MEDIPLUS TRICARE Retired Reserve Supplement Insurance Plan

MEDIPLUS TRICARE Retired Reserve Supplement Insurance Plan  

Overview

MEDIPLUS® TRICARE Retired Reserve Supplement Insurance Plan

ATTN: National Guard and Reserve retirees to help with out-of-pocket expenses — as a member of the Military Officers Association of America (MOAA), you may now be eligible for this Military Officers Association of America (MOAA) benefit!

 

As a National Guard or Reserve retiree you may now qualify to purchase the TRICARE Retired Reserve coverage recently made available with the FY2010 National Defense Authorization Act. This is good news because now you may have this alternative healthcare option available to you. In fact, it may be ideal for members who have been forgoing healthcare coverage altogether, are self-employed or who are currently covered by a more expensive civilian healthcare plan.

 

TRICARE Retired Reserve can help provide you and your family with quality healthcare coverage. But as good as TRICARE is, it’s not intended to cover everything. If you purchase TRICARE Retired Reserve, there may be out-of-pocket costs for co-payments, cost-shares and excess charges you will have to pay for. And these costs could add up to hundreds—even thousands—of dollars out of your pocket.

 

The MOAA MEDIPLUS TRICARE Retired Reserve Supplement can help reduce your co-pays, excess charges and cost shares after you meet your annual TRICARE Retired Reserve and MEDIPLUS deductibles.

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National Guard and Reserve retirees may be eligible to purchase the DoD’s TRICARE Retired Reserve coverage. This means, as a member of the Military Officers Association of America (MOAA), you also qualify for MOAA’s MEDIPLUS TRICARE Retired Reserve Supplement. Team them together for more valuable coverage!

 

Why choose the MEDIPLUS® TRICARE Retired Reserve Supplement Insurance Plan?

MOAA sponsors the MEDIPLUS® TRICARE Retired Reserve Supplement Insurance Plan to help reduce your unexpected out-of-pocket expenses. The MEDIPLUS TRICARE Retired Reserve Supplement helps cover cost-shares not fully reimbursed by TRICARE for covered doctor visits, hospital stays, surgeries, prescription drug cost-shares and excess charges (up to 15% above the TRICARE allowed amount), once any applicable TRICARE and MEDIPLUS deductibles have been met.

The MEDIPLUS TRICARE Retired Reserve Supplement has you covered:

  • Pays cost-shares and co-pays
  • Pays excess charges (up to 15% above the TRICARE allowed amount)
  • Affordable members-only group rates
  • Guaranteed acceptance for eligible MOAA members and their families — you’re covered immediately for all new health conditions. Any current injuries or illnesses are subject to the Pre-Existing Conditions Limitation and are covered after six months.

 

MEDIPLUS Also Includes These Competitive Advantages:

Choice of two deductible options to help fit your lifestyle and budget.

The MEDIPLUS In- and Outpatient Plans may be ideal for you. You’ll get additional protection to help pay for Hospital bills, doctor visits, outpatient care and prescription drugs. You can choose between two deductible options to fit your budget:
— $250 per person/$500 per family
— $400 per person/$800 per family

 

You’re 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.
Your MEDIPLUS coverage starts on the first day of the month after the administrator receives your Enrollment Form and first premium payment. You will be immediately covered for all new health conditions. Any current injuries or illnesses will not be covered until after six months.

  • Rates

    Affordable members-only group rate.

    TRICARE Retired Reserve Supplement Monthly Rates*
    Retiree In- and Outpatient Plans
        $400 Per-Person Deductible $250 Per-Person Deductible
      Age Nonsmoker Smoker Nonsmoker Smoker
    Member/
    Surviving Spouse
    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


    * For your convenience, you will be billed quarterly. Premiums are based on each person’s attained age and increase upon entry into each new 5-year age bracket. Rates and/or premiums may be changed on a class-wide basis. Your 12-month deductible period will begin with the effective date of your coverage. (This may not coincide with the TRICARE calendar year deductible period.)
     

    †Upon reaching age 60, your MEDIPLUS coverage will continue under the MEDIPLUS TRICARE Select Supplement Insurance Plan. The age 60-64 rates listed are for the MEDIPLUS TRICARE Select Supplement.
     

    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.

  • Additional Plan Details

    Coverage is Portable.

    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.)

    • Moving from an employer plan? You’ll qualify for full MEDIPLUS coverage from Day 1 … with no waiting period for current health conditions … if you enroll within 30 days after your civilian employer-sponsored benefits end because you are no longer an eligible participant (for example: if you change jobs, move or retire). If you voluntarily leave your civilian employer plan while you’re still eligible for coverage, you will not  be covered for current health conditions until a period of six months.
    • Are you just eligible for TRICARE? You’ll have NO waiting period for current health conditions when you enroll within 30 days of the date of your initial eligibility for TRICARE Retired Reserve benefits.

     

    Seamless transition to other MEDIPLUS coverage when your military status changes. So when you’re no longer eligible for TRICARE Retired Reserve in the future, you can continue your MEDIPLUS Supplement with TRICARE Select. And if you switch to TRICARE Prime for retirees, you can also switch to a MEDIPLUS TRICARE Prime Supplement you just need to notify the MOAA Insurance Plans Administrator of this change.

     

    Freedom to see your own TRICARE-authorized doctor or specialist.

     

    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 Retired Reserve Supplement will be paid directly to the provider(s).

     

    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

     

    You can count on MEDIPLUS to help take care of your family.

    MEDIPLUS is ideal for the whole family - yourself, your spouse and your kids. It's even perfect for your kids at college. It provides valuable 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 will be there for your family, even if something happens to you. 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.

     

    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.

    This benefit is not available with the MEDIPLUS TRICARE Prime Plan, but would continue if your family moves from TRICARE Retired Reserve to TRICARE Select coverage for retirees.

     

    Important Information About This Coverage

    Type of Insurance: MEDIPLUS TRICARE Retired Reserve Supplement
    Designed For: Military Officers Association of America (MOAA) members and dependents
    Underwritten by: Hartford Life and Accident Insurance Company, One Hartford Plaza, Hartford, CT 06155
    Policy Form Number: TRICARE Form Series includes SRP-1269, or state equivalent.
    Policy Number: AGP-1134
    Issue Ages Through age 59

     

    Eligibility:

    As an MOAA member under age 60, you and your family are eligible for coverage. Your spouse is eligible as long as he/she is under age 60 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 and your family must not yet be eligible for Medicare. Member and Spouse cannot duplicate coverage by enrolling as dependents of each other.

     

    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, remain ineligible for Medicare and the MEDIPLUS master policy remains in force. 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. 21.) any expense applied to the TRICARE Outpatient Deductible, TRICARE Point-of-Service Deductible, Retiree Inpatient-Only Supplement Deductible or Retiree Inpatient/Outpatient Supplement Deductible.

     

    Important Information Regarding Veterans' Administration (VA) Hospitals — TRICARE supplement insurance policies pay benefits only after TRICARE has first reviewed and approved the expense. A review by TRICARE results in a TRICARE Explanation of Benefits ("EOB"). Many VA Hospitals currently do not submit their claims through TRICARE. Only claims TRICARE processes, resulting in an EOB, are subject to benefits under Hartford Life and Accident Insurance Company's TRICARE supplement insurance policies. If you use VA facilities for your care, please be aware of this TRICARE supplement policy requirement.

    VA Hospitals also can charge the veteran a Category C copayment based on a means test per Public Law 99 Section 272. This law specifically applies only to the veteran and not the insurance company. The Hartford is not liable for payment of these charges.

     

Forms

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

 

Note: MEDIPLUS may not be available in all states.


Enrollment Form


Tips for Filing a MEDIPLUS® Claim


Claim Form


HIPAA Privacy Notice



Contact Us

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

 Address
Mercer Consumer
12421 Meredith Drive
Urbandale, IA 50398
 Phone
1-800-247-2192
 Hours
 M-F 7:30a-5p CT
 Email
moaa.service@mercer.com
 Insurance Company Address
Hartford Life Insurance Company
One Hartford Plaza
Hartford, CT 06155

FAQs

Answers about the plan, including eligibility, options, enrollment, customer service and more.
  • What if I have second thoughts after I enroll?

    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.
  • Do I have to meet with an insurance agent?

    Issuance of this Insurance Certificate 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.
  • Who is eligible for this insurance?

    This supplement is only for retired National Guard and Reserve MOAA members and their families who have purchased coverage under the TRICARE Retired Reserve Program. Your spouse is eligible as long as he or she is under age 60 and not legally separated or divorced from you. Your unmarried children are eligible for coverage if they are under 21 (23 if full-time in higher learning or 26 if enrolled in TRICARE Young Adult).
  • What if I switch my primary coverage from TRICARE Retired Reserve to TRICARE Standard or TRICARE Prime?

    As your military status or your eligibility for TRICARE changes, your MEDIPLUS coverage can change with you. If you come off TRICARE Retired Reserve, you can continue your MEDIPLUS Supplement with TRICARE Standard. And if you switch to TRICARE Prime for retirees, you can also switch to a MEDIPLUS TRICARE Prime Supplement. You just need to notify the MEDIPLUS Insurance Plan Administrator of your change in status by calling 1-800-247-2192.
  • How do I enroll?

    Download an enrollment form by clicking on the ‘Enrollment Form’ Button.

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 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. Central Time.

 

TRICARE Form Series includes SRP-1269, or state equivalent.

Mercer's Role & Compensation

Details of Mercer disclosure of the compensation.