CHAMPVA Supplemental Insurance Plan | Rates 2013
Economical Premiums To Fit Your Budget
The CHAMPVA deductible is applied to the first medical or pharmacy claims processed in 2013 until the deductible is met.
- Annual CHAMPVA Deductible is $50 per beneficiary or a maximum of $100 per family per year.
- Annual Supplement Deductible is $250 per beneficiary or a maximum of $500 per family per year.
Premiums illustrated are Per Person.
|Age of Spouse, Widow/er||Monthly Check-O-Matic||Quarterly||Semi-Annual||Annual|
|40 - 44||$33.00||$99.00||$198.00||$396.00|
|45 - 49||$38.67||$116.00||$232.00||$464.00|
|50 - 54||$49.67||$149.00||$298.00||$596.00|
|55 - 59||$58.33||$175.00||$350.00||$700.00|
|60 - 64||$70.33||$211.00||$422.00||$844.00|
It's So Easy To Enroll in the CHAMPVA SUPPLEMENT Enrollment Form
CHAMPVA SUPPLEMENTAL INSURANCE
This coverage is available to USBA members and their dependents only. If you are not a member of USBA (no enrollment fee), it is easy to become one. A membership application is included with the CHAMPVA SUPPLEMENT Enrollment Form
Pre-Existing Conditions Limitation
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.
The Pre-existing condition limitation may be waived under the following conditions:
For individuals who were previously enrolled in a non-TRICARE Supplement Employer Group Plan and loses that coverage due to involuntary termination. Such individuals must enroll in the Supplement Plan within 31 days following the termination date of the prior insurance plan. Application for coverage under the Supplement Plan should include a copy of the Certificate of Creditable Coverage for the prior group insurance plan.
For inquiries, call CHAMPVA Supplement Insurance office toll-free at: (866) 919-6572
The Plan is currently not available in ME, MT, NH, NV, WA, VT.