Using Your TRICARE Benefit with Other Health Insurance
Do you have employer-sponsored health insurance? Any health insurance you have in addition to TRICARE is known by TRICARE as “other health insuranceHealth insurance you have in addition to TRICARE, such as Medicare or an employer-sponsored health insurance. TRICARE supplements don’t qualify as "other health insurance.",” or OHI. TRICARE supplements are not OHI. If you have OHI, it becomes your primary insurance and pays any claims before TRICARE does.
Typically, having OHI can affect you if you’re a retired TRICARE beneficiary who also uses Medicare, or if you’re a spouse of an active duty beneficiary who also gains coverage through their employer. OHI never applies to active duty service members. If you’re on active duty, then TRICARE is your only coverage. Learn more about how TRICARE works with OHI to make the most of your benefit.
Reporting Other Health Insurance
It’s important to keep your OHI coverage updated with your doctors and applicable TRICARE contractors. This includes health care, pharmacy, dental, and TRICARE For Life contractors. This will help them coordinate your benefits and prevent claim delays or denials. You can report your OHI through the following:
Coordinating Your Benefits
Your OHI is your primary insurance and processes your health care claims before TRICARE. Then, you or your doctor files your claim with TRICARE. TRICARE pays after all OHI except for Medicaid, TRICARE supplements, and the Indian Health Service. If you have Medicare, TRICARE pays after Medicare and your other health insurance for TRICARE-covered services. Find more details on Medicare coordination of benefits in the TRICARE For Life Handbook and on the Medicare website.
If TRICARE receives your claim before your other health insurance processes it, TRICARE will deny it. If TRICARE pays first and later discovers you had other health insurance, TRICARE will take back any payments made and will reprocess the claim after your OHI has processed it.
Losing Other Health Insurance
If you lose your other health insurance, TRICARE becomes your primary payer. If you have TRICARE For Life, TRICARE becomes the second payer. Inform the applicable TRICARE contractors and your health care provider of loss of OHI. If you don’t share the loss of OHI, then you risk the chance of TRICARE denying your claim.
Using Other Health Insurance with Prescription Drug Coverage
When you have OHI with pharmacy benefits, your OHI pays first and TRICARE pays second. You can save money by filling prescriptions at a TRICARE network pharmacy that your OHI also covers. Tell Express Scripts, Inc. you have OHI by completing the TRICARE Other Health Insurance Form.
If you have OHI prescription coverage, you can’t use TRICARE Pharmacy Home Delivery unless the drug isn’t covered by your OHI or you have met the OHI benefit cap.
If you have OHI, you can still use a TRICARE retail network pharmacy. Your other plan pays first and TRICARE pays second. Visit Using Other Insurance for more information on how to coordinate OHI with pharmacy benefits and file claims.
Knowing the dos and don’ts of having multiple health coverage will help you and your family take full advantage of your benefits. For more on OHI, go to Using Other Health Insurance and check out the TRICARE Stateside Guide.