TRICARE means the Department of Defense regional managed care program for members of the uniformed services and their families, and survivors and retired members and their families. TRICARE provides CHAMPUS beneficiaries three choices for their health care delivery: TRICARE Standard, a fee for service option which is the same as standard CHAMPUS; TRICARE Extra, a preferred provider option which offers discounts; and TRICARE PRIME, an enrolled health maintenance organization (HMO) option.
Pre-Existing Condition Limitation
Any Injury or Sickness, whether diagnosed or undiagnosed, for which any person proposed for coverage has received medical treatment or care within the 12 months (6 months in California, Indiana, and Montana) immediately preceding their effective date will not be covered: (a) until that person (except in California, Indiana, and Montana) has not received medical treatment or care for that condition during a period of 12 consecutive months ending on or after his or her effective date; or (b) until the end of a 6-month period from the person's effective date in California or the end of a 12-month period from the person's effective date in Indiana and Montana. After 2 years (1 year in Indiana, Montana, North Carolina, and South Carolina; 6 months in California) from that person's effective date, he or she will become covered regardless of any pre-existing conditions he or she may have.
Effective date: You and your family will become covered effective on the first of the month following receipt of your signed enrollment form and premium payment.
Deferred Effective Date: If on the date that you are to become covered under the Policy you are confined in a Hospital, your coverage will be deferred until the first day after you are discharged.
Insured Person Termination: The Insured Person's coverage under the Policy will cease on the first to occur:
- 1. the date the Policy terminates;
- 2. the date the required premium is not paid, subject to the Grace Period provision;
- 3. the first premium due date on or next following the date he or she ceases to be a Member;
- 4. the first premium due date on or next following the date he or she ceases to be eligible for the Plan under which he or she is covered;
- 5. the date we or the Policyholder cancels coverage for a Class of Eligible Persons to which he or she belongs;
- 6. the first premium due date on or next following the date he or she becomes eligible for Medicare;
- 7. the first premium due date on or next following the date he or she attains age 65, unless he or she is not eligible for Medicare.
- Dependent Termination: The dependent's coverage under the Policy will cease on the first to occur of:
- a. the date the Policy terminates;
- b. the date the required premium is not paid, subject to the Grace Period provision;
- c. the first premium due date on or next following the date he or she ceases to be an Eligible Spouse or an Eligible Child;
- d. the first premium due date on or next following the date he or she ceases to be eligible for the Plan under which he or she is covered;
- e. the date we or the Policyholder cancels coverage for a Class of Eligible Person to which he or she belongs;
- f. the date the Member ceases to be covered, subject to the Covered Dependent Continuation provision; (This will not apply to the Spouse or Child of an Active Duty Member or a Service Disabled Member.)
- g. the first premium due date on or next following the date he or she becomes eligible for Medicare;
- h. if a spouse, the first premium due date on or next following the date he or she attains age 65 unless he or she is not eligible for Medicare;
- i. if a child, the date he or she attains age 21 or age 23 if he or she is enrolled full time at a school of higher learning.
Termination of a Covered Dependent's insurance will not prejudice any claim that occurred before the effective date of termination.
Confined or Confinement means being an Inpatient in a Hospital (or Skilled Nursing Facility) due to Sickness or Injury.
A Hospital or a Skilled Nursing Facility does not mean any institution or part thereof used principally as a rest home, a home for the aged, or a place for custodial care; or a place for the care of drug addicts, alcoholics, or the mentally ill.
This policy does not cover: injury or sickness resulting from war or act of war, whether war is declared or undeclared; intentionally self-inflicted injury; suicide or attempted suicide, whether sane or insane (in Missouri, while sane); routine physical exams and immunizations, except when: a) rendered to a child up to 6 years from his or her birth; or b) ordered by a Uniformed Service: (1) for a Covered Spouse or Child of an Active Duty Member; (2) for such spouse's or child's travel out of the United States due to the Member's assignment; domiciliary or custodial care; eye refractions and routine eye exams except when rendered to a child up to 6 years from his or her birth; eyeglasses and contact lenses; prosthetic devices, except those covered by TRICARE; cosmetic procedures, except those resulting from Sickness or Injury while a Covered Person; hearing aids; orthopedic footwear; care for the mentally incapacitated or physically handicapped if the care is required because of the mental incapacitation or physical handicap; or the care is received by an Active Duty Member's child who is covered by the "Program for the Handicapped" under TRICARE; drugs which do not require a prescription, except insulin; dental care unless such care is covered by TRICARE, and then only to the extent that TRICARE covers such care; any confinement, service, or supply that is not covered under TRICARE; Hospital nursery charges for a well newborn, except as specifically provided under TRICARE; any routine newborn care except Well Baby Care, as defined, for a child up to 6 years from his or her birth; expenses in excess of the TRICARE Cap; expenses which are paid in full by TRICARE; any portion thereof which is in excess of the Legal Limit; any expense or portion thereof applied to the TRICARE Outpatient Deductible; that part of any Covered Expense which is in excess of the TRICARE Allowed Amount, except as otherwise stated in the Supplement Benefits; treatment for the prevention or cure of alcoholism or drug addiction except as specifically provided under TRICARE and this Policy; any part of a covered expense which the Covered Person is not legally obligated to pay because of payment by a TRICARE alternative program. TRICARE Prime is not available in Florida.
Nervous, Mental, Emotional Disorder, Alcoholism, and Drug Addiction Limits:
The coverage provided under the Inpatient Benefits of the TRICARE Supplements for nervous, mental and emotional disorders, including alcoholism and drug addiction, is limited to: a) 30 Inpatient treatment days for a Covered Person age 19 or older; or b) 45 Inpatient treatment days for a Covered Person under age 19; per Fiscal Year.
NOTE: This information 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 brochure 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, reduction of benefits 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. AGIA, Inc. is the Plan Administrator and Insurance broker that administers the insurance plan on behalf of the Hartford Life and Accident Insurance Company for the benefit of the Group Policyholder. AGIA, Inc. is compensated for the placement of insurance and for the services it provides to customers on behalf of the insurance company, in addition to other compensation it may receive. This is a participating group policy under which dividends and/or experience credits may be paid to the Marine Corp Association.
Endorsed by: MCA&F
Underwritten by Hartford Life and Accident Insurance Company, Simsbury, CT 06089
The Hartford® is The Hartford Financial Services Group, Inc., and its subsidiaries, including issuing company Hartford Life and Accident Insurance Company.
John B. Wigle, License No. 0482924
MCA&F Insurance Program Administered by:
PO BOX 26610
Phoenix, AZ 85068
Questions? Call toll-free 1-888-611-6010
Policy Form # SRP-1269/HLA (5516)
Downloadable Enrollment Form