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CHAMPVA Supplement
Insurance Plan






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About Our Plan

How the CHAMPVA Supplement Works

Termination/Exclusions

Rate Schedule

How To Enroll



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Maximize Your Coverage Options

The Government Employees Association CHAMPVA Supplement Plan, when combined with your CHAMPVA benefits, is designed to provide you with the protection you need when you need it. The plan will pay your cost share for both covered inpatient and outpatient medical expenses after you satisfy the calendar year plan deductible of $250 per person, $500 family maximum. Take a moment now to read the details below. Then enroll today to give your family the additional protection of the Government Employees Association CHAMPVA Supplement Plan that complements your CHAMPVA benefits.

Plan Sponsor: Government Employees Association

The Government Employees Association is a non-profit, tax-exempt organization; incorporated in 1965 in Washington, D.C. GEA was established to provide active and retired federal, state and local government employees (including members of the military and National Guard services) with a network of resources.

Important Notice

This coverage is available to Government Employees Association members and their dependents. If you are not already a member of Government Employees Association, please complete the enclosed Government Employees Association membership application or contact Government Employees Association to apply. The $24.00 per year membership dues will be added to your insurance premium according to the payment option you select. Continued membership and benefit enjoyment requires renewal of membership upon expiration of the initial period. For additional inquiries, call Selman & Company, the plan administrator, toll‐free at: 1.800.638.2610.

Eligibility

Eligible Spouse means your spouse who is under age 65 and a CHAMPVA benefits recipient, but not a spouse from whom you are legally separated or divorced. Spouse also means widow(er) if he or she is a member of the Participating Organization. Spouses over age 65 are also eligible if documentation from the Social Security Administration certifying their non-entitlement to Medicare Part A benefits is submitted with their enrollment form. Eligible dependent and unmarried children under age 18 (23 if a full-time college student) may also enroll. Individuals who are Medicare beneficiaries may not enroll in the CHAMPVA Supplement Plan.

Effective Date

Coverage for dependents becomes effective on the first day of the month following receipt of your Enrollment Form and first premium payment.

Covered Dependent Effective Date

Subject to the Deferred Effective Date provision, an Eligible Dependent will become covered by the Policy on the Certificate Effective Date that first shows coverage for him or her. Your coverage is shown on your Schedule of Insurance. 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.

Deferred Effective Date

If on the date that an Eligible Dependent is to become covered under the Policy he or she is confined in a Hospital, coverage of such person will be deferred until the first day after he or she is discharged.

Renewability

Your coverage is renewable to age 65. As long as premiums are paid on time, everyone remains eligible, the Master Policy remains in effect, and Government Employees Association membership remains current, no one can be individually canceled. So even if you or a covered dependent develops a serious health condition in the future, the coverage will not terminate, provided these four conditions are met.

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.

Limitations (Nervous, Mental, Emotional Disorder, Alcoholism, and Drug Addiction Limits)

The coverage provided under the Inpatient Benefit of the CHAMPVA Supplement plan for nervous, mental and emotional disorders, including alcoholism and drug addiction, is limited to: 1) 30 Inpatient treatment days for a Covered Person age 19 or older; or 2) 45 Inpatient treatment days for a Covered Person under age 19; or 3) 150 Inpatient treatment days in a CHAMPVA authorized Residential Treatment Center for a Covered Person under age 21 per Calendar Year. This Inpatient limit is based on the number of days CHAMPVA normally provides each Calendar Year for such confinements. In rare instances, CHAMPVA extends these daily limits. If this occurs, we will limit the number of days that we provide for such confinement to the lesser of: 1) the number of days CHAMPVA pays for such Inpatient treatment during the Calendar Year; or 2) 90 Inpatient days per Calendar Year. The coverage provided under the Outpatient Benefit of the CHAMPVA Supplement plan for: 1) nervous, mental, and emotional disorders; and 2) alcoholism and drug addiction; is limited to $500 during any Fiscal Year for all such disorders. Coverage provided under the CHAMPVA Supplement plan for: 1) routine newborn and Well Baby Care; 2) hospital nursery charges for a well newborn; 3) dental care; 4) treatment for the prevention or cure of alcoholism or drug addiction; 5) and prosthetic devices; will be limited to those expenses covered by CHAMPVA for such care or service.







This plan is sponsored by:

GEA Logo
Government Employees Association

Administered by:

Selman&Company
Selman & Company
Cleveland, OH

Underwritten by:

Transamerica Premier Life Insurance Company (TPLIC), Cedar Rapids, IA
Group Policy MLTRC1000GP
Transamerica Financial Life Insurance Company (TFLIC),Harrison, NY
Group Policy TFTRC1000GP
TFLIC is authorized to conduct business in New York.
TPLIC is authorized to conduct business on all other states.


Click on the following links to learn more!
About Our Plan | How the CHAMPVA Supplement Works
Termination/Exclusions | Rate Schedule | How to Enroll