Other Health Insurance and TRICARE

All beneficiaries should understand their TRICARE benefit, which includes how TRICARE pays claims for beneficiaries who have other health insurance (OHI) .  Understanding how the two work together is very important for ensuring timely and accurate claims processing.
                                                                                                                                               
What is OHI? 
Basically, other health insurance or health care coverage beneficiaries have in addition to TRICARE.  Beneficiaries may be eligible for OHI through an employer, private insurer, school health care coverage or entitlement programs such as Medicare.
 
Navigating two health care plans can be quite confusing at first.  The most important thing to remember if you have OHI is that, by law, your OHI is the primary payer, and TRICARE is secondary.  You or your provider must file health care claims with your primary health insurance beforeyou file with TRICARE.  Check with your OHI provider and your regional contractor to find out the  appropriate steps to take to ensure your claims are paid.  You can also consult the TRICARE’s OHI page or OHI Claims Flyer for more information.
 
Visit the TRICARE Web site on working with TRICARE and Medicare for specific information.
 
 
Keep Us Informed
Another key to managing more than one plan is to keep TRICARE in the loop.  Denials or delays in processing are likely if a beneficiary does not inform their appropriate TRICARE contacts about their OHI.  First of all, make sure your doctor knows that you have OHI.  If your doctor fills out your claim incorrectly, this may delay processing.
 
Secondly, each TRICARE region has an OHI Questionnaire to help you communicate any changes:

North Region 
South Region 
West Region

Lastly, for your pharmacy benefit, please let us know about your OHI by calling the TRICARE pharmacy contractor, Express Scripts, Inc. (ESI) at 1-866-DoD-TRRx (1-866-363-8779).


TFL and OHI
For our TRICARE For Life (TFL) beneficiaries, Medicare pays first, then your OHI, then TRICARE.  In most cases, you will need to file the claim with TRICARE and include your explanation of benefits after your OHI pays its share.  You can find more information on how OHI and TFL work together on our Web site.  Remember to notify TFL that you have OHI with the TFL OHI Questionnaire.
 

National Health Insurance & Supplemental Plans
National health insurance programs overseas are considered OHI.  If you are enrolled in such programs, seek guidance from your appropriate overseas TRICARE Service Center (TSC) before obtaining health care from a host nation provider:
 
TRICARE Area Office-Latin America and Canada
TAO-LAC, Building 38716, 38th Alley
Ft Gordon, GA 30905-5650
Toll-free: 1-888-777-8343
1-706-787-2424
DSN: 773-2424
Fax:  1-706-787-3024
taolac@tma.osd.mil


TRICARE Area Office-Pacific
Toll-free: 1-888-777-8343
011-81-6117-43-2036
DSN: 643-2036
Remote Sites:  011-65-6-338-9277
Fax: 011-81-611-743-2037
DSN Fax: 643-2037
TPAO.CSC@oki10.med.navy.mil


TRICARE Area Office-Europe
Toll-free: 1-888-777-8343
011-49-6302-67-7432
DSN: 496-7432
Fax:  011-49-6302-67-6374
DSN Fax: 496-6374
teurope@europe.tricare.osd.mil


Keep in mind that “supplemental” insurance programs are different than OHI plans. “Supplemental” plans are offered for purchase by some military associations and private companies, and do not fall under OHI rules.  Visit the TRICARE Web site to learn more about “supplemental” plans.
 
In Conclusion
For more information, you can also check out TRICARE’s press room to find an informative article on balancing OHI and TRICARE.  Please let me know if you have experienced any difficulties with TRICARE and OHIs.  Your input is always valuable in helping us make TRICARE work better.