TRICARE and CHAMPVA are health benefit programs for the military community.
These programs help eligible members with medical expenses such as hospital stays, doctor visits, emergency care, prescription medications, ambulance, medical equipment, mental health care, etc.
TRICARE is for Active Duty military personnel as well as eligible retired military and reserve members. Spouses and children are also eligible for TRICARE.
TRICARE is available overseas. Military retirees who reside overseas have TRICARE Select. Active Duty personnel have access to TRICARE Select and TRICARE Prime.
CHAMPVA stands for Civilian Health and Medical Program of the Department of Veterans Affairs. It is similar to TRICARE, but it is specifically for spouses and children of disabled veterans..
Tricare & CHAMPVA Plan Based on Calendar Year (January 1 through December 31)
There is no underwriting or requirement to submit Evidence of Insurability.
No medical or health questions are asked, and every eligible applicant is accepted.
Overseas Providers: When your insured lives overseas, the benefit checks will only go to the sponsor. We do not pay overseas providers. Please set clear expectation with the insureds when they want the benefits issued to the providers.
Purpose of TRICARE/CHAMPVA Supplement Insurance |
These plans help members pay the out-of-pocket expenses, such as co-pays and cost shares, left behind by TRICARE/CHAMPVA.
Most members use TRICARE/CHAMPVA as their primary and the supplement as their secondary plan.
Some TRICARE members have other health insurance (OHI). The OHI pays primary, TRICARE/CHAMPVA pays secondary, and the supplement pays tertiary.
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Carrier |
Hartford Life and Accident Insurance Company
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Background / History of Administration |
Our TRICARE/CHAMPVA supplement plans were originally administered by Association & Society Insurance Corporation (ASI). ASI was founded in 1975 and is located in Rockville, Maryland. In 2014, ASI was purchased by Selman & Company of Cleveland, Ohio. Selman & Company was founded in 1980. Our TRICARE/CHAMPVA supplement insureds come from over 500 organizations and employer groups.
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There are three TRICARE options, and we provide supplement plans for each one.
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TRICARE Select/Extra
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TRICARE Select/Extra comes together in one package. This TRICARE option is free and does not require any special request for enrollment.
TRICARE Extra is the in-network option for TRICARE Select. If the member goes to an in-network, participating provider, the cost shares are lower and there is no risk of excess charges. A list of providers can be obtained by calling the TRICARE contractor for each region or by checking the TRICARE contractor’s website.
TRICARE Select gives members the freedom to seek care from any provider. There are no network restrictions. Cost shares are higher and there is a chance the provider may bill excess charges.
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TRICARE Prime/Point of Service (POS)
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TRICARE Prime/POS comes together in one package. There is an annual fee, and members must request to be enrolled in this option. The in-network cost shares are lower than TRICARE Select/Extra.
TRICARE Prime is similar to an HMO plan. Members must use providers from the network. All care must be coordinated through a Primary Care Manager. Referrals are required to see a specialist.
TRICARE POS is the out-of-network option for TRICARE Prime. Members have the option to go out of network or to see a provider without referral from the Primary Care Manager (higher deductibles and cost shares will apply). | |||
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TRICARE Reserve Select (TRS)
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TRS is for qualified National Guard and Reserve members. Insureds have the freedom to seek care from any provider. There are no network restrictions. As such, the member is susceptible to excess charges. | |||
What is CHAMPVA? |
CHAMPVA stands for Civilian Health and Medical Program of the Department of Veterans Affairs. It is similar to TRICARE, but it is specifically for family members (spouses and children) of disabled veterans.
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What is a TRICARE-Authorized Provider? |
These include network, non-network, participating, or non-participating providers. These providers meet certain licensing and certification requirements.
TRICARE-authorized providers must be used in order for TRICARE to pay the covered benefits.
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What is a TRICARE Network Provider? |
These providers sign contracts with a regional contractor to be part of the network of providers who participate in the TRICARE program.
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What is a TRICARE Non-Network Provider? |
These providers do not sign contracts with a regional contractor. A non-network provider may be participating or non-participating. Non-network providers may determine whether to participate or not participate on a claim-by-claim basis.
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What is a Participating Provider? |
These providers agree to file claims for the TRICARE member and accept the TRICARE allowed amount as payment in full (no excess charges).
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What is a Non-Participating Provider? |
These providers do not agree to accept the TRICARE allowed amount as payment in full and may bill for excess charges (up to the legal limit).
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Finding Network/Participating Providers for TRICARE |
TRICARE members may contact the regional contractor or visit the website at www.tricare.mil.
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Does the TRICARE **Supplement** Plan Have Network/Participating Providers? |
No. There is no separate network of doctors connected to the supplement plan. We pay our benefits regardless of whether or not the doctor participates with TRICARE. We simply follow TRICARE’s lead (i.e., we cover the co-pays and sometimes the deductibles left behind on TRICARE approved services).
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CHAMPVA Providers
The above information applies only to TRICARE. CHAMPVA is different. For CHAMPVA, there is no network or such a thing as participating or non-participating. Each provider may decide, on a claim-by-claim basis, whether or not to accept CHAMPVA assignment.
If the provider accepts CHAMPVA assignment, the provider agrees to file the claim for the member and to accept the CHAMPVA allowed amount as payment in full (no excess charges). The only thing the member pays for is the deductible, if it applies and has not already been met, and the cost share (usually 25%).
If the provider does not accept CHAMPVA assignment, the member can still utilize that provider, but the member will likely have to pay in full at the time of the visit and file a claim for reimbursement from CHAMPVA. The member is still responsible for the deductible, if it applies and has not already been met, and the cost share (usually 25%). Additionally, the member will also be responsible for paying any excess charges.
The member should inquire directly with the provider’s office to find out if the doctor accepts CHAMPVA or not. If the member does not know where to begin or where to find names/phone numbers of providers, we can suggest that the member go to www.medicare.gov or to www.tricare.mil to view provider listings. Most providers who accept TRICARE and/or Medicare also accept CHAMPVA. However, the member must call the doctor to see if his/her office accepts CHAMPVA. | |