TRICARE Supplement Insurance Plan (ReserveCare)

TRICARE Supplement Insurance Plan (ReserveCare)  

Overview

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.

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

ENROLLMENT FORM & BROCHURE

 

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TRICARE Supplement Claim Form

 

HIPAA Privacy Notice

 

HIPAA PRIVACY NOTICE

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Monthly Rates

ReserveCare Retired Supplement Premiums
with $300 plan Deductible

 

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

 

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

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

Spouse

$9.80

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.

 

Qualified Hospital

To qualify for TRICARE Select, 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 Condition 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. If your dependents are currently insured under the Active Duty Supplement with ROA and you join the ReserveCare 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 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.

Eligibility

You and your spouse are eligible for coverage if you are a Member of ROA. 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 or 26 if enrolled in TRICARE Young Adult) are eligible
for coverage.

Termination

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. Your dependent's coverage will remain in effect as long as your coverage is active, premiums are paid, and dependents meet the eligibility requirements.

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, and Talcott Resolution Life Insurance Company, Home Office Windsor, CT, (formerly known as Hartford Life Insurance Company). Hartford Life and Accident Insurance Company acts as the administrator for Talcott Resolution Life Insurance Company. 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 and Talcott Resolution Life Insurance Company (formerly known as Hartford Life Insurance Company)

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 four ROA ReserveCare Supplement Plans — the ReserveCare Active Duty Family Plan, ReserveCare TRICARE Retired Select Basic Plan, the ReserveCare TRICARE Retired Select High-Option Plan and the ReserveCare TRICARE Prime Plan.
  • 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. If the spouse is enrolling for initial coverage and the member is Medicare eligible, the spouse must obtain auxiliary membership in order to be covered by our supplement.


    **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

  • Is there a guarantee with ReserveCare?

    ReserveCare includes a 30-Day, NO-HASSLE GUARANTEE. If you decide ReserveCare is not for you, just return your Certificate within 30 days of your effective date. You'll be under no obligation; no questions asked.
  • TRICARE Select includes an annual deductible. Does ReserveCare pay it?

    You choose the TRICARE Retired Select Deductible. The ReserveCare Retired Select Supplement also has a $400 Plan Deductible you must pay.
  • What are the TRICARE Select allowed charges?

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

  • When does my ReserveCare protection begin?

    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.

AGP-5367

 

TRICARE Form Series includes SRP-1269, 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 and Talcott Resolution Life Insurance Company (formerly known as Hartford Life 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.

Mercer's Role & Compensation

Details of Mercer disclosure of the compensation.