatient

    Age

    Member or Spouse

    Member or Spouse

    Under 45

    $25.62

    $31.10

    45-49

    $31.10

    $41.17

    50-54

    $36.14

    $51.69

    55-59

    $46.66

    $64.04

    60-64

    $55.80

    $74.10

    Each Child

    $13.72

    $17.15

     

    ReserveCare Retired Supplement Premiums with $400 plan Deductible (Monthly Rates)

     

    Basic In- & Outpatient

    High Option In- & Outpatient

    Age

    Member or Spouse

    Member or Spouse

    Under 45

    $22.18

    $26.93

    45-49

    $26.93

    $35.64

    50-54

    $31.29

    $44.75

    55-59

    $40.40

    $55.44

    60-64

    $48.32

    $64.16

    Each Child

    $11.88

    $14.85

     

    TRICARE Prime Supplement Premiums (Monthly Rates)

    Age

    Member or Spouse

    Under 40

    $15.68

    40-44

    $16.99

    45-49

    $20.91

    50-54

    $25.49

    55-59

    $28.10

    60-64

    $30.06

    Each Child

    $11.76

     

    Active Duty Family Plan (Monthly Rates)

    Spouse

    $9.80

    Each Child

    $9.15

     

    TRICARE Retired Reserve Supplement (Monthly Rates)

      Basic In- & Outpatient High Option In- & Outpatient
    Age Member or Spouse Member or Spouse
    Under 45 $25.62 $31.10
    45-49 $31.10 $41.17
    50-54 $36.14 $51.69
    55-59 $46.66 $64.04
    60-64 $55.80 $74.10
    Each Child $13.72 $17.15

     

    TRICARE Reserve Select Supplement Plan (Monthly Rates)

    Member

    $9.81

    Spouse

    $9.81

    Each Child

    $9.15

     

    For your convenience, you’ll be billed just four times a year. Rates and/or benefits may be changed on a class basis. If you wish to be billed monthly, this will be done through Electronic Funds Transfer.

     

    Your ReserveCare 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.

     

    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.

  • Additional Plan Details

    Hospital/Skilled Nursing Facility

    Hospital means an institution which TRICARE recognizes as a hospital. Skilled Nursing Facility means an institution that operates pursuant to law; in addition to room and board accommodations, is primarily engaged in providing skilled nursing care under the supervision of a Physician; provides continuous 24 hour a day nursing service by or under the supervision of a registered graduate nurse (R.N.); and maintains a daily medical record of each patient. Skilled Nursing Facility does not mean a Hospital that does not include a place for the aged, or for rest, custodial or educational care; alcoholism and drug addiction; the treatment of Mental Illness.

     

    Pre-Existing Condition Limitation

    A Pre-existing Conditions means any Injury or Sickness for which medical care is received by the Covered Person within the 6 consecutive months prior to the date the Covered Person’s insurance starts or within the 6 consecutive months prior to the effective date of the Covered Person’s increase in coverage.

     

    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.

    The Policy limits coverage for: routine physical exams and immunizations, except when: rendered to a child up to 6 years from the child’s birth; or ordered by a Uniformed Service: for a Covered Dependent of an Active Duty Member; for such Dependent’s travel out of the United States due to your assignment; or required for school enrollment (but not sports physicals) by a Covered Child aged 6 through 11 domiciliary or custodial care; care received in a retirement home, rest home or halfway house eye refractions and routine eye exams except when rendered to a child up to 6 years from the child’s birth; eyeglasses and contact lenses; prosthetic devices, except those covered by TRICARE; cosmetic procedures, except those resulting from Sickness or Injury, while a Covered Person; hearing aids; orthopedic footwear; care for the mentally or physically incapacitated if the care is required because of the mental or physical incapacitation; 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; any expense or portion thereof which is in excess of the Legal Limit; expenses in excess of the TRICARE Catastrophic Cap; that part of any Covered Expense which is in excess of the TRICARE Allowed Amount, except as otherwise stated in the plan benefits; expenses which are paid in full by TRICARE; any expense or portion thereof applied to the TRICARE Outpatient Deductible, except as otherwise stated in the plan benefits; treatment for the prevention or cure of alcoholism or drug addiction, except as specifically provided under TRICARE and The Policy; treatment or confinement not covered by a Physician or necessary for medical care; nursing services, unless it is for the nurse’s full-time service while the Covered Person is an Inpatient in a Hospital; purchase of a wheel chair, hospital type bed, or other durable equipment, unless TRICARE determines that purchasing the equipment costs less than renting it; care received as part of a grant, study or a research program; care consider experimental or investigational; any part of a Covered Expense which the Covered Person is not legally obligated to pay because of payment by a TRICARE alternative program; any claim under more than one of the TRICARE Supplement Plans. If a claim is payable under more than one plan or benefit, payment will only be made under the provision that provides the highest coverage.

     

    Eligibility

    You must enroll for coverage in order for your spouse and children to be covered under this plan. Your spouse can not be legally separated or divorced from you. Member or Auxiliary Member means a member of the Policyholder or Participating Organization in good standing. To be eligible for coverage, the Member must be under Age 65; and not be eligible for Medicare; not be on Active Duty; and be covered under the TRICARE plan that matches Your plan under The Policy. To be eligible for coverage, Your Spouse must be under Age 65; and not be eligible for Medicare; not be on Active Duty; and be covered under the TRICARE plan that matches his or her plan under The Policy. If both You and Your Spouse are Members and are eligible for coverage, coverage may not be duplicated by applying as Dependents of each other and both cannot enroll Dependents. No Covered Person can be insured as a Dependent of more than one Member under The Policy. Children are eligible until they marry or reach age 21 (23 if a full-time student or 26 if covered under TRICARE Young Adult).

     

    Termination

    Your coverage will end on the earliest of the following: the date The Policy terminates; the date You are no longer in a class eligible for coverage, or The Policy no longer covers Your class; the date the required premium is due but not paid, subject to the Individual Grace Period; the date You Request We terminate Your coverage; the date You cease to be covered under TRICARE; the date You return to Active Duty; the date You cease to be a Member of the Policyholder; the date You attain Age 65 unless You are not eligible for Medicare and can provide documentation of such from the Social Security Administration; the date You become eligible for Medicare (unless You reside in an area where Medicare is not available. Coverage will not terminate until You reside in an area where Medicare is available); unless continued under the Continuation Provisions. In addition to the events listed, if Your coverage was continued in accordance with the Widow or Widower’s Continuation provision, Your coverage will end on the Premium Due Date on or next following the date You remarry or enter or enter into a legal relationship recognized as a spouse. Coverage for Your Dependent(s) will end on the earliest of the following: the date The Policy terminates; the date Your Dependent is no longer in a class eligible for coverage, or The Policy no longer covers Your Dependent’s class; the date Your Dependent ceases to be covered under TRICARE; the date the required premium is due but not paid, subject to the Individual Grace Period; the date You cease to be a Member of the Policyholder; the date Your coverage ends (this does not apply to a Dependent of an Active Duty Member or Service Disabled Member); the date We or the Policyholder terminate Dependent coverage; the date You Request We terminate Dependent coverage; the date Your Dependent’s coverage ends in accordance with the Newborn or Newly Adopted Child Coverage provision; the date Your Spouse attains Age 65 unless he or she is not eligible for Medicare and can provide documentation of such from the Social Security Administration; the date Your Dependent becomes eligible for Medicare unless he or she resides in an area where Medicare is not available. Coverage will not terminate until Your Dependent resides in an area where Medicare is available; the date Your Spouse no longer satisfies the definition of Spouse; the date Your child no longer satisfies the definition Dependent Child(ren); unless coverage is continued under the Continuation Provisions.

     

    Effective Date

    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.

    Policies are underwritten by Hartford Life and Accident Insurance Company, Home Office Hartford, CT 06155. The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, including Hartford Life and Accident Insurance Company.

Contact Us

We're here to help! Please contact us in whatever manner is most convenient for you.

Administered by:

 Address
Mercer Consumer
12421 Meredith Drive
Urbandale, IA 50398
 Phone
1-800-247-7988
 Hours
 M-F 7:30a-5p CT
 Email
roa.service@mercer.com

 

Underwritten by:

Hartford Life and Accident Insurance Company, One Hartford Plaza, Hartford, CT 06155

FAQs

Answers about the plan, including eligibility, options, enrollment, customer service and more.
  • Can my coverage be canceled because I get sick later on?

    No. You'll have ReserveCare protection right up until you reach age 65. 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, or if you are no longer a member of ROA. Coverage for your spouse and children ends when your coverage ends or when they are no longer eligible. In the event of your death, their coverage continues as long as premiums are paid.
  • Do I have a choice of plans?

    Yes! You have a choice between ROA ReserveCare Supplement Plans — the ReserveCare Active Duty Family Plan, ReserveCare TRICARE Retired Select Basic Plan, the ReserveCare TRICARE Retired Select High-Option Plan, the ReserveCare TRICARE Prime Plan, the ReserveCare TRICARE Retired Reserve Supplement and and the ReserveCare Reserve Select Supplement.

  • How about my spouse and children?

    Yes ... your spouse and all your children can be enrolled, too.** In fact, ROA feels that it's very important you help protect your entire family. You can even get coverage for just your spouse and children under the ReserveCare Active Duty Plan.


    **Unmarried dependent children up to age 21 (23 if full-time students or 26 if enrolled in TRICARE Young Adult).

  • How do I enroll?

    To enroll for coverage, download an enrollment form, or speak to a customer service representative at 1-800-247-7988

  • What are the TRICARE "allowed" charges?

    TRICARE 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 doesn't pay. ReserveCare helps pay this amount for you.
    • When your doctor or hospital charges more than the amount TRICARE allows, you must pay the difference yourself. This 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 won't pay for at all. You must pay the cost of these procedures yourself.

  • Will I need a physical to request coverage?

    No, you're guaranteed acceptance* in ReserveCare. However, insurance benefits payable are subject to your policy's Pre-Existing Conditions Limitation.

     

    *This policy is guaranteed acceptance, but it does contain a Pre-Existing Conditions Limitation. Please refer to this website for more information on exclusions and limitations, such as Pre-Existing Conditions.

AGP-5897, AGP-5898 (NY)

 

TRICARE Form Series includes GBD-3000, GBD-3100, or state equivalent.
 

Important Notes: This web site 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 web site and the policy, the terms of the policy apply. All benefits are subject to the terms and conditions of the policy. Policies underwritten by the 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.

 

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Mercer's Role & Compensation

Details of Mercer disclosure of the compensation.