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RAUS TRICARE Prime Supplement Plan
Coverage
What the TRICARE Prime
Supplement Plans Pays
For Retirees and Eligible
Dependents
(You must be enrolled in TRICARE Prime to apply for one of the following
plans)
|
In-Network Charges
The Plan Pays |
Out-of-Network
Charges
(Point of Service Option)
The Plan Pays |
You Pay |
|
Plan A |
Your eligible TRICARE Prime copayments and cost shares up to
the TRICARE Prime catastrophic limits.1 |
|
Nothing |
The Point of
Service deductable3
your 50% cost share for Out-of-Network charges and charges in excess of
the TRICARE allowed amount. |
|
Plan B |
Your eligible TRICARE Prime copayments and cost shares up to
the TRICARE Prime catastrophic limits.1 |
|
Your 50% of the TRICARE allowed amount2
(your cost share) for In-Patient and Out-Patient charges after you pay
the Point of Service deductible. |
The Point of Service
deductable3
and charges in excess of the TRICARE allowed amount. |
| 1
In-Network-$3,000
per enrollemnt year for retirees and dependents. In-Network
Care must be provided or referred by a Primary Care Manager;
or referred by a Health Care Finder; or is for an emergency. |
| 2
Subject to a maximum payable under this benefit of $7,500
per family per fiscal year. |
| 3
These plans do not cover the Point of Service (POS)
deductible. |
| |
| - These plans do not pay the
TRICARE Prime annual enrollment fee. |
| - The Prime Supplement Plan A
and B are not available in NC and ND. Plan B is not
available in FL, VT and IA. |
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