TRICARE or CHAMPVA Supplement Insurance Plan

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If you have any questions, please contact a Customer Service Representative toll-free at 1-800-638-2610, Monday through Friday, from 9:00 a.m. to 7:00 p.m., Eastern Standard Time.

FAQs

The following information will help give you a better understanding of your VFW Group TRICARE or CHAMPVA Supplement Insurance Plan.

What is TRICARE or CHAMPVA Supplement?
Who is eligible for the TRICARE or CHAMPVA Supplement Insurance?
When does the plan terminate?
What about pre-existing conditions?
When does my insurance go into effect?
Will I have to provide information regarding my medical history?
How are benefits paid?
Are there any exclusions or limitations?
What is my obligation when I enroll for coverage?
If my status changes, can I keep my TRICARE Supplement insurance for myself and/or my family?
Are there any restrictions with TRICARE or CHAMPVA Supplement insurance as to what doctor or hospital I use?
What is the TRICARE Catastrophic Cap?
How are the TRICARE or CHAMPVA Supplement insurance premium rates determined?
Are CHAMPVA Supplement insurance benefits available?
How do I enroll?

What is TRICARE or CHAMPVA Supplement?
TRICARE and CHAMPVA Supplement insurance was developed to help fill in your coverage gaps and to pay for coinsurance/fees.

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Who is eligible for the TRICARE or CHAMPVA Supplement Insurance?
VFW members and their families who have TRICARE or CHAMPVA are eligible for TRICARE or CHAMPVA Supplement insurance. TRICARE is available to active duty service members and retirees of the seven uniformed services, their family members survivors and eligible TRICARE individuals registered in the Defense Enrollment Reporting System (DEERS), and also to members of the National Guard and Reserves and their families. CHAMPVA is available to the spouse or widow(er) and to the children of a veteran who meets certain criteria. For questions regarding eligibility for TRICARE, please contact DEERS at 1-800-538-9552.

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When does the plan terminate?
Your coverage will continue until one of the following occurs:
1) Your premium is not paid, subject to the Grace Period provision;
2) You cease to be a member of the VFW;
3) You are no longer eligible for the Plan under which you are covered;
4) The VFW cancels coverage for all persons covered under the Policy;
5) You attain age 65;
6) You are no longer covered under TRICARE or CHAMPVA;
7) You become eligible for Medicare unless you reside in an area where Medicare is not available, in which case coverage will not terminate until you return to residency in an area where Medicare is available.

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What about pre-existing conditions? All VFW members who are eligible for TRICARE (as defined by TRICARE) or CHAMPVA are eligible for guaranteed issuance for this TRICARE or CHAMPVA Supplement insurance. A limit to coverage may apply during the first 6 months from the effective date due to Pre-Existing Conditions. Pre-Existing Conditions, as used in this limitation, Medical Care received when 1)a Physician is consulted or medical advice is given; or (2) Treatment is recommended or prescribed by; or received from, a Physician; (b) Treatment to include; but not limited to, any; (1) medical examination, test, attendance, or observation; (2) medical services supplies; or equipment, including their prescription or use; or (3) prescribed drugs or medicines, including their prescription or use.

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When does my insurance go into effect?
The effective date of your coverage depends on when you meet the eligibility requirements, when you enroll, and when your first premium payment is received. If you enroll and agree to pay premiums your TRICARE or CHAMPVA Supplement insurance becomes effective the first of the month after the enrollment form and first premium payment are received.

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Will I have to provide information regarding my medical history?
Your acceptance is guaranteed. An injury or sickness for which any person to be covered under the TRICARE or CHAMPVA Supplement insurance has received medical treatment or care within 6 months immediately preceding their effective date will not be covered until that person has ceased receiving medical treatment or care for that condition for 6 consecutive months. Any new conditions will be covered immediately.

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How are benefits paid?
Most TRICARE or CHAMPVA Supplement claims are processed and paid directly to the provider(s). If the member is required to pay the provider at the time of service, the TRICARE or CHAMPVA Supplement will reimburse the co-pays directly to the member. It is important that your name on the enrollment form appears exactly the same as it is on your military ID card to ensure proper claims processing.
Please be aware that some TRICARE or CHAMPVA Supplement claims cannot be processed electronically.

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Are there any exclusions or limitations?
Nervous, Mental, Emotional Disorder, Alcoholism, and Drug Addiction Limits — The coverage provided under the Inpatient Benefits of the TRICARE or CHAMPVA Supplements for nervous, mental, emotional disorders, including alcoholism and drug addiction, is limited to: (a) 30 days Inpatient treatment for a Covered Person age 19 and older per Fiscal Year; or (b) 45 days Inpatient treatment for a Covered Person under age 19; per Fiscal Year.

This Inpatient limit is based on the number of days TRICARE or CHAMPVA normally provides each Fiscal Year for such confinements. In rare instances, TRICARE or CHAMPVA extends these daily limits. If this occurs, we will limit the number of days that we provide for such Confinement to the lesser of: (a) the number of days TRICARE or CHAMPVA pays for such Inpatient treatment during the Fiscal Year; or (b) 90 Inpatient days per Fiscal Year.

The coverage provided under the Outpatient Benefits of the TRICARE or CHAMPVA Supplement Plan for: (a) nervous, mental, and emotional disorders; and (b) alcoholism and drug addiction; is limited to $500 during any period of 12 consecutive months for all such disorders.

TRICARE or CHAMPVA Cap— TRICARE or CHAMPVA will increase its rate of payment to 100% of the TRICARE Allowed Amount when a Covered Person has met the TRICARE Cap. After the TRICARE Cap has been met, we will not duplicate benefits by paying any part of the cost-share which is payable under TRICARE.

Other Insurance With Us — If a Covered Person is insured under more than one policy underwritten which provides TRICARE Supplement benefits, we will limit our payment of benefits to the one policy that affords the greater level of benefits.

Non-Duplication of Coverage under Employer Health Program — If a claim payable under the Policy is also payable under an Employer Health Program with TRICARE as the secondary payor, we will limit our payment to an amount which, when added to the amounts paid by the Employer Health Program and TRICARE, will not exceed 100% of TRICARE Covered Expenses.

Exclusions — The Policy does 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 Colorado and Missouri while sane); 4) routine physical exams, unless required for school enrollment (but not sports physicals) by a Covered Child ages 5 through 11, and immunizations, except when: (a) rendered to a child up to 6 years from the child’s birth; or (b) ordered by a Uniform 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 your assignment; 5) domiciliary or custodial care; 6) eye refractions and routine eye exams except when rendered to a child up to 6 years from the child’s birth; 7) eyeglasses and contact lenses; 8) prosthetic devices (except that artificial limbs and eyes and devices which must be implanted by surgery are covered); 9) cosmetic procedures, except those resulting from Sickness or Injury; 10) hearing aids; 11) orthopedic footwear; 12) care for the mentally incapacitated or physically handicapped if the care is required because of the mental incapacitation or physical handicap or the care is received by an Active Duty Member’s child who is covered by the Program for the Handicapped under TRICARE; 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 well newborn, except as specifically provided under TRICARE; 17) any routine newborn care except Well Baby Care, as defined, for a child up to 6 years from the child’s birth;18) expenses in excess of the TRICARE Cap; 19) expenses which are paid in full by TRICARE; 20) any expense or portion thereof applied to the TRICARE Outpatient Deductible; 21) treatment for the prevention or cure of alcoholism or drug addiction except as specifically provided under TRICARE; 22) any part of a covered expense which the Covered Person is not legally obligated to pay because of payment by a TRICARE alternative program; 23) 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 Condition Limitation; 24) treatment or confinement not ordered by a physician or necessary for medical care; 25) expenses in excess of the TRICARE Allowed Amount except as specifically provided. Limitations and exclusions may vary by state. Please refer to your certificate for details.

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What is my obligation when I enroll for coverage?
There is absolutely no obligation. When you enroll, your certificate of coverage will be mailed to you upon processing and acceptance of the enrollment form. Review the certificate of coverage at your leisure. If you are not completely satisfied, simply mail back your certificate within 30 days and any money paid will be refunded in full. We will consider your coverage void from the effective date. After the 30 day free-look, you may cancel coverage at any time by giving us notice (the termination date will be the first day of the following month).

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If my status changes, can I keep my TRICARE Supplement insurance for myself and/or my family?
This VFW TRICARE Supplement insurance offers many plan options to best fit your situation. TRICARE Supplement is available for both active duty and retiree status. TRICARE Supplement works with TRICARE Standard, Extra or Prime. The coverage is yours to keep even if you change jobs or move.

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Are there any restrictions with TRICARE or CHAMPVA Supplement insurance as to what doctor or hospital I use?
No. There are no preferred provider lists. No doctor or hospital networks. And no referrals required for specialized care. You may see the TRICARE or CHAMPVA-authorized doctor of your choice.

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What is the TRICARE Catastrophic Cap?
The TRICARE Catastrophic Cap limits the amount that a family would have to pay out of their own pocket for medical expenses incurred in a given TRICARE fiscal year. The maximum "out-of-pocket" is $3,000 per family for TRICARE Standard or Extra and $1,000 for TRICARE Prime. The expenses applied to the Catastrophic Cap are cost-shares and deductibles. Excess charges are not applied to the out-of-pocket. The combined cost-shares, deductibles and excess charges could add up to thousands of dollars each year and are your responsibility unless you have TRICARE Supplement insurance.

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How are the TRICARE and CHAMPVA Supplement insurance premium rates determined?
The VFW TRICARE or CHAMPVA Supplement is a group insurance policy. Premiums are based on the group claims history and not based on the individual. We have the right on each premium due date to change the rate at which further premiums will be calculated. Any change will be applied to all individuals of the same class, age, plan and effective date. We will give the Policyholder notice of any change at least 45 days before the premium due date to which the change will become effective.

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Are CHAMPVA Supplement insurance benefits available?
Yes. CHAMPVA Supplement benefits are available. CHAMPVA Supplement policy has a $200 policy deductible and covers full excess charges.

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How do I enroll?
Enrolling for TRICARE or CHAMPVA Supplement is easy. Click for the Enrollment Form, select the appropriate state and download the form. Sign and mail the enrollment form to VFW TRICARE and CHAMPVA SUPPLEMENT, Administrative Office, Attn: Application Fulfillment, 6110 PARKLAND BLVD CLEVELAND, OH 44124. Or contact a Customer Service Representative toll-free at 1-800-638-2610, Monday through Friday, from 9:00 a.m. to 7:00 p.m., Eastern Standard Time.

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