Step 1. Get a Quote Step 1 of 5
Get a no-obligation quote in seconds! If you are satisfied, you can enroll online through our secure web site. If you have any questions, please call 1-800-247-2192 or email moaa@marshpm.com.
Yes! I'd like a no-obligation quote for TRICARE Supplement Insurance. Coverage Selection1 * -- Select -- TRICARE Standard Supplement Plan (In- and OutPatient) TRICARE Standard Supplement Plan (InPatient Only) TRICARE Prime Supplement Plan Military Status * -- Select -- Retired Active Duty Member Age * -- Select -- Under 45 45-49 50-54 55-59 60-64 Member Smoking Status2 * -- Select -- Non-Smoker Smoker Person(s) To Be Covered * -- Select -- Member Auxiliary Member (surviving spouse of eligible officer) Spouse Member + Spouse Child Coverages Needed * -- Select -- 0 1 2 3 4 5		Quick Tips If you are a Widow/Widower, simply select the 'Retired' military status to get a quote. If you are currently not a member of MOAA, don't worry! Membership will be handled automatically at the end of this process. If you have any questions, please call 1-800-247-2192 or email moaa@marshpm.com.
Items marked with an asterisk (*) are required. Your personal information is protected with high level 128 bit encryption. Your information will not be shared with any other source. 1. If you select Prime Coverage, you will be required to provide a copy of of the     applicant(s) Prime card(s) prior to issuing coverage. You will receive a letter     in the mail requesting this information. 2. You classify as a "non-smoker" if you haven't smoked a cigarette, cigars, or used     a pipe or chewing tobacco, nicotine product or snuff within the past 12 months.

Step 1b. Get a Quote Step 1 of 5
Get a no-obligation quote in seconds! If you are satisfied, you can enroll online through our secure web site. If you have any questions, please call 1-800-247-2192 or email moaa@marshpm.com.
Yes! I'd like a no-obligation quote for TRICARE Supplement Insurance. Spouse Age * -- Select -- Under 45 45-49 50-54 55-59 60-64 Spouse Smoking Status * -- Select -- Non-Smoker Smoker
Items marked with an asterisk (*) are required.   Your personal information is protected with high level 128 bit encryption. Your information will not be shared with any other source.

Step 2. Get a Quote Step 2 of 5
Get a no-obligation quote in seconds! If you are satisfied, you can enroll online through our secure web site. If you have any questions, please call 1-800-247-2192 or email moaa@marshpm.com.
Your TRICARE Supplement Insurance Quote For Monthly Premiums: Select Your Plan Preference * -- Select -- Option 1 Option 2 Option 3		Quick Tips Remember, as an MOAA member your acceptance is guaranteed! You cannot be turned down for ANY reason.
Items marked with an asterisk (*) are required. Click the Next button to begin enrollment for this insurance. Note that your coverage will begin on the first of the month after we receive your first payment and you will be billed on a quarterly basis. Your quarterly rate is your monthly rate multiplied by 3.   Your personal information is protected with high level 128 bit encryption. Your information will not be shared with any other source.

Step 3. Enroll for Coverage Step 3 of 5
On-line enrollment is fast and secure. Follow these easy steps.
Member Information: Name must be identical to how it appears on your military ID card. First Name * Middle Initial Last Name * Address * Address 2 City * State * -- Select -- Alabama Alaska Arkansas California Colorado Connecticut Delaware District of Columbia Florida Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip * Daytime Phone * (no dashes, 10-digit numeric) Birthdate * (mm/dd/yyyy) Social Security Number * (no dashes, 9-digit numeric) Gender -- Select -- Male Female MOAA Member Number Branch of Service * -- Select -- ANG ARNG AUS NOAA OTHER USA USAF USAFR USAR USCG USCGR USMC USMCR USN USNR USPHS USPHSR Rank -- Select -- 1st Lieutenant 2nd Lieutenant Admiral Brigadier General Captain Commander Colonel Chief Warrant Officer 1 Chief Warrant Officer 2 Chief Warrant Officer 3 Chief Warrant Officer 4 Chief Warrant Officer 5 Ensign General Lieutenant Commander Lieutenant Colonel Lieutenant General Lieutenant Lieutenant Jr Grade Major Major General Rear Admiral Vice Admiral Email Address * Retirement Date * (mm/dd/yyyy) (or initial eligibility for TRICARE benefits) Check all that apply (if any): I am enrolling within 30 days of the date my employer health insurance ends because I am no longer an eligible participant in that program. Member Spouse I am enrolling within 30 days of termination of active duty service or initial eligibility for TRICARE benefits. Member Spouse		Quick Tips Online Enrollment is not allowed in the state of Arizona or Georgia. Please call 1-800-247-2192 for a paper enrollment form.
Items marked with an asterisk (*) are required.   Your personal information is protected with high level 128 bit encryption. Your information will not be shared with any other source.

Step 3. Enroll for Coverage Step 3 of 5
You have chosen to cover your dependent(s). Please fill in the following.
Dependent Information: Name(s) must be identical to how they appear on military ID card.   First Name Middle Initial Last Name Birthdate (mm/dd/yyyy) Spouse Child Child Child Child Child		Quick Tips NOTE: Children must be under age 21 (23 if a full-time student). If you would like each child to have a different plan, please contact the administrator for an enrollment form. For children 21 to 23, proof of full-time student status will be required prior to issuing coverage. You will receive a letter in the mail requesting this information.
Your personal information is protected with high level 128 bit encryption. Your information will not be shared with any other source.

Step 4. Confirm Your Information Step 4 of 5
Please check that all information provided below is accurate. Please click "Next" button below to proceed further. Or, click "Previous" button to make any necessary changes.
Quote Information: Coverage Selection: Person(s) to be Covered: Deductible: Children Covered: Monthly Premium: Applicant Information: (Please verify names are identical to how they appear on your military ID card) Full Name: Address: Address 2: City: State: Zip: Daytime Phone: Birthdate: Gender: MOAA Member Number: Email Address: Dependent Information: Name(s) must be identical to how they appear on military ID card(s). Spouse: Child: Child: Child: Child: Child: Billing Information: Payment Method: Bill me later Billing Frequency: Quarterly Quarterly Payment:		Quick Tips Please note that your coverage will begin on the first of the month after we receive your first payment and you will be billed on a quarterly basis.
Your personal information is protected with high level 128 bit encryption. Your information will not be shared with any other source.

Step 5. Provide your eSignature Step 5 of 5
I hereby enroll myself and/or my dependents with The Hartford for coverage under the Military Officers Association of America Group Health Insurance Program (MEDIPLUS). I understand I must be a member of MOAA. I understand that this program will not cover pre-existing conditions (conditions [including pregnancy] for which medical advice or treatment was rendered or recommended by a physician for those being enrolled within six months of this new coverage) unless six months have passed from the effective date of this new coverage. This pre-existing condition limitation will not apply if waived in accordance with policy provisions. I understand that the MEDIPLUS TRICARE Prime Supplement does not provide a Waiver of Premium provision for my surviving insured spouse and/or children. I understand that my coverage will become effective on the first day of the month following receipt of my completed enrollment form and payment of my initial premium. I understand that eligibility to receive benefits under the TRICARE Retiree Supplement is dependent on my (or my deceased spouse’s) entitlement to uniformed services retired pay. California residents only: California law prohibits an HIV test from being required or used by health insurance companies as a condition of obtaining health insurance coverage. Florida residents only: Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony in the third degree. I have read and understand Hartford's Fraud Statement Language * I have read and understand Hartford's Terms of Service * Group Policy Number AGP-1134.
Complete E-SIGNATURE below and click "Enroll Now!" to process your enrollment. Your Membership Status * I am a member of MOAA Yes! I want to become a member of MOAA and understand that I will be billed separately for an annual membership at the following rate: $27 (Regular Member), $24 (Auxiliary), or $13 (Introductory Active Duty Rate) Your TRICARE Supplement Enrollment Decision: * Yes, I want to enroll in MOAA TRICARE Supplement Coverage Full Name * Confirm Full Name * Date Signed * (mm/dd/yyyy)
Yes, I agree to recieve via email future recommendations and suggestions regarding MOAA Sponsored Insurance Plans. Items marked with an asterisk (*) are required.   Your personal information is protected with high level 128 bit encryption. Your information will not be shared with any other source.

TRICARE Supplement Insurance

Online Enrollment is not allowed in your state. Please call 1-800-247-2192 for a paper enrollment form.