Gts short version 97 2003 two

Group TRICARE Supplement (GTS)
Serving Employers and Their
Military Retiree Employees and Spouses

What is TRICARE?
TRICARE is a health care benefit similar to an
employer sponsored health plan that is
provided by the US Department of Defense
Military Health System
A military retiree and eligible spouse (usually
with 20+ years of service) retains TRICARE to
age 65
There are 3.3 million military retirees and
spouses (some work for you!)
Whitley Agency, Inc.
http://grouptricaresupplement.com

So What?
When a TRICARE employee is hired, he/she is
offered the new employer’s health care plan
When the employer’s plan is elected, It pays
first, and TRICARE considers what’s left over
This, obviously, is not as good for the new
employer as TRICARE paying first
And why would someone who already has a
good benefit plan, want more insurance?

Why Buy More Insurance?
New Employee is:
*Older – Likely to have more claims
*Unhealthy – Likely to have more claims
*Fear of future illness
*Wants insurance company to pay out
of pocket expenses rather than self-pay

What is the Group
TRICARE Supplement?
The Group TRICARE Supplement (GTS) is an
insurance plan designed to pay what TRICARE
does not pay
Offering the GTS allows TRICARE employees to
use TRICARE as primary coverage, with the
supplement paying all or most of the balance
The employee is not on the employer’s health
plan and any associated costs are saved

Why Offer the GTS?
Fully insured plans pay no premium on
employees who are not covered
Self-funded plans pay no claims on employees
who are not covered
Since the GTS premium is generally less than
payroll deductions for the employer plan, the
likelihood of someone joining the employer
plan as health care needs increase, is virtually
eliminated

Why Offer the GTS?
Offering the GTS is an additional way
to show support for those who have
given much to protect our freedoms
It allows TRICARE beneficiaries to
choose an alternate health care
solution that better serves their
needs

Why Offer the GTS?
The average age of a GTS enrollee is 55, and is
at higher risk to have more frequent and higher
cost claims than the average age employee
As TRICARE eligible employees choose to be
removed from (or do not enroll in) the
employer sponsored plan, the employer plan’s
risk level is reduced, which results in lower
costs for other employees and the employer;
everyone wins!

TRICARE Offers Two Plans
 Prime—Managed Care, HMO type plan:
1. High benefits and low out of pocket costs (less
likely to buy additional insurance)
2. Restrictive network of mainly military
providers
3. Requires an annual enrollment fee
4. Prime is currently primary coverage for
approximately 49% of military retirees and
their covered dependents*
*According to a 2011 GAO report

TRICARE Offers Two Plans
 Standard—Fee for service plan
1. Lower benefits and higher out of pocket costs
than Prime (more likely to buy insurance)
2. No restrictive network—use civilian or military
providers
3. No annual enrollment fee
4. Standard is primary coverage for
approximately 26% of military retirees*

TRICARE Has A Cost Problem
 From 2001 through 2010, Department of Defense health care
spending rose from $19 billion to $49 billion*
 a $30,000,000,000 increase! + 158%
 When Prime and Standard plans were created, they were
designed so more people would choose Prime, and it worked
 The problem is that Prime costs about 25% more than
Standard
 In order to save money, Prime members are being forced to
move from Prime to Standard
 As this happens, more TRICARE employees will opt into their
employer’s plan, especially those in poor health
 Or they will buy the GTS if it’s offered to them

Self-fund or Buy Insurance?
For individual health risk; deductibles, copays, cost share,
costs unpaid by the employer plan or TRICARE, can be paid
by the employee (self-fund) or by an insurance company
(buy insurance)
Self-funding is chosen when risk is low; out of pocket costs
are low (Prime), the person is healthy and has financial
resources to pay unpaid bills
Buying Insurance is chosen when risk is high; out of pocket
costs are higher (Standard), the person is unhealthy and
lacks cash on hand to pay unpaid bills, or is diagnosed with
a costly illness or has a high-cost accident
As risk increases, employees buy insurance, either the
employer health plan or the GTS!

The GTS Works Like a
Group Benefit
 No underwriting, no health questions, everyone is
accepted
 No pre-existing waiting period, GTS pays from the
effective date
 No minimum enrollment required
 Any employer may offer the GTS
 Group rates, everyone pays the same rate
 No restrictive provider network, use civilian or
military providers
 Full portability when employment terminates

Implementation Is Easy*
We provide:
Enrollment meetings / assistance, as necessary
Employee communications
Staff training, as necessary
A micro-website, customized for your company, to
provide GTS information and enrollment for your
employees
*Since TRICARE covers Active Military Members as well as Military Retirees, most of
these employees have been covered by TRICARE for at least 20 years. They already
know what it is and how it works, which makes the GTS much easier to implement and
maintain.

More Important Facts
The GTS has been available since 1998
Underwritten by Transamerica and Monumental
Insurance Co. (both are Transamerica
Companies)
Administered by Association and Society
Insurance Company (ASI)
 Offered by more than 500 corporations
 Offered by 19 of the top 20 US defense contractors
 Offered by many state and local governments

Is This Legal?
YES!
In 2007, the federal government reviewed this
product and legislated its permissibility in Section 707
of the John Warner National Defense Authorization Act
of 2007
Employers may not pay any portion of the GTS
premium
There are several conditions employers are required
to meet in order to legally offer the GTS
We provide what you need in order to certify your
compliance with federal regulations!

For More Information
Billy A Whitley, CHC, HIA
Employee Benefit Consultant
1019 Bent Pine Ct
Columbus, Georgia 31909
706-507-9764 Office
706-332-4585 Cell
Request a Proposal at:
billy.whitley@grouptricaresupplement.com

Gts short version 97 2003 two

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