Using Other Insurance
When you have Other Health InsuranceClick to closeHealth 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." (OHI) with pharmacy benefits, your other health insurance pays first and TRICARE pays second. You can avoid higher costs by getting your prescriptions filled at a TRICARE network pharmacy that is also in your other plan's network.
TRICARE Pharmacy Home Delivery
You can’t use Home Delivery if you have other health insurance, including Medicare Part D, unless:
- Your other plan doesn’t include pharmacy benefits,
- The drug you need isn’t covered by your other plan, or
- You’ve met your other plan’s benefit cap
If you’ve met any of these requirements, you can get your prescription filled through Home Delivery. You'll need to send proof from your other plan that it isn't covered or you've met the benefit cap.
TRICARE Network Pharmacies
If you have other health insurance, it doesn’t prevent you from using a TRICARE retail network pharmacy. Your other plan pays first and TRICARE pays second.
Online Coordination of Benefits
When you get your prescriptions at a network pharmacy, tell your pharmacist you also have TRICARE. Your pharmacist will submit your prescription online to both plans at the same time.
When you process your pharmacy claims online, you:
- Pay minimal out-of-pocket expenses
- Never pay more than the TRICARE copaymentClick to closeA fixed dollar amount you may pay for a covered health care service or drug.
- Don't need to submit paper claims
If you're using a mail order program through your other plan, online coordination of benefits isn't possible.
TRICARE becomes the first payer when:
- The drug isn't covered by your other plan, but is covered by TRICARE
- Coverage under your other plan is exhausted for the year
Filing Claims with OHI
You must file a prescription claim to get reimbursed for the eligible portion of your out-of-pocket expenses. To avoid delays or problems when processing your prescriptions claims, tell Express Scripts you have other health insurance. Complete a TRICARE Other Health Insurance Form and mail it to:
P.O. Box 60903
Phoenix, AZ 85082-0903
Once you've exceeded the dollar limit for your OHI, or if the drug isn't covered by your OHI, you can file a claim with TRICARE for reimbursement. To file a claim:
- Fill out the TRICARE Claim Form-Patient's Request for Medical Payment (DD 2642)
- Mail the form, your OHI explanation of benefits and receipts, to:
Express Scripts, Inc.
P.O. Box 52132
Phoenix, AZ 85082
Ending Other Health Insurance Coverage
If you no longer have other health insurance with pharmacy benefits, you must tell Express Scripts. >>Contact Express Scripts
You can file a claim with TRICARE for reimbursement once you’ve exceeded the dollar limit for your other health insurance (OHI) or if the drug isn’t covered by your OHI.
Last Updated 9/21/2016