Retired Association for the Uniformed Service

RAUS
RETIRED ASSOCIATION FOR THE UNIFORMED SERVICES, INC.

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The RAUS Group TRICARE Supplement Plan
Available to all TRICARE eligible recipients (E-1 through O-10) regardless of service!
(This product is currently unavailable in ME, MT, NH and VT)

Get the protection you need at a price you can afford.
The TRICARE Standard/Extra Supplement High Option II Plan provides benefits to help pay your TRICARE cost share for in-hospital and outpatient care, doctor visits, emergency room care, prescription medications, and much more.

The High Option II Plan also pays 100% of Covered Excess Charges up to the Legal Limit.

The High Option plan has a fiscal year Plan Deductible of $250 per person and $500 family maximum.

There is also a plan for Dependents of Active Duty Members.

TRICARE Young Adult (TYA) Program
TRICARE Young Adult (TYA) is a “premium-based health care plan available for purchase” by qualified adult children, under age 26, after their eligibility for regular TRICARE ends. TYA offers TRICARE Standard coverage and includes medical and pharmacy benefits.

For further information on TRICARE Young Adult, please visit the TRICARE web site at www.tricare.mil/tya.

Effective May 1, 2011, the TRICARE Supplement Plan will provide supplemental coverage for dependents enrolled in TYA.

These young adult dependents will have the same supplement plan premium rates, benefits and coverage limitations as dependent children under the age of 21 or 23 if full-time student.

To enroll your adult dependent child in the TRICARE Supplement Plan, complete the enrollment form and mail to ASI along with a copy of his/her TYA enrollment card.

Your adult dependent child must enroll in TRICARE Young Adult before enrolling in the TRICARE Supplement Plan. TYA coverage ends if any of the following occurs:

  • Dependent attains age 26

  • Gets married

  • Becomes eligible for an employer-sponsored plan

  • Gains other TRICARE coverage

  • Sponsor ends TRICARE coverage

Eligibility
You are eligible to enroll provided you are an eligible TRICARE recipient, under age 65, and entitled to retired, retainer, or equivalent pay. If you are age 65 or over and ineligible for Medicare, you may enroll in the plan by attaching a copy of your Social Security Notice of Disallowance of Benefits to your Enrollment Form.

Coverage is also available for your TRICARE-eligible spouse under age 65, and dependent, unmarried children under age 21 (23 if in college). Eligible spouses and children of active-duty service members may enroll; TRICARE-eligible widow(er)s and ex-spouses may also enroll.

TRICARE eligible dependent, unmarried children under age 21 (23 if in college) may also enroll.

Effective Date
Your coverage and that of your covered dependents becomes effective 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.

Limitations
Routine newborn and well baby care, hospital nursery charges for a well newborn, dental care, treatment for prevention or cure of alcoholism or drug addiction, and prosthetic devices are limited to expenses covered by TRICARE. See coverage information below for mental, nervous, or emotional disorders.

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.

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.

Exclusions for the state of New York
The 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; eyeglasses; rest cures; custodial care; eye refractions and routine eye exams when rendered to a child up to 2 years (730 days) from the child’s birth; cosmetic surgery, except that cosmetic surgery shall not include reconstructive surgery when such surgery is incidental to or follows surgery resulting from trauma, infection, or other diseases of the involved part, and reconstructive surgery because of a congenital disease or anomaly of a covered dependent child which has resulted in a functional defect; hearing aids; dental care or treatment, except for such care or treatment due to accidental injury to sound natural teeth within 12 months of the accident and except for dental care or treatment necessary due to congenital disease or anomaly; any confinement, service, or supply that is not covered under TRICARE; TRICARE eligible cost-share and deductible amounts expenses in excess of the TRICARE Cap except as specifically provided; expenses in excess of the TRICARE Allowed Amount except as
specifically provided; expenses which are paid in full by TRICARE except as specifically provided; any expense or portion thereof applied the TRICARE Outpatient Deductible except as specifically provided; 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; 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.

Nervous, Mental, Emotional Disorder, Alcoholism, and Drug Addiction Limits
     The coverage provided under the Inpatient Benefit of the TRICARE Supplement plan 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.

This Inpatient limit is based on the number of days TRICARE normally provides each Fiscal Year for such confinements. In rare instances, TRICARE extends these daily limits. If this occurs, we will limit the number of days that we provide for such confinement to the lesser of:
     a) the number of days TRICARE pays for such Inpatient treatment during the Fiscal Year; or
     b) 90 Inpatient days per Fiscal Year.

The coverage provided under the Outpatient Benefit of the TRICARE Supplement plan for:
     a) nervous, mental, and emotional disorders; and
     b) alcoholism and drug addiction; is limited to $500 during any Fiscal Year for all such disorders.

Termination
Insured Person Termination:

The Insured Person's coverage under the Policy will cease on the first to occur of:
     1) the date the Policy terminates, or the date the Organization ceases to be a Participating Organization of the Policyholder;
     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 he or she ceases to be a Member;
     4) the first day of the month 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 group cancel coverage for a Class of Eligible Person to which he or she belongs;
     6) the date the Member attains age 65;
     7) the date he or she becomes eligible for Medicare, if under age 65 at time of Medicare eligibility, you must notify ASI in writing.

Termination of an Insured Person's insurance will not prejudice any claim which occurred before the effective date of termination.

Dependent Termination: The dependent's coverage under the Certificate will cease on the first to occur of:
     a) the date the Certificate terminates, or the date the Organization ceases to be a Participating Organization of the Policyholder;
     b) the date the required premium is not paid, subject to the Grace Period provision;
     c) the first day of the month on or next following the date he or she ceases to be an Eligible Spouse or an Eligible Child;
     d) the first day of the month 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 group cancel coverage for a Class of Eligible Person to which he or she belongs;
     f) the date he or she ceases to be covered under TRICARE;
     g) the date he or she becomes eligible for Medicare (must notify ASI in writing);
     h) the date the Member ceases to be covered, subject to the Covered Dependent’s Continuation Provision; (This will not apply to the Spouse or Child of an Active Duty Member or a Service Disabled Member.)
     i) if a Spouse, the date he/she attains age 65.

Termination of a Covered Dependent's insurance will not prejudice any claim which occurred before the effective date of termination.

Non-Duplication of Coverage under Employer Health Program
If a claim payable under the Certificate, it is also payable under an Employer Health Program with TRICARE as the secondary payor, we will limit our payment to an amount which, when added to the amounts paid by the Employer Health Program and TRICARE, will not exceed 100% of TRICARE Covered Expenses.

Change of Policy Premiums
We have the right on each Premium Due Date to change the rate at which premiums will be calculated. This includes the right to change premium rates for a benefit that applies to all individuals of the same class, age, plan and effective date. Rates may be changed based on claims experience of the Policy. We will give the Policyholder or Organization notice of any change at least 45 days before the Premium Due Date on which it is to become effective.


Guaranteed Acceptance - Satisfaction Guaranteed

It's easy to enroll in the TRICARE Standard/Extra Supplement Plan. Just complete the Enrollment Form—making sure to provide all information requested—and return it with your check for the first premium payment. That's all there is to it! You cannot be turned down for coverage, although a pre-existing condition may initially limit the extent of your coverage. After your completed Enrollment Form and first premium payment have been processed, you'll receive a certificate of insurance which you can examine for 30 days risk-free. Return it for a full refund if you are not completely satisfied.


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

Group TRICARE Standard/Extra Supplement Plan Enrollment Form - For residents of all states except NY.
Group TRICARE Standard/Extra 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 Plan Profile
View RAUS TRICARE Standard Brochure
View TRICARE Choices: At A Glance Brochure
View TRICARE Supplement Sample Certificate
View TRICARE Supplement Sample Certificate (NY Residents)

For more about TRICARE Supplement Plan, select:

 

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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