Tricare/CHAMPVA There are Two Types of Member Groups

Learn about the two types of member groups for Tricare/CHAMPVA and how to distinguish between them.

Corporate Members

Corporate groups are employer-based. These employer groups have several employees who are eligible for TRICARE. Most TRICARE-eligible employees can sign up for the Corporate supplement plan through work. Always review the Corporate Groups Rate manual to determine how the EE enrolls in our supplement

The employer group decides which supplement plan will be offered to its employees. There are currently three possible plans, but the employees will not have a choice – the choice is made for them by the employer group. These plans work with both TRICARE Select/Extra and TRICARE Prime/POS

The group policies that are offered through employer groups (clients) are AGP-5942, AGP-5943 and AGP-5944.  

HOWEVER, there is one "employer group" -- GEA Services Client #0003460 -- that is used for Retail Members with certificates issued under AGP-5942

There are also some employer groups that have policies issued directly to the group for greater State Availability.  These policy numbers would have two extra digits at the end, such as AGP-594456 for Dyncorp International.

Please see the State Availability matrix for additional detail about which policy numbers are used in various states and the direct issue policies.  TRICARE State Availability.xlsx

Corporate insureds enroll through an association -- usually GEA, but there could be some exceptions.  GEA dues for Corporate insureds are $1.50 per month and included in the amount that is deducted from their paychecks if the client offers payroll deduction (List Bill payment method) or added to their billing statements if they are Direct Bill payment method.

Corporate plans are not available for people who are covered under CHAMPVA. 

Additionally, Corporate plans are not available for Active Duty or TAMP (the Transitional Assistance Management Program available to newly-separated Active Duty participants).

Most Corporate groups utilize payroll deduction and pay the supplement premiums via group/list bill. We need to be sure we are communicating to the insured that if their policy is A01 status with List Bill payment method, the insured needs to communicate through their Employer and should not submit payment directly to Selman.  

However, if the insured has terminated their employment and wants to continue coverage. A LB to DB (list bill to direct bill) notice will be in the archive documents. Ask the caller if the will email it to you. Please place a copy in Imagenow and then ROUTE the document to billing. 

For instructions on how to ROUTE please search HelpJuice "Imagenow" and scroll to the bottom of the article for instructions. 

Please notify Selman's Client Management team for assistance if needed. Yolonda Roulete & Twanna Tilghman: yroulette@selmanco.com & ttilghman@selmanco.com 

Some groups/employees may be set up in the system as Direct Bill payment method.  Also, insureds who have terminated their employment but continued coverage under the Supplement plan would be set up as Direct Bill.

Corporate groups have open enrollment periods that are established by the employer group.  If someone is trying to enroll for coverage, please use the Corporate Rate Manual to determine how an insured should enroll. If they are file feed please refer to their HR department. If additional assistance is needed notify Selman's Client Management team for assistance. 

If the caller is asking about the open enrollment period for TRICARE itself, please refer them to TRICARE (www.TRICARE.mil).

Please use your Corporate Groups Rate Manual (formerly OEP manual) for information about which plan the employer groups (clients) sponsor, the rates, and whether the client is List Bill or Direct Bill.


Retail Members

 

Retail insureds enroll through an association -- which is likely to be GEA, USBA, RAUS, NCOA or VFW. 

Retail plans are available for Military Retirees who are not covered under Medicare and have as their primary health insurance, one of these plans:

TRICARE Select

TRICARE Prime

TRR (TRICARE Retired Reserve)

Active Duty Family Member – Active Duty military personnel do not need a supplement plan, but their dependents may opt to purchase one.

TRS (TRICARE Reserve Select) – Qualified National Guard and Reserve members who cannot purchase a supplement through work may opt to buy one through our Retail program. The TRS plan is the only plan that requires the sponsor to be covered on the policy. 

CHAMPVA – CHAMPVA is for the spouses and children of disabled veterans. Since the military member is disabled, there is no employer from which to obtain a supplement plan.

Retail members choose a supplement plan based on which type of TRICARE they have. These insureds send payments to us in the mail or allow us to automatically debit a bank account (this is preferred).


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