Economical Premiums To Fit Your Budget
The CHAMPVA deductible is applied to the first medical or pharmacy claims processed 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.
| Age of Spouse, Widow/er | Monthly | Quarterly | Semi-Annual | Annual |
|---|---|---|---|---|
| Under 40 | $32.04 | $96.12 | $192.24 | $384.48 |
| 40 - 44 | $35.60 | $106.80 | $213.60 | $427.20 |
| 45 - 49 | $40.94 | $122.82 | $245.64 | $491.28 |
| 50 - 54 | $52.51 | $157.53 | $315.06 | $630.12 |
| 55 - 59 | $62.30 | $186.90 | $373.80 | $747.60 |
| 60 - 64 | $74.76 | $224.28 | $448.56 | $897.12 |
| 65+ | $94.34 | $283.02 | $566.04 | $1,132.08 |
| Each Child | $24.92 | $74.76 | $149.52 | $299.04 |
Premiums illustrated are Per Person. Includes first year discount of 11%.
Rates and/or benefits are based on the attained age of the Insured Person and increase as the Insured Person enters each new age category. Rates and/or benefits may be changed on a class basis.
Important Notice
This coverage is available to GEA members and their dependents only. If you are not a member of GEA, 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, covered expenses due to new conditions will be covered immediately.
IMPORTANT NOTICE:
The Plan is currently not available in CO, ME, NH, NM, NY, OR, PR, UT, WA.
- The Corporate Plan Sponsor: Government Employee Association (GEA)
- Plan Administer: SelmanCo
- Underwritten by: Harford Life and Accident Insurance Company, Harford, CT 06155
- 19837953
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