TRICARE SUPPLEMENT PLAN

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CHARLESTON SOUTHERN UNIVERSITY
TRICARE SUPPLEMENTPLAN
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About Association Society Insurance Corporation
(ASI)

• ASI Third Party Administrator
• Specializing in TRICARE Supplement plans
• 30 Years in Business
• The only company to offer a Corporate TRICARE
  Supplement
• Approx. 200,000 insureds from all sources
• ASI clients include 19 of the top 20 defense
  contractors

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ASI and The HARTFORD

• The Hartford Life - Plan Underwriter
• financial stability and instant name recognition
• long association with ASI
• 4th Largest financial services company
• A Rating by A.M. Best
• AA Rating by Standards and Poors

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Partial List of Clients

• NC State University
• East Carolina University
• UNC Chapel Hill
• UNC Greensboro
• UNC Wilmington
• Appalachian State University
• Fayetteville State University
• NC Central University
• A T State University
• UNC Pembroke
• Western Carolina University
• Winston-Salem State University
• UNC Asheville
• Old Dominion University Research Foundation

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Partial List of Clients

• SAIC
• General Dynamics
• Raytheon Company
• Computer Sciences Corporation
• Lockheed Martin Corporation
• Honeywell Technology Solutions, Inc.
• BAE Systems, NA
• ARINC
• L-3 Communication Companies
• CACI
• Sprint
• Southwest Research Institute
• State of South Carolina
• State of North Carolina
• State of Florida
• Continental Airlines

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Eligible Employees (must be under age 65 with two
exceptions see next slide for details of
exceptions)

• Retired Military entitled to retired, retainer or
  equivalent pay
• Spouses, surviving spouses or some former spouses
  of Retired Military Active Duty personnel
• Retired Reservists National Guardsmen (age 60 -
  65) with 20 years of creditable service. Spouses
  and dependents will also become eligible
• Reserve Component member and/or spouse who are
  enrolled in TRICARE Reserve Select (TRS)
• Active Duty service members who separate from
  military service. They and their family members
  will have Transitional Assistance Management
  Program for 180 days after separation
• Spouses or surviving spouses of 100 disabled
  veteran eligible for CHAMPVA
• Registered in the Defense Enrollment Eligibility
  Reporting System

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Eligible Employees (exceptions to the age 65
eligibility guidelines)

• Employees and/or spouses who live or work outside
  the U.S. territories.
• These individuals must be enrolled in Medicare
  Part B and eligible for Medicare Part A.
• Employees and/or spouses who are not eligible for
  Medicare.
• These individuals must receive a statement of
  disallowance from Social Security Administration
  and their DEERS files must be updated.

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Eligible Dependent Children

• Eligible unmarried dependent children are covered
  up to age 21 or age 23, if a full-time student.
• Eligibility continues past age 21 or 23, if the
  dependent is mentally or physically incapacitated
  and continues TRICARE eligibility.

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ABOUT TRICARE
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What is TRICARE?

• The Department of Defenses health benefit
  program for the military community.
• Centered around military treatment facilities
  augmented by a Civilian Network and Civilian
  authorized providers and facilities.
• Serving Active Duty personnel, their families,
  and Retired Military and families world wide.

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The Three TRICARE Options
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TRICARE Benefits

• TRICARE coverage is an earned benefit
  (Entitlement).
• ALL Retired Military have TRICARE Standard and
  TRICARE Extra.
• No enrollment required
• No enrollment fee
• These options work together
• TRICARE Prime requires enrollment and yearly
  enrollment fee.
• TRICARE beneficiaries must be listed in DEERS
  (Defense Enrollment Eligibility Reporting System)
  to be eligible for coverage.

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TRICARE Standard

• A) Standard
• Indemnity- Fee-for-Service Plan
• No Enrollment required/ No enrollment fee to pay
• Earned Entitlement
• Flexibility Freedom of choice when selecting
  civilian healthcare provider
• No Referral Required
• Worldwide Access
• Works with TRICARE Extra

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TRICARE Standard
TRICARE Standard beneficiaries who reside within
a 40 mile radius of a military treatment facility
(MTF) may seek care from any TRICARE authorized
hospital of their choice. They are no longer
required to obtain a non-availability statement.
This also applies to obstetric care and specialty
care for those beneficiaries residing within a
200 mile radius of an MTF. A non-availability
statement is still required for in-patient mental
health care.
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TRICARE Standard
TRICARE recognizes all healthcare providers
(under TRICARE provider class) who accept
Medicare as TRICARE authorized. The individual
providers may participate with TRICARE on a claim
by claim basis or may accept TRICARE as a
non-participating provider.
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TRICARE Extra

• B) Extra
• PPO
• NO Enrollment required/ No enrollment fee to pay
• Earned Entitlement
• Flexibility-Freedom of choice when using civilian
  network providers (same network of providers
  under TRICARE Prime but with none of the
  restrictions of Prime)
• No Referral Required
• Works with TRICARE Standard

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TRICARE Prime

• C) Prime
• Similar to an HMO w/POS (out of network ) option.
• Advantage less out of pocket expenses
• Disadvantage significant network restrictions
• Requires Referral from Primary Care Manager
• Must use Military Treatment Facility (MTF) or
  authorized civilian network provider
• Retirees must pay enrollment fee of 230
  individual/460 family per year.
• May go out-of-network to use POS option
• Care provided to retired military on a
  non-priority status

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HOW THE TRICARE SUPPLEMENT PLAN WORKS AFTER
TRICARE HAS PAID
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The TRICARE Supplement Plan

• A voluntary health benefit option available to
  employees and their dependents who are eligible
  for TRICARE (the militarys health benefit
  program).
• Eligible employees who elect to enroll in the
  TRICARE Supplement Plan must disenroll from any
  other NHRA medical plan.

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Features of The Supplement

• Works with all three TRICARE options, Standard,
  Extra and Prime
• Pays the portion of covered expenses that the
  beneficiary is responsible for after TRICARE pays
  

• Pays 150 individual/300 family deductible
  under TRICARE Standard, Extra or Prime
• Pays the 25/20 TRICARE Standard/Extra cost
  share or 50 Prime POS
• Pays 100 of applicable excess charges when
  non-participating providers are used.
• Limitation on mental health does apply

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Example - Non-participating Provider

• Assumption - Non-participating Provider/Standard
• Dr bills the patient -
  1000.00
• TRICARE Standard allowable amount -
  500.00
• TRICARE applies deductible (patients resp)
  150.00
• 
  350.00
• TRICARE pays 75 of the 350
  262.50
• Cost Share (patients responsibility)
  87.50
• Dr bills for the full excess charge 500 (1000
  - 500)
• Total Patient responsibility is 737.50 (150
  87.50 500)
• The TRICARE Supplement pays 737.50

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Why the TRICARE Supplement?

• Makes good sense - Beneficiaries able to utilize
  their military benefits
• Costs less than using other group insurance
• Worldwide access to quality healthcare
• Flexibility in using civilian providers - many
  choices, many doctors
• Virtually 100 coverage with TRICARE and the
  Supplement. (Limitation on mental
  health/substance abuse)

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Benefits of taking the Supplement

• No pre-existing condition limitation.
• No plan deductibles or out-of-pocket expenses.
• Guaranteed issue
• Low monthly premium - Payroll deduction.
• Full reimbursement of the TRICARE Standard
  deductible cost share.
• Protection from excess charges when
  non-participating providers are used.
• Full portability if employment ends.
• Claims generally processed within 7-10 business
  days

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Submitting Claims to ASI

• Notify provider of change of insurance by
  providing your military ID card for primary
  claims filing to TRICARE and Supplement ID card
  for secondary claims filing to ASI
• If you must submit claims
• Write ASI Certificate number (found on ID card)
  on the TRICARE EOB
• If payment should go to provider, write Pay
  Provider on the EOB
• Fax or mail the EOB and providers bill to ASI. If
  prescription drug charges from TRICARE Mail Order
  Pharmacy or Civilian Network Pharmacy - fax or
  mail the prescription drug copay receipt (not
  cash register receipt)
• If using Civilian Non-network Pharmacy- Fax or
  mail TRICARE EOB
• TRICARE Prime enrollees using network providers-
  fax or mail copay receipt.

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Before using TRICARE and the Supplement

• Employees who are changing insurance coverage
  from a commercial health insurance to the TRICARE
  Supplement must notify TRICARE and Express
  Scripts of their change of health insurance
  coverage To notify TRICARE, please do the
  following
• complete the Other Health Insurance (OHI) Change
  form. Forms may be found on the ASI web site at
  www.asicorptricaresupp.com or TRICAREs web site
  at www.tricare.osd.mil. Select the form for the
  region in which you reside. Forms should be
  completed signed and faxed to TRICARE at the
  address indicated on the form.
• To notify Express scripts, please do the
  following
• first contact Pharmacoeconomic Center at
  1-866-275-4732 or by email at pdts.ameddcs_at_amedd.a
  rm.mil to update your records for prescription
  drugs.
• Next contact Express Scripts at 1-866--363-8667
  to inform them of the update with
  Pharmacoeconomic Center.
• A TRICARE Supplement is not considered other
  health insurance.

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ASI Contact Information

• Employees Call ASIs Toll-Free Customer Service
  Number - 800-638-2610, ext. 255
• Customer Service Toll-Free Fax - 800-311-3124
• Claims Department Toll-Free Fax - 800-310-5514
• HR Reps/Benefits Specialists call ASIs Client
  Services Department - ext. 256
• Client Services Department Fax - 800-311-3126
• ASI web site address - www.asicorptricaresupp.com
  

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Welcome Package

• After enrollment, employees will receive the
  following
• Certificate of Insurance
• ID Cards
• TRICARE Supplement Handbook
• Claim Form

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Portability
Remember the TRICARE Supplement is Portable. This
means that if you leave your company for any
reason, you may take the Supplement with you.
You will be billed directly by ASI.
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THANK YOU FROM