Other Health Insurance

Complete this form to notify your contractor that you have 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.". When you do, TRICARE is the second payer.

Download Form	Submit To
East Region OHI Questionnaire	PGBA—Other Health Insurance P.O. Box 202151 Florence, SC 29502 Fax: 877-489-0038
West Region OHI Questionnaire	TRICARE West Region ATTN: TriWest P.O. Box 202168 Florence, SC 29502 Fax: 877-989-0060
Overseas OHI Questionnaire	TRICARE Overseas P.O. Box 7992 Madison, WI 53707-7992 USA
TRICARE For Life OHI Questionnaire	WPS/TRICARE For Life P.O. Box 7889 Madison, WI 53707-7889 Fax: 608-301-2114