Click Below to
Learn More
About Our Plan
How the CHAMPVA
Supplement Works
Termination/Exclusions
Rate Schedule
How To Enroll
Return to Index
Links
TRICARE Official Site
DEERS Info
|
|
|
Termination
A Covered Person’s coverage under the Policy will cease on the first to occur of the date the Policy terminates, or the date
Government Employees Association ceases to be a Participating Organization of the Policyholder; the date the required premium
is not paid, subject to the Grace Period provision; the date you or your widow(er) terminates membership in the Participating
Organization; the first premium due date on or next following the date a dependent ceases to be an Eligible Spouse or an Eligible
Child; the date we or the group cancel coverage for a class of Eligible Person to which he or she belongs; the first premium due
date on or next following the date he or she ceases to be covered by CHAMPVA; the date he or she becomes eligible for
Medicare unless the covered person resides in an area where Medicare is not available, in which case coverage will not terminate
until the covered person returns to residency in an area where Medicare is available.; if a child, the date he or she attains age 18,
or age 23 if enrolled full-time in a school of higher learning; if a spouse, the date he or she attains age 65. Termination of
insurance will not prejudice any claim which occurred before the effective date of termination. Limitations and exclusions may
vary by state. Please see your Certificate for details.
|
Exclusions
This Policy does not cover:
1) injury or sickness resulting from war or act of war, whether war is declared or undeclared;
2) treatment or confinement not ordered by a Physician or necessary for medical care;
3) intentionally self-inflicted injury;
4) suicide or attempted suicide, whether sane or insane (in Colorado and Missouri while sane);
5) routine physical exams and immunizations, except when considered Well Baby Care covered by CHAMPVA;
6) domiciliary or custodial care, care received in a retirement home, rest home or halfway house;
7) rest cures;
8) eye refractions and routine eye exams except when considered Well Baby Care covered by CHAMPVA;
9) eyeglasses and contact lenses;
10) cosmetic procedures, except those resulting from Sickness or Injury while a Covered Person;
11) hearing aids or hearing exams except when considered Well Baby Care covered by CHAMPVA;
12) orthopedic footwear;
13) care for the mentally incapacitated or physically handicapped if the care is required because of
the mental incapacitation or physical handicap;
14) drugs which do not require a prescription, except insulin and other diabetic supplies;
15) any confinement, service, or supply that is not covered under CHAMPVA;
16) expenses in excess of the CHAMPVA Cap;
17) expenses in excess of the CHAMPVA Allowed Amount;
18) expenses which are paid in full by CHAMPVA;
19) any expenses or portion thereof applied to the CHAMPVA Deductible;
20) any part of a covered expense which the Covered Person is not legally obligated to pay;
21) care received as part of a grant, study or research program; 22) care
considered experimental or investigational.
Exclusions for the State of New York
This 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;
4) custodial care;
5) rest cures;
6) eye refractions and routine eye exams except when considered Well Baby Care covered by CHAMPVA;
7) eyeglasses;
8) 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;
9) hearing aids or hearing exams except when considered Well Baby Care covered by CHAMPVA;
10) any confinement, service, or supply that is not covered under CHAMPVA;
11) expenses in excess of the CHAMPVA Cap;
12) expenses in excess of the CHAMPVA Allowed Amount;
13) expenses which are paid in full by CHAMPVA;
14) any expenses or portion thereof applied to the CHAMPVA Deductible;
15) any part of a covered expense which the Covered Person is not legally obligated to pay.
|
|
