Here's How The Tricare Extra/Standard Supplement Works To Pay What Tricare Extra/Standard Doesn't Pay
CARE REQUIRED	Tricare Extra/ Standard Pays	Your Tricare Extra/Standard Supplement Pays
Inpatient care in civilian hospitals for RETIREES and dependent family members (room, board, supplies and staff services billed by the hospital)	The Tricare Standard/DRG amount (contracted rate for Tricare Extra) minus your cost share.	Comprehensive Plan & High Option Plan II - The lesser of $535/day or 25% of billed amount, not to exceed the Tricare Standard DRG amount (lesser of $250/day or 25% cost share** of the contracted rate for Tricare Extra) PLUS 100% of covered excess charges up to the reasonable and customary community standard level. (After you satisfy the fiscal year plan deductible.)
Inpatient care in civilian hospitals for RETIREES and dependent family members (doctors, & other inpatient services not billed by the hospital)	75% of the Tricare Standard allowed amount (80% for Tricare Extra) for doctors and other professional services.	Comprehensive Plan and High Option Plan II - Your cost share** PLUS 100% of covered excess charges up to the reasonable and customary community standard level.
Inpatient care in military hospitals	All but the daily subsistence fee.	All PLANS - The daily subsistence fee.
Outpatient care for RETIREES and dependent family members (office visits, clinics, lab,prescription drugs, etc.)	75% of the Tricare Standard allowed amount (80% for Tricare Extra) after you pay the Tricare Outpatient Deductible.	Comprehensive Plan- After you satisfy the fiscal year plan deductible of $75 per person, and $150 family maximum, the plan will reimburse you (1) the Tricare fiscal year outpatient deductible of $150 per person and $300 family maximum,* (2) your cost share** and (3) 100% of covered excess charges up to the reasonable and customary community standard level. High Option II Plan - Your cost share** PLUS 100% of covered excess charges up to the reasonable and customary community standard level, AFTER you pay the fiscal year plan deductible of $150 per person, $300 family maximum.*
Inpatient care in civilian hospitals for ACTIVE DUTY dependents	All allowable charges except daily subsistence fee or $25, whichever is greater.	Active Duty Plan - $25 or the daily subsistence fee, whichever is greater, PLUS 100% of covered excess charges up to the reasonable and customary community standard level.
Outpatient care for ACTIVE DUTY dependents (office visits, clinics, lab, prescription drugs, etc.)	80% of the Tricare Standard allowed amount (85% for Tricare Extra) after you pay the Tricare Outpatient Deductible.	Active Duty Plan - Your cost share** PLUS 100% of covered excess charges up to the reasonable and customary community standard level, AFTER you pay the Tricare Extra Standard Outpatient Deductible.*
* Expenses incurred to satisfy the fiscal year Tricare Standard/Extra Outpatient Deductible cannot be used to satisfy the High Option II and Comprehensive Plan deductibles. Also, reimbursement toward the fiscal year Tricare Standard/Extra outpatient deductible under the Comprehensive Plan is made only if the deductible is incurred after the effective date of coverage. It will be prorated if you are insured less than a full year. ** Until the Tricare Cap is met. NOTE: Inpatient and outpatient expenses can be used to satisfy the fiscal year plan deductible. Economical Quarterly Premiums To Fit Your Budget As a member, you benefit from your organization's mass purchasing power, making the rates for this valuable coverage surprisingly affordable. What's more. . .the insurance company guarantees you'll never be singled out for a rate increase, no matter how many claims you file! The retail rates listed below are for new members only and do not Apply to the ASI Corporate TRICARE Supplement Program. Age of Retiree, Spouse, Widow/er, Former Spouse (Premiums shown are per person) High Option II Plan Comprehensive Plan Active Duty Plan Under 40 $ 55 $ 92   40-44   59   100   45-49   68   107   50-54   88   134   55-59   104   157   60-64   126   195   Each Child* of Retiree   43   68   Spouse of Active Duty Member Not Available Not Available $ 21 Each Child* of Active Duty Member Not Available Not Available $ 18 * Newborn children not named in your enrollment form are automatically covered from birth for injury or sickness, including treatment of congenital defects and birth abnormalities, for 31 days. You must notify the Plan Administrator in writing and pay the additional premium due within 31 days of birth for coverage to continue beyond this period. Insured children who are incapable of self-sustaining employment because of mental retardation or physical disability—and who are unmarried and chiefly dependent on the insured member for support and maintenance—may continue coverage past policy age limits, with requested proof. Otherwise, each dependent child's insurance terminates on the premium due date following the date he or she is no longer a dependent. Premiums shown are PER PERSON. Premiums increase based on your effective date of coverage and as you move from one age bracket to another. The insurance company reserves the right to change benefits or premiums on a group wide bases. NOTE: To pay premium semi-annually or annually, just multiply your quarterly premium by 2 or 4 respectively.