Retired Association for the Uniformed Service

RAUS
RETIRED ASSOCIATION FOR THE UNIFORMED SERVICES, INC.

 Membership
 Member Benefits
 RAUS Purpose
 Communications
 Discounts
 Health
 Partnering
 Resources
 Finance
 Education
 Newsletter
 Contact Us
 Merchandise

 

The RAUS Group TRICARE Prime Supplement Plan
(The Prime Supplement Plan A and B are not available in NC and ND. Plan B is not available in FL, VT and IA.)

What is TRICARE Prime and Why do I Need a TRICARE Prime Supplement?

TRICARE Prime is the DoD’s “managed care” health care program for the military community. It is modeled after the Civilian Health Maintenance Organization approach (HMO). The two TRICARE Prime Supplement Plans available to you are de signed to help pay your cost share and copayments under TRICARE (In-Network and Out-of-Network expenses).

Enrollment in the TRICARE Prime Supplement Plan provides you and your eligible family members with flexibility in converting your coverage should you move out of a TRICARE Prime area and then apply for a TRICARE Standard/Extra Supplement. When this happens, under the TRICARE Standard/ Extra Supplement Plan, you receive credit towards the Pre-Existing Condition Provision for the time spent in the TRICARE Prime Supplement Plan.

Eligibility
Retired RAUS members and spouses, under age 65, who are currently enrolled in TRICARE PRIME, are eligible to apply for any one of the two supplemental plans described in this brochure. Unmarried dependent children under age 21(23 if full-time college student) are also eligible to enroll.

Coverage is also available to eligible surviving spouses, who are en rolled in TRICARE PRIME.

Termination
Your coverage under the Policy will cease on the first to occur of:

     1) the date the Policy terminates;
     2) the date the required premium is not paid, subject to the Grace Period provision;
     3) the first day of the month on or next following the date you cease to be a Member of the Policyholder;
     4) the first day of the month on or next following the date you cease to be eligible for the Plan under which he or she is covered;
     5) the date we or the Policyholder cancel coverage for a Class of Eligible Person to which you belong;
     6) the date the you attain age 65;
     7) the date you cease to be covered under TRICARE;
     8) the  date you become eligible for Medicare unless you reside in an area where Medicare is not available, in which case coverage will not terminate until you return to residency in an area where Medicare is available. Termination of coverage will be without prejudice to any claim which originated before the effective date of termination.

Exclusions
The Policy does 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 (in Colorado and Missouri while sane);
4. 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 Uniform Service: (1) for a Covered Spouse or Child of an Active Duty Member; (2) for such spouse or child’s travel out of the United States due to your assignment;
5. domiciliary or custodial care;
6. eye refractions and routine eye exams except when rendered to a child up to 6 years from the child’s birth;
7. eyeglasses and contact lenses;
8. prosthetic devices (except that artificial limbs and eyes and devices which must be implanted by surgery are covered);
9. cosmetic procedures, except those resulting from Sickness or Injury;
10. hearing aids;
11. orthopedic footwear;
12. 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;
13. drugs which do not require a prescription, except insulin;
14. dental care unless such care is covered by TRICARE, and then only to the extent that TRICARE covers such care;
15. any confinement, service, or supply that is not covered under TRICARE;
16. Hospital nursery charges for well newborn, except as specifically provided under TRICARE;
17. any routine newborn care except Well Baby Care, as defined, for a child up to 6 years from the child’s birth;
18. expenses in excess of the TRICARE Cap;
19. expenses which are paid in full by TRICARE;
20. any expense or portion thereof applied to the TRICARE Outpatient Deductible;
21. treatment for the prevention or cure of alcoholism or drug addiction except as specifically provided under TRICARE;
22. any part of a covered expense which the Covered Person is not legally obligated to pay because of payment by a TRICARE alternative program;
23. any claim under more than one of the TRICARE Supplement Plans, or under more than one Inpatient Benefit or more than one Outpatient Benefit of the TRICARE Supplement Plans. If a claim is payable under more than one of the stated Plans or Benefits, payment will only be made under the one that provides the highest coverage, subject to the Pre-Existing Condition Limitation.

Effective Date
Your coverage and that of your covered dependents becomes effec tive on the first day of the month following receipt of your enrollment form and first premium payment. If, on that day, you or a covered dependent are confined in a hospital, the effective date will be the day following discharge from the hospital.

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.

Deferred Effective Date (Dependent): If on the date that an Eligible Dependent is to become covered under the Policy he or she is confined at home, in a Hospital or elsewhere because of injury or sickness, coverage of such person will be deferred until the first day after he or she is discharged from the Hospital or place of confinement.

Conversion
If you end your participation in TRICARE Prime because you leave the network area, you may convert your TRICARE Prime supplement to a TRICARE Standard/Extra Supplement Plan within 60 days of disenrollment. Premiums for the TRICARE Standard/Extra Supple ment Plan will be those then in effect at time of conversion an Pre-Existing Condition Limitation will be credited for the period of time covered by the TRICARE Prime supplement.

Conversion from the TRICARE Prime supplement to a TRICARE Standard/Extra supplement is available following disenrollment ft any other reason from TRICARE Prime (after a minimum of one year. enrollment in TRICARE Prime) and is subject to satisfaction of the TRICARE Supplement Plan Pre-Existing Conditions Limitation.


Limitations
Routine newborn and well baby care, hospital nursery charges for a well newborn, dental care, treatment for prevention or cure of alcohol ism or drug addiction, and prosthetic devices are limited to expenses covered by TRICARE PRIME. INPATIENT treatment for mental, nervous or emotional disorders in excess of 45 days if under age 19, or 30 days if 19 or older, is limited to 90 days (if approved by TRICARE PRIME) per fiscal year. OUTPATIENT benefits for mental, nervous or emotional disorders, drug addiction or alcoholism are limited to a maximum of $500 per fiscal year.

Pre-Existing Conditions Limitations
Any injury or sickness whether diagnosed or undiagnosed, for which a covered person received medical care or treatment within the 6 month period preceding the effective date of his or her insurance will not be covered until the coverage has been in effect for 6 months. However, new conditions will be covered immediately.

Click below to download and print the RAUS Membership Application and insurance enrollment forms including rates.

RAUS TRICARE Prime Supplement Plan Enrollment Form - For residents of all states except NY.
RAUS TRICARE Prime Supplement Plan Enrollment Form - For NY State residents

Mail membership application and enrollment forms with your payment for dues and premium to:

RAUS
504 Autumn Springs Court, Suite 8
Franklin, TN  37067-8278
1-800-321-RAUS (7287)
(This product is currently unavailable in ME, MT, NH, OR and WA)

If you do not have the current Acrobat Reader software, obtain it FREE from Adobe's web site. Click here.

View RAUS TRICARE Prime Supplement Plan Profile
View RAUS TRICARE Prime Supplement Plan Brochure

For more about TRICARE Prime Supplement Plan, select:

 

To top of page

This plan is sponsored by:
Retired Association for the Uniformed Services
504 Autumn Springs Court, Suite 8
Franklin, TN 37067-8278

RAUS
Administered by:
Selman & Company
6110 Parkland Boulevard
Cleveland, OH 44124-4187
Phone: 800.735.6262
Fax: 440.646.9339

Underwritten by:
Monumental Life Insurance Company, Cedar Rapids, IA

Transamerica Financial Life Insurance Company, Harrison, NY (NY residents only)
AEGON companies

(# 19837953)
 

Copyright (c) 1997-2014 Retired Association for the Uniformed Services, Inc.
Revised: April 11, 2016