This supplement is only for Military Officers Association of America (MOAA) members and their families and, as a result, you and your family are guaranteed acceptance. This means your acceptance into this plan is guaranteed, however, insurance benefits payable are subject to the policy’s Pre-Existing Conditions Limitation. Just complete and sign the enrollment form.
Your MEDIPLUS® protection will start on the first day of the month after we receive your completed enrollment form and first premium payment. You'll have protection for new health conditions right away and current health conditions are covered after six months.
Plus, the waiting period for current health conditions can be waived if you're losing your civilian employer plan or leaving active duty. In some cases it can also be waived for active duty family members.
- Employer plan - You qualify for MEDIPLUS without the waiting period for current conditions if you enroll within 30 days after your civilian employer-sponsored plan ends because you are no longer an eligible participant in that program (if you are changing jobs, moving or retiring, for example). If you've voluntarily ended your civilian employer-sponsored plan while you are still an eligible participant, the six-month waiting period for current health conditions will apply.
- Active Duty - When you enroll in MEDIPLUS within 60 days of the date your active duty coverage ends, you qualify for MEDIPLUS without the waiting period for current conditions. This also applies if you enroll in MEDIPLUS within 30 days of your initial eligibility for TRICARE benefits.
DirectClaim: MOAA’s electronic filing process for MEDIPLUS TRICARE Supplement claims
Filing MEDIPLUS claims is fast and easy with DirectClaim, another unique benefit to MEDIPLUS. With DirectClaim, you will not have to complete MEDIPLUS claim paperwork after you access most of your eligible TRICARE benefits. You will be informed when your claim is filed electronically by a message on your MEDIPLUS Explanation of Benefits (EOB) form.
Please be aware that some TRICARE Supplement claims cannot be processed electronically, such as any prescription claims and most Skilled Nursing or Skilled Nursing Facility, nursing home claims and claims filed from overseas. For these, you will need to submit paper claim filings to MEDIPLUS. Claim forms are accessible on this website.
If a claim for service is submitted through DirectClaim and TRICARE has paid the provider(s) directly, any payment due under a MEDIPLUS TRICARE Select Supplement will be paid directly to the provider(s). Under TRICARE Prime most network providers require the patient’s $25 co-pay at the time of the office visit, so the MEDIPLUS TRICARE Prime Supplement reimbursement of those Prime outpatient co-pays will be sent directly to the member. Only the Prime $25 co-pay for office visits will be reimbursed to the member. All other Prime co-pays will be reimbursed to the provider.
It's important that the MEDIPLUS applicant’s name appears on the enrollment form the same as it is on their military ID card to ensure proper claims processing.
If you have any questions about DirectClaim, please call the MOAA Insurance Plans Administrator at 1-800-247-2192 or email [email protected]
Switching from the MEDIPLUS Retired TRICARE Prime Supplement to a MEDIPLUS TRICARE Select Supplement
Current health conditions will be covered right away, as long as you've had continuous MEDIPLUS coverage for six months and you discontinue TRICARE Prime during the TRICARE open enrollment period or you move to an area where TRICARE Prime is unavailable.
If you discontinue TRICARE Prime on a date other than the TRICARE open enrollment period, current health conditions will not be covered under your MEDIPLUS TRICARE Select Supplement for the first six months.
Even if you decide not to enroll yourself in MEDIPLUS, your spouse and children are still guaranteed acceptance. This means your acceptance into this plan is guaranteed, however, insurance benefits payable are subject to the policy’s Pre-Existing Conditions Limitation.
MEDIPLUS Pays Covered "Excess Charges" For You
Make sure any TRICARE Supplement you use has this important benefit. If your TRICARE-authorized doctor charges you more than what TRICARE allows, MEDIPLUS picks up the bills for you to cover up to 15% above the TRICARE-allowed amount. MEDIPLUS will help cover these excess charges as long as the TRICARE and MEDIPLUS deductibles are met.
MEDIPLUS can help take care of your family
MEDIPLUS can be ideal for the whole family - yourself, your spouse and your kids, even if they're at college. It provides coverage at affordable group rates. And, MEDIPLUS can be used at most student health service centers where TRICARE is accepted. But that's not all.
MEDIPLUS can be there for your family, even if something happens to you. As a retired member, if you die, your eligible spouse's MEDIPLUS TRICARE Select Supplement coverage will continue at no cost until he or she remarries, reaches age 65 or becomes Medicare-eligible. Spouses of active duty members will be covered for up to ten years or until they remarry, reach age 65 or qualify for Medicare.
Children can continue their MEDIPLUS protection premium-free for ten full years, or until they marry or reach age 21 (23 if a full-time student or 26 if enrolled in TRICARE Young Adult; or age 25 if a resident of Montana). Your family automatically qualifies for this additional benefit as long as you, your spouse and children are continuously covered by MEDIPLUS for at least six months before you die. (The Waiver of Premium Benefit is not available under the MEDIPLUS TRICARE Prime supplement.)
Your MEDIPLUS protection can go where you go
When you say "YES" to MEDIPLUS, you can rest assured your protection can stay with you wherever you go. Even if you change jobs or move, you can keep your MEDIPLUS protection. (Unlike employer-provided plans that end when you leave your job.)
Details
This is a listing of highlights for this Insurance plan. Be sure to review the entire website for a detailed plan description.
| Type of Insurance: |
MEDIPLUS TRICARE Supplement |
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| Designed For: |
Military Officers Association of America (MOAA) members and dependents |
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| Underwritten by: |
Hartford Life and Accident Insurance Company, One Hartford Plaza, Hartford, CT 06155 |
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| Policy Form Number: |
TRICARE Form Series includes GBD-3000, GBD-3100, or state equivalent. |
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| Policy Number: |
AGP-5889 |
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| Issue Ages: |
Through age 64 |
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Important Information About This Coverage
Eligibility:
Members who are on Active Duty are not eligible for coverage but they may enroll their eligible dependents who are covered by TRICARE.
As a TRICARE-covered member of MOAA under age 65, and not yet eligible for Medicare you and your family are eligible for coverage. Your spouse is eligible as long as he/she is under age 65, not yet eligible for Medicare and not legally separated or divorced from you. Your unmarried children are eligible if they are under age 21 (23 if enrolled full-time in higher-learning or 26 if enrolled in TRICARE Young Adult; or age 25 if a resident of Montana). Member and Spouse cannot duplicate coverage by enrolling as dependents of each other.
Termination:
Your MEDIPLUS protection will not be canceled due to claims or a change in your health, and you cannot be singled out for a rate increase. Your coverage continues as long as you pay your premiums when due, keep your Military Officers Association of America (MOAA) membership, and the MEDIPLUS master policy remains in force. Coverage will terminate on the date you become eligible for Medicare. Your dependent’s coverage will remain in effect as long as your coverage is active, premiums are paid, and they meet eligibility requirements. Your spouse is eligible for coverage as long as they are not legally separated or divorced from you.
Hospital/Skilled Nursing Facility:
Hospital means an institution which TRICARE recognizes as a hospital. 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. Confined or Confinement means being an inpatient in a Hospital or Skilled Nursing Facility due to Sickness or Injury.
Pre-Existing Conditions Limitation (Waiting Period for Current Health Conditions):
We will not pay a benefit under The Policy for any expenses Incurred during the first 6 months of the Covered Person’s coverage; and which are the result of Pre-existing Conditions. Please consider this limitation before canceling any other health insurance you may have.
Exclusions and Limitations:
These TRICARE Supplements do 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: a) rendered to a child up to 6 years from the child’s birth; or b) ordered by a Uniformed Service: i)for a Covered Dependent of an Active Duty Member; ii)for such Dependent’s travel out of the United States due to your assignment; or c) required for school enrollment (but not sports physicals) by a Covered Child aged 5 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: a) the care is required because of the mental or physical incapacitation; 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) purchase of a wheel chair, hospital type bed, or other durable equipment, unless TRICARE determines that purchasing the equipment costs less than renting it; 21) any part of a Covered Expense which the Covered Person is not legally obligated to pay because of payment by a TRICARE alternative program; 22) 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.
