Many military associations and private companies offer supplemental insurance policies. Unlike other health insurance, which pays first for health care services, supplemental insurance pays after TRICARE pays its portion of the bill, reimbursing you for out-of-pocket medical expenses paid to civilian providers based on the plan's policies.
Each supplemental insurance plan has its own rules. Carefully consider your health care needs and the health care needs of your family before purchasing a supplemental insurance plan. In some cases, such as with TRICARE Prime, the cost of the supplemental plan may exceed your out-of-pocket expenses.
The following are some questions you should answer before purchasing a supplemental insurance plan.
- What type of health care services does the supplement cover? Will the plan cover amounts beyond what TRICARE allows?
- Does the supplement pay for services not covered by TRICARE or limit the conditions it does cover?
- How much is the supplement premium? How often is it paid?
- Are there different premium rates based on military status (active or retired) or age?
- Can premium payments be increased? Under what conditions?
- Is there a deductible to pay before the supplement pays?
- Is there a maximum limit on benefits (lifetime, annual, etc.)?
- Is there a pre-existing condition clause? If so, how long is the waiting period?
- Are there treatments that must be pre-approved before care can be received?
- Does the supplement cover enrollment fees or copayments?
- Will the supplement pay my cost share under the TRICARE Diagnostic Related Group system?
- Does the TRICARE supplement convert to a Medicare supplement? If so, how long before it can convert?
- Does the supplement cover inpatient, outpatient, long term or overseas care?
- Does the supplement have membership fees (annual or lifetime)?
- Will the supplement continue to cover care upon retirement from active duty?
- Will the plan continue to provide coverage for surviving TRICARE-eligible spouses and family members?
- What are the procedures for filing a claim? Is there a time limit to file a claim?
- Does the plan have higher rates for smokers?
- Does the plan cover college students who live in a different part of the country?
- What happens if beneficiaries move to another region, does the plan move with them?