Frequently Asked Questions

Selman & Company brings you supplement plans that make a difference

Q: Who is eligible for TRICARE Supplement?
Any TRICARE eligible person under the age of 65 is eligible for the TRICARE Supplement including:

Q: Who is eligible for CHAMPVA?
Spouses and dependents of disabled veterans are eligible for the CHAMPVA program.

Q: Do I need a TRICARE/CHAMPVA Supplemental?
Because TRICARE Standard is a fee-for-service health plan and Extra is a Preferred Provider Organization (PPO) the beneficiary is responsible for some out-of-pocket expenses. The supplemental can provide reimbursement the 20% or 25% cost shares and prescription drug co-payments. In addition to that, reimbursement of any applicable excess charges when non-participating providers are used up to the legal limit.

Although federal regulation 38 CFR 17.272 (b) limits the amount that providers can bill a CHAMPVA beneficiaries they still have some out-of-pocket expenses as well. A supplemental plan can provide reimbursement of the 25% cost shares for in- and out-patient services and prescription drugs.

Q: What is the difference between TRICARE Standard, Extra and Prime?
TRICARE Standard is a fee-for-service health plan. It offers beneficiaries flexibility and a greater choice of providers. Beneficiaries receive most of their care from TRICARE authorized civilian doctors, hospitals and other providers. They also receive care from military treatment facilities on a space available basis. TRICARE Standard is available overseas.

For outpatient care for most TRICARE eligible families, there is a fiscal year deductible of $150 for one person or $300 for a family. After the deductible is met, TRICARE Standard pays 75% of the allowable amount. The beneficiary is responsible for the deductible, 25% cost share plus applicable excess charges when a non-participating provider is used.

TRICARE Extra is a Preferred Provider Organization (PPO). Beneficiaries have access to the same network of providers as the TRICARE Prime but with none of the restrictions of Prime. The beneficiary receives a discount on the cost by using the Extra network provider and the provider files the claim. Like TRICARE Standard, after the deductible is met, TRICARE Extra pays benefits at 80% of the negotiated rate. The beneficiary is responsible for the deductible plus the 20% cost share.

TRICARE Prime is an HMO-type plan and is composed of military hospitals, clinics and civilian networks. TRICARE Prime offers lower out-of-pocket costs but restricts an individual's choice of providers and facilities. Beneficiaries pay co-payments for covered services obtained from civilian network providers. Beneficiaries enrolled in Prime have to select a primary care manager (PCM) - a doctor or team of providers -- who treat them and is responsible for coordinating all aspects of their health care.

Beneficiaries must enroll in TRICARE Prime. Military retirees pay an annual enrollment fee of $230 for an individual or $460 for a family. There is no enrollment fee for active duty members and their families.

Q: I'm traveling overseas will I still be coverage under my TRICARE and the Supplement?
Yes. TRICARE Standard overseas is identical to TRICARE Standard in the U.S. The benefits and cost shares remain the same. The Supplement will follow TRICARE guidelines and maintain the same benefits as in the U.S. under TRICARE Standard. TRICARE Extra and Prime cannot be used overseas.

Q: What happens to my TRICARE/CHAMPVA Supplemental coverage when I turn 65?
When TRICARE or CHAMPVA beneficiaries attain age 65 and become eligible for Medicare, eligibility for TRICARE Prime, Standard and Extra and CHAMPVA ends and eligibility for TRICARE for Life or CHAMPVAfor Life begins. The supplemental policy will also terminate. TRICARE for Life and CHAMPVA for Life act as a secondary payer to Medicare.

Q: Is there a Pre-existing Conditions Limitations on the Supplemental policy?
The supplemental will not cover injuries and illnesses diagnosed and undiagnosed within 6 months prior to effective date of coverage. Unless you have been treatment free for that condition for 6 consecutive months or have been on the policy for 6 months. After you have been on the policy for 6 months all pre-existing conditions will be considered for reimbursement.

Q: What is a participating and non-participating TRICARE Provider?
Participating providers agree to accept TRICARE payment and any cost share as payment in full. (TRICARE determines an allowable amount and pays 75% of the allowable with a 25% cost share due from the beneficiary.)

Non-participating providers do not agree to accept the TRICARE-determined allowable charge as the total charge for services; they can bill up to the legal limit of the TRICARE allowable charge. TRICARE will send the reimbursement to the beneficiaries and they have to pay the provider.

Q: Does CHAMPVA have participating or network providers?
CHAMPVA does not have network and/or participating providers. Regulation 38 CFR 17.272 (b) states the following:

1. A Medicare-participating hospital; must accept the CHAMPVA determined allowable amount for inpatient services as payment-in-full.

2. An authorized provider of covered medical services or supplies must accept the CHAMPVA-determined allowable amount as payment-in-full.

3. A provider who has collected and mot made appropriate refund, or attempts to collect from the beneficiary, any amount in excess of the CHAMPVA determined allowable amount may be subject to exclusion from Federal benefit program.

Q: Is a claim form needed every time you file a claim with the TRICARE Supplement?
All new insured members will be asked to complete a claim form for every covered member under the supplemental policy. The Selman & Company examiner will request this from the member once the first initial claim is received for each person. The member will be asked to give us past medical history and complete the authorization to release medical records section on the claim form. Once this claim form is on file for each covered member claim forms are not needed when the member is filing their claims. The certificate number is needed on all submissions. We do require that if the member is still in their pre-existing period of the policy that they submit a detailed bill from the provider and the TRICARE explanation of benefits (eob). When filing for reimbursements of prescription drugs, the member needs to remit the receipt from the pharmacy that has the patients name, the drug name, date filled and the co-payment amount, a TRICARE eob (if available) or a printout from the pharmacist is acceptable. (Cash register receipts are not acceptable for reimbursement)

Q: Will Selman & Company continue supplemental coverage for my dependent child age 24 enrolled in the new TYA program offered by TRICARE?
Effective May 1, 2011, covered dependents under the TRICARE Supplement Plan have been expanded to the following dependent groups. Eligibility for coverage under the TRICARE Supplement Plan will end if a dependent is no longer eligible for TYA. If a dependent's TYA coverage ends, you must notify the administrator immediately.

1. A young adult dependent child is an unmarried dependent child who is under age 26 and is enrolled in the TRICARE Young Adult (TYA) program.

2. Adult dependent children who are not covered by TRICARE are not eligible for coverage under the Policy.

Coverage under TYA ends if any of the following occurs:

Q: I saw on the internet that the individual (direct) plans are less expensive than the employer plan. Why can't I switch to an individual policy?
The individual plans are available to you. Please understand these plans have deductibles in addition to the TRICARE/CHAMPVA deductibles. Any injury or sickness whether diagnosed or undiagnosed, for which you received medical care or treatment within the 6 month period before the effective date of your new policy will not be covered until the coverage has been in effect for 6 months. However, new conditions will be covered immediately.

With TRICARE Prime the point service deductible would be your full responsibility. Under the policy offered by your employer, Selman & Company pays a portion or in some cases 50% of the POS deductible depending on the plan offered to you.

Q: I have a question which isn't covered here.
Please reach us with your questions at the contacts below.

Supplement plans, billing, premium payments, claims, or general concerns
CUSTOMER SERVICES
memberservices@selmanco.com
1-800-638-2610
9:00 AM - 7:00 PM ET, Monday - Friday