For military retirees under age 65 and their dependents and dependents of active duty military personnel.

AFA offers supplement Insurance coverage to TRICARE SELECT, TRICARE PRIME and TRICARE RESERVE SELECT

You Are Guaranteed Acceptance*

Through AFA, members are guaranteed acceptance* for the TRICARE supplemental Insurance coverage. Members cannot be denied coverage based on age or health as long as the member is eligible for TRICARE benefits.

*Pre-existing health conditions may not be covered initially. Please refer to the Pre-existing Conditions explanation below for details.

Competitively Priced Family Coverage

Adding TRICARE Supplement Insurance with your existing TRICARE coverage helps get you and your family great health insurance at competitive group rates.

Goes With You Anywhere

AFA's TRICARE Supplement Insurance is completely portable; it goes with you when you travel or change jobs. It is the ideal choice for you if you are self-employed or if your employer does not offer insurance.

Exclusions and Limitations Apply To Your TRICARE Supplement Coverage

Who Is Eligible for Coverage?

TRICARE Select Supplement Plan: Retiree High Option Plan
You, your spouse (under age 65) and unmarried dependent children under age 21 (age 23 if a full-time student, age 26 if enrolled in TRICARE Young Adult) are eligible for coverage. All family members must be covered by TRICARE.

TRICARE Select Supplement Plan: Active Duty – Family Plan
Your spouse (under age 65) who is not on active duty and not eligible for Medicare, and your unmarried dependent children under age 21 (age 23 if a full-time student, age 26 if enrolled in TRICARE Young Adult) are eligible for coverage. All family members must be covered by TRICARE.

TRICARE Prime Supplement Plans: WithOUT Point of Service and With Point of Service
You, your spouse (under age 65) and unmarried dependent children under age 21 (age 23, if a full-time student, age 26 if enrolled in TRICARE Young Adult) are eligible for coverage. All family members must be covered by TRICARE.

TRICARE Reserve Select Supplement Plan
You, your spouse (under age 65) who is not on active duty and not eligible for Medicare and unmarried dependent children under age 21 (age 23 if a full-time student, age 26 if enrolled in TRICARE Young Adult) are eligible for coverage. All family members must be covered by TRICARE Reserve Select and cannot be eligible for Federal Employees Health Benefits Program (FEHBP) or currently covered under FEHBP.

Eligibility

Member means a member of the Policyholder. To be eligible for coverage, the Member must be under Age 65; and not be eligible for Medicare; not be on Active Duty; and be covered under the TRICARE plan that matches Your plan under The Policy. To be eligible for coverage, Your Spouse must be under Age 65; and not be eligible for Medicare; not be on Active Duty; and be covered under the TRICARE plan that matches his or her plan under The Policy. Your spouse can not be legally separated or divorced from you. If both You and Your Spouse are Members and are eligible for coverage, coverage may not be duplicated by applying as Dependents of each other and both cannot enroll Dependents. No Covered Person can be insured as a Dependent of more than one Member under The Policy. Children are eligible until they marry or reach age 21 (23 if a full-time student or 26 if covered under TRICARE Young Adult).

When Does Coverage Start And End?

Effective Date of Coverage
Your coverage will become effective on the first day of the month following the date your enrollment form is received. If you are confined in a hospital on the date you are to become covered under the policy, your coverage will be deferred until the first day after you are discharged.

Termination
Your coverage will remain in effect as long as you continue to pay your premiums when due, the group policy remains in force, and you remain eligible for coverage. Your coverage ends when you become eligible for Medicare, or you reach age 65 (unless you are not eligible for Medicare).

Termination of Your Dependents’ Coverage
Coverage for Your Dependent(s) will end on the earliest of the following: the date The Policy terminates ceases to participate in The Policy; the first day of the month on or next following the date Your Dependent is no longer in a class eligible for coverage, or The Policy no longer covers Your Dependent’s class; the date Your Dependent ceases to be covered under TRICARE; the date the required premium is due but not paid, subject to the Individual Grace Period or Policyholder Grace Period; the first day of the month on or next following the date You cease to be a Member of the Policyholder; the date Your coverage ends (this does not apply to a Dependent of an Active Duty Member or Service Disabled Member); the date We or the Policyholder terminate Dependent coverage; the date You Request We terminate Dependent coverage; the date Your Dependent’s coverage ends in accordance with the Newborn or Newly Adopted Child Coverage provision; the date Your Spouse attains Age 65 unless he or she is not eligible for Medicare and can provide documentation of such from the Social Security Administration; the date Your Dependent becomes eligible for Medicare unless he or she resides in an area where Medicare is not available. Coverage will not terminate until Your Dependent resides in an area where Medicare is available; the first day of the month on or next following the date Your Spouse no longer satisfies the definition of Spouse; the first day of the month on or next following the date Your child no longer satisfies the definition Dependent Child(ren); unless coverage is continued under the Continuation Provisions.

Extension of Benefits for Total Disability

If a covered person is Totally Disabled on the date his or her coverage ends, TRICARE supplement coverage will extend inpatient benefits until the date he or she is no longer Totally Disabled; or 90 days from the date his or her Inpatient Benefit ended, whichever is the first to occur. Outpatient Benefits under the Plan will continue up to 90 days from the date of termination. The continuation will only apply to expenses incurred for the injury or sickness that caused the total disability.

Pre-Existing Conditions Limitation

Any injury or sickness, whether diagnosed or undiagnosed for which any person proposed for coverage has received medical treatment or care within 6 months immediately preceding their effective date will not be covered (a) until that person has not received medical treatment or care for that condition during a period of 6 consecutive months (ending any time on or after the covered person’s effective date) or (b) until the coverage has been in effect for 6 months. New conditions will be covered immediately.

DEFINITIONS

Confined or Confinement means being an Inpatient in:
a Hospital; or
a Skilled Nursing Facility;
due to Injury or Sickness

Skilled Nursing Facility means an institution that:
operates pursuant to law; in addition to room and board accommodations, is primarily engaged in providing skilled nursing care under the supervision of a Physician;
provides continuous 24 hour a day nursing service by or under the supervision of a registered graduate nurse (R.N.); and
maintains a daily medical record of each patient.

Skilled Nursing Facility does not mean a Hospital or any institution or part thereof that is used mainly as a home or place for:
the aged, or for rest, custodial or educational care;
alcoholism and drug addiction; the treatment of Mental Illness.

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

The Policy limits coverage for:

1. routine physical exams and immunizations, except when:
   1. a. rendered to a child up to 6 years from the child’s birth; or
   2. b. ordered by a Uniformed Service:
      1. i. for a Covered Dependent of an Active Duty Member;
      2. ii. for such Dependent’s travel out of the United States due to your assignment; or
   3. c. required for school enrollment (but not sports physicals) by a Covered Child aged 6 through 11;
2. domiciliary or custodial care;
3. eye refractions and routine eye exams except when rendered to a child up to 6 years from the child’s birth;
4. eyeglasses and contact lenses;
5. prosthetic devices, except those covered by TRICARE;
6. cosmetic procedures, except those resulting from Sickness or Injury, while a Covered Person;
7. hearing aids;
8. orthopedic footwear;
9. care for the mentally or physically incapacitated if: 
   1. a. the care is required because of the mental or physical incapacitation; 
   2. b. or the care is received by an Active Duty Member’s child who is covered by the TRICARE Extended Care Health Option (ECHO);
10. drugs which do not require a prescription, except insulin;
11. dental care unless such care is covered by TRICARE, and then only to the extent that TRICARE covers such care;
12. any confinement, service, or supply that is not covered under TRICARE;
13. Hospital nursery charges for a well newborn, except as specifically provided under TRICARE;
14. any routine newborn care except Well Baby Care;
15. any expense or portion thereof which is in excess of the Legal Limit;
16. expenses in excess of the TRICARE Catastrophic Cap;
17. that part of any Covered Expense which is in excess of the TRICARE Allowed Amount, except as otherwise stated in the plan benefits
18. expenses which are paid in full by TRICARE;
19. any expense or portion thereof applied to the TRICARE Outpatient Deductible;
20. treatment for the prevention or cure of alcoholism or drug addiction, except as specifically provided under TRICARE and The Policy;
21. nursing services, unless it is for the nurse’s full-time service while the Covered Person is an Inpatient in a Hospital;
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. If a claim is payable under more than one plan or benefit, payment will only be made under the provision that provides the highest coverage.

This program is not available in all states.
 

TRICARE Form Series includes Form GBD-3000 (2017); Form GBD-3100 (2017) or state equivalent.

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.

TRICARE Form Series includes Form GBD-3000 (2017); Form GBD-3100 (2017) or state equivalent.

AGP-5924

93218-TS