| Age of Retiree, Spouse, Widow(er) |
Quarterly Rate with First Year Discount | Base Rate**** |
| Under 40 |
$78.96 | $84 |
| 40 - 44 |
$84.60 | $90 |
| 45 - 49 |
$94.94 | $101 |
| 50 - 54 |
$119.38 | $127 |
| 55 - 59 |
$150.40 | $160 |
| 60 - 64 |
$166.38 | $177 |
| Each Child |
$62.98 | $67 |
* After the TRICARE Deductible and TRICARE Supplement Plan Deductible have been met. Not to exceed 115% of the Tricare allowable amount for Tricare Select.
** Check with TRICARE to confirm your actual deductible and co-pay portion. TRICARE’s portion of coverage is provided here for your convenience, but is subject to change by Defense Health Agency; visit www.tricare/mil for the most up-to-date information. The Supplement Insurance reimburses for co-pay costs for covered services after deductibles have been met.
*** 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. Plan or rate changes may be subject to final approval by the applicable regulatory authorities.
**** First year discounted rates are not available to insureds in OH or KY. Members receive a 6% rate discount during their first twelve months of coverage. There are no other discounts. After the 12th month, the rates go up 6%.
