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MEDIPLUS® TRICARE Supplement Insurance Plan

MEDIPLUS®coverage is designed to be flexible, allowing you to choose the coverage that's best for you and your family. Whether you choose the TRICARE Standard In- and Outpatient Plan, Inpatient Only Plan or TRICARE Prime Plan, Military Officers Association of America (MOAA) members can count on valuable protection.

MEDIPLUS 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.

To learn more about how this plan works to supplement your current TRICARE plan, including costs, exclusions, limitations and terms of coverage, go to the Forms tab and click on the appropriate link.

Coverage may vary and is not available in ID and MT. Please call 1-800-247-2192 for additional information.

TSTND-OVR-0315

SRP-1269 ASN (1134)

MEDIPLUS® TRICARE Supplement Insurance Plan

Affordable Group Rates

As a Military Officers Association of America (MOAA) member, you are eligible for group rates as shown.

TRICARE Standard Supplement Monthly Rates*
Retiree In- and Outpatient Plans - $400 Per-Person / $800 Per Family and $250 Per-Person / $500 Per Family Deductible
  Age $400 Deductible $250 Deductible
    Nonsmoker Smoker Nonsmoker Smoker
Member/
Auxiliary Member
Under 45 $14.86 $15.78 $26.03 $27.66
45-49 $16.71 $18.56 $29.29 $32.54
50-54 $23.22 $25.07 $40.68 $43.93
55-59 $31.58 $33.42 $55.32 $58.58
60-64** $40.04 $44.05 $71.00 $78.10
Spouse Under 45 $20.44 $23.22 $35.80 $40.68
45-49 $25.07 $27.85 $43.93 $48.81
50-54 $30.64 $34.35 $53.69 $60.20
55-59 $34.35 $39.00 $60.20 $68.33
60-64** $42.04 $47.06 $74.55 $83.42
Each Child   $13.93 $24.42

Retiree In- and Outpatient Plans - $300 Per-Person / $600 Per Family and $150 Per-Person / $300 Per Family Deductible
  Age $300 Deductible $150 Deductible
    Nonsmoker Smoker Nonsmoker Smoker
Member/
Auxiliary Member
Under 45 $18.85 $20.04 $30.19 $32.09
45-49 $21.22 $23.57 $33.97 $37.74
50-54 $29.47 $31.84 $47.19 $50.96
55-59 $40.09 $42.44 $64.17 $67.95
60-64** $50.85 $55.94 $82.36 $90.59
Spouse Under 45 $25.94 $29.47 $41.52 $47.19
45-49 $31.84 $35.37 $50.96 $56.62
50-54 $38.90 $43.63 $62.28 $69.83
55-59 $43.63 $49.52 $69.83 $79.27
60-64** $53.39 $59.76 $86.47 $96.76
Each Child   $17.69 $28.31

Retired Inpatient Only Plans
  Age $200 Per Person Deductible No Deductible
    Nonsmoker Smoker Nonsmoker Smoker
Member/
Auxiliary Member
Under 50   $5.67   $5.95   $7.90   $8.30
50-54   $7.83   $8.22 $10.97 $11.50
55-59 $12.33 $12.95 $17.25 $18.12
60-64** $13.53 $14.22 $24.58 $25.82
Spouse Under 50 $6.28 $6.62 $9.78 $10.28
50-54 $8.78 $9.22 $13.17 $13.83
55-59 $13.82 $14.50 $19.95 $20.93
60-64** $14.26 $14.96 $23.88 $25.08
Each Child   $4.90 $5.73

Active Duty In and Outpatient Plan
  No Deductible
  Nonsmoker Smoker
Spouse (all ages) $12.81 $13.44
Each Child $11.25

Retired TRICARE Prime Supplement
Member or Spouse Age Nonsmoker Smoker
Under 50 $12.64 $13.28
50-54 $19.29 $20.26
55-59 $22.78 $23.91
60-64** $29.12 $30.59
Each Child $16.43

*For your convenience, you will be billed quarterly. Premiums are based on each person's age when coverage becomes effective and increase after the next-highest age bracket is reached. Rates and/or benefits may be changed on a class basis.

**If you are age 65 or older and ineligible for Medicare, you can continue MEDIPLUS as long as you remain TRICARE eligible. Please contact the Plan Administrator for age 65+ rates.

You qualify for nonsmoker rates if you have not smoked cigarettes, cigars, or used a pipe or chewing tobacco, nicotine product or snuff in the past 12 months.

This supplement is only for Military Officers Association of America (MOAA) members and their families and, as a result, you and your family are guaranteed acceptance. This means your acceptance into this plan is guaranteed, however, insurance benefits payable are subject to the policy’s Pre-Existing Conditions Limitation. Just complete and sign the enrollment form.

Your MEDIPLUS® protection will start on the first day of the month after we receive your completed enrollment form and first premium payment. You'll have protection for new health conditions right away and current health conditions are covered after six months.

Plus, the waiting period for current health conditions can be waived if you're losing your civilian employer plan or leaving active duty. In some cases it can also be waived for active duty family members.

  • Employer plan - You qualify for MEDIPLUS without the waiting period if you enroll within 30 days after your civilian employer-sponsored plan ends because you are no longer an eligible participant in that program (if you are changing jobs, moving or retiring, for example). If you've voluntarily ended your civilian employer-sponsored plan while you are still an eligible participant, the six-month waiting period for current health conditions will apply.
  • Active Duty - When you enroll in MEDIPLUS within 60 days of the date your active duty coverage ends, you qualify for MEDIPLUS without the waiting period. This also applies if you enroll in MEDIPLUS within 30 days of your initial eligibility for TRICARE benefits.

DirectClaim: MOAA's electronic filing process for MEDIPLUS TRICARE Supplement claims

Filing MEDIPLUS claims is fast and easy with DirectClaim, another unique benefit to MEDIPLUS. With DirectClaim, you will not have to complete MEDIPLUS claim paperwork after you access most of your eligible TRICARE benefits. You will be informed when your claim is filed electronically by a message on your MEDIPLUS Explanation of Benefits (EOB) form.

Please be aware that some TRICARE Supplement claims cannot be processed electronically, such as any prescription claims and most Skilled Nursing or Skilled Nursing Facility, nursing home claims and claims filed from overseas. For these, you will need to submit paper claim filings to MEDIPLUS. Claim forms are accessible on this website.

If a claim for service is submitted through DirectClaim and TRICARE has paid the provider(s) directly, any payment due under a MEDIPLUS TRICARE Standard Supplement will be paid directly to the provider(s). Under TRICARE Prime most network providers require the patient's $12 co-pay at the time of the office visit, so the MEDIPLUS TRICARE Prime Supplement reimbursement of those Prime outpatient co-pays will be sent directly to the member. Only the Prime $12 co-pay for office visits will be reimbursed to the member. All other Prime co-pays will be reimbursed to the provider.

It's important that the MEDIPLUS applicant's name appears on the enrollment form the same as it is on their military ID card to ensure proper claims processing.

If you have any questions about DirectClaim, please call the MOAA Insurance Plans Administrator at 1-800-247-2192 or email moaa.service@mercer.com

Switching from the MEDIPLUS Retired TRICARE Prime Supplement to a MEDIPLUS TRICARE Standard Supplement

Current health conditions will be covered right away, as long as you've had continuous MEDIPLUS coverage for six months and you discontinue TRICARE Prime on your Prime anniversary date.

If you discontinue TRICARE Prime on a date other than your anniversary date, current health conditions will not be covered under your MEDIPLUS TRICARE Standard Supplement for the first six months.

Even if you decide not to enroll yourself in MEDIPLUS, your spouse and children are still guaranteed acceptance. This means your acceptance into this plan is guaranteed, however, insurance benefits payable are subject to the policy’s Pre-Existing Conditions Limitation.

Mediplus Pays Covered "Excess Charges" For You

Make sure any TRICARE Supplement you use has this important benefit. If your doctor charges you more than what TRICARE allows, MEDIPLUS picks up the bills for you to cover up to 15% above the TRICARE-allowed amount. MEDIPLUS will help cover these excess charges as long as the TRICARE and MEDIPLUS deductibles are met.

Freedom of choice

With MEDIPLUS, you can be in better control because you choose your family's doctors and specialists. There are no "network" or "preferred provider" lists. Your family can go to any TRICARE-authorized doctor at any time.

MEDIPLUS can help take care of your family

MEDIPLUS can be ideal for the whole family - yourself, your spouse and your kids, even if they're at college. It provides coverage at affordable group rates. And, MEDIPLUS can be used at most student health service centers where TRICARE is accepted. But that's not all.

MEDIPLUS can be there for your family, even if something happens to you. As a retired member, if you die, your eligible spouse's MEDIPLUS coverage will continue at no cost until he or she remarries, reaches age 65 or becomes Medicare-eligible. Spouses of active duty members will be covered for up to ten years or until they remarry, reach age 65 or qualify for Medicare.

Children can continue their MEDIPLUS protection premium-free for ten full years, or until they marry or reach age 21 (23 if a full-time student or 26 if enrolled in TRICARE Young Adult). Your family automatically qualifies for this additional benefit as long as you, your spouse and children are continuously covered by MEDIPLUS for at least six months before you die. (The Waiver of Premium Benefit is not available under the MEDIPLUS TRICARE Prime supplement.)

Your MEDIPLUS protection can go where you go

When you say "YES" to MEDIPLUS, you can rest assured your protection can stay with you wherever you go. Even if you change jobs or move, you can keep your MEDIPLUS protection. (Unlike employer-provided plans that end when you leave your job.)

Details – This is a listing of highlights for this Insurance plan. Be sure to review the entire website for a detailed plan description.

Type of Insurance: MEDIPLUS TRICARE Supplement
Designed For: Military Officers Association of America (MOAA) members and dependents
Underwritten by: Hartford Life Insurance Company and Hartford Life and Accident Insurance Company, Hartford, CT 06155
Policy Form Number: SRP-1269 ASN (1134)
Policy Number: AGP-1134
Issue Ages Through age 64

Important Information About This Coverage

Eligibility:

As an MOAA member under age 65, you and your family are eligible for coverage. Your spouse is eligible as long as he/she is under age 65 and not legally separated or divorced from you. Your unmarried children are eligible if they are under age 21 (23 if enrolled full-time in higher-learning or 26 if enrolled in TRICARE Young Adult).

Termination:

Your MEDIPLUS protection will not be canceled due to claims or a change in your health, and you cannot be singled out for a rate increase. Your coverage continues as long as you pay your premiums when due, keep your Military Officers Association of America (MOAA) membership, and the MEDIPLUS master policy remains in force. Coverage will terminate on the date you become eligible for Medicare. Your dependent’s coverage will remain in effect as long as your coverage is active, premiums are paid, and they meet eligibility requirements. Your spouse is eligible for coverage as long as they are not legally separated or divorced from you.

Qualified Hospital:

A Hospital must be engaged primarily in medical care and treatment of sick and injured persons on an inpatient basis, have full surgical facilities, be under the supervision of legally qualified physicians and provide 24-hour nursing services by R.N.'s to qualify. A sanitarium operated by or certified by the First Church of Christ Scientist, Boston, Massachusetts, also qualifies. A convalescent home; Skilled Nursing Facility; a place for rest, custodial care or care for the aged; or a place primarily caring for mental illness, drug addiction, or alcoholism does not qualify. In certain situations, an institution for the treatment of nervous, mental or emotional disorders is considered a Hospital under the MEDIPLUS TRICARE supplements.

Confined or Confinement means being an inpatient in a Hospital or Skilled Nursing Facility due to sickness or injury. Periods of Confinement in a Hospital separated by less than 90 days and due to the same or related causes are considered part of the same Period of Confinement.

Pre-Existing Conditions Limitation (Waiting Period for Current Health Conditions):

If you or your covered dependents received medical treatment or advice for a health condition (including pregnancy) during the six months before the date your protection starts, that health condition won't be covered until the person has been enrolled in the plan for six months. Please consider this limitation before canceling any other health insurance you may have.

Exclusions and Limitations:

These TRICARE Supplements do not cover: 1.) injury or sickness resulting from war or act of war, whether war is declared or undeclared; 2.) intentionally self-inflicted injury; 3.) suicide or attempted suicide, whether sane or insane (in Missouri, while sane); 4.) routine physical exams and immunizations, except when: a) rendered to a Child who is less than 6 years of age; or b) required for school enrollment (but not sports physicals) by a Child aged 5 through 11; or c) 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; 5.) domiciliary or custodial care; 6.) eye refractions and routine eye exams except when rendered to a child up to 6 years from his or her birth; 7.) eyeglasses and contact lenses; 8.) prosthetic devices, except those covered by TRICARE; 9.) cosmetic procedures, except those resulting from Sickness or Injury while a Covered Person; 10.) hearing aids; 11.) orthopedic footwear; 12.) care for the mentally or physically incapacitated if: a) the care is required because of the mental or physical incapacitation; or b) the care is received by an Active Duty Member’s child through the TRICARE Extended Care Health Option (ECHO); 13.) drugs which do not require a prescription, except insulin; 14.) dental care unless such care is covered by TRICARE, and then only to the extent that TRICARE covers such care; 15.) any confinement, service, or supply that is not covered under TRICARE; 16.) Hospital nursery charges for a well newborn, except as specifically provided under  TRICARE; 17.) any routine or newborn care except Well Baby Care, as defined; 18.) expenses which are paid in full by TRICARE; 19.) any part of a covered expense which the Covered Person is not legally obligated to pay because of payment by a TRICARE alternative program; and 20.) any claim under more than one of the TRICARE Supplement Plans, or under more than one Inpatient Benefit or more than one Outpatient Benefit of the TRICARE Supplement Plans. If a claim is payable under more than one of the stated Plans or Benefits, payment will only be made under the one that provides the highest coverage, subject to the Pre-Existing Conditions Limitation. 22.) any expense applied to the TRICARE Outpatient Deductible, TRICARE Point-of-Service Deductible, Retiree Inpatient-Only Supplement Deductible or Retiree Inpatient/Outpatient Supplement Deductible.

Nervous, Mental, Emotional Disorder, Alcoholism, and Drug Addiction Limitations:
The coverage provided under the TRICARE Supplement does not cover inpatient treatment for mental, nervous, or emotional disorders in excess of 45 days if under age 19, or in excess of 30 days if age 19 or older (or 90 days if approved by the TRICARE Standard) in any one calendar year. Outpatient benefits for such disorders are limited to $500 during any period of 12 consecutive months. In addition, for Mental Illness we will pay up to 150 days of inpatient care for covered expenses for a covered dependent child up to age 21.
Plan may not be available in all states.

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 and Hartford Life Insurance Company detail exclusions, limitations 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.

Your association shares a financial interest in this program, which benefits the entire membership.

The information on this site describes benefits available through this insurance program and is intended to provide a brief overview of the coverage. In the event of any conflict or inconsistency between the information on this site and the information contained in the underlying plan documents, the plan documents will in all respects control and govern. If any provision is not explained or only partially explained, your rights will always be determined under the provisions of the underlying plan documents. Insurance coverage and availability may differ by state. For complete plan details, please contact the Program Administrator, Military Officers Association of America (MOAA) Insurance Plans at 1-800-247-2192, Monday-Friday, 7:30 a.m. - 5:00 p.m. and Saturday-Sunday, 8:00 a.m. - 5:00 p.m. Central Time.


TSTND-TMM-0315

SRP-1269 ASN (1134)

MEDIPLUS® TRICARE Supplement Insurance Plan

Answers about the plan, including eligibility, options, enrollment, customer service and more.

This supplement is only for Military Officers Association of America (MOAA) members under age 65 and their families. Even if you decide not to enroll yourself in MEDIPLUS, your spouse and children are still eligible for coverage. Your spouse is eligible as long as he/she is under age 65 and not legally separated or divorced from you. Your unmarried children are eligible if they are under age 21 (23 if enrolled full-time in higher-learning or 26 if enrolled in TRICARE Young Adult).

You will have 30 days from the date coverage is effective to review the insurance certificate. If you are not satisfied with the terms of the certificate, simply return it to the Insurance Administrator and any premiums paid will be refunded in full, minus any claims paid.

To enroll online click on the Get a Quote Now! button. Or, you can choose to download an enrollment form.

Issuance of this Insurance coverage is handled over the Internet and the mail. You can review the materials in the privacy of your home and purchase your Insurance directly through the mail without meeting with an agent. You can, of course, talk to a customer service representative if you’d like by calling 1-800-247-2192.

TSTND-FAQ-0315

SRP-1269 ASN (1134)

MEDIPLUS® TRICARE Supplement Insurance Plan

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

MEDIPLUS & Retired TRICARE Standard Plan Information Chart

MEDIPLUS & Active Duty TRICARE Standard Plan Information Chart

MEDIPLUS & Retired TRICARE Prime Plan Information Chart

MEDIPLUS Enrollment Form - Not available in ID and MT.

Tips for Filing a MEDIPLUS® Claim

Claim Form



Download Adobe Acrobat Reader

TSTND-FMS-0315

SRP-1269 ASN (1134)

MEDIPLUS® TRICARE Supplement Insurance Plan

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

Program Administrator:

Mercer Consumer
12421 Meredith Drive
Urbandale, IA 50398
Phone: 1-800-247-2192
Hours: 7:30 am to 5 pm Monday-Friday and 8 am to 5 pm Saturday-Sunday (Central)

Email: moaa.service@mercer.com
Website: www.mercer.com

Insurance Company:

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

Website: http://www.mercer-web.com/products/thehartford.html

 TSTND-CTS-0315

SRP-1269 ASN (1134)

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