Philippines Itemized OHI Claim Checklist

This form has two purposes to assist you in with your claims:

TRICARE Philippine Demonstration 

Waiver Request

Use this form to requst a waiver to visit a non-approved demonstration provider. International SOS will review beneficiary submitted waivers and notify the beneficiary of the decision.

Beneficiary Waiver Appeal 

Use this form to formally request a review if the waiver is denied. Appeals are forwarded to the TRICARE Area Office (TAO)-Pacific for subsequent consideration.

Send all Beneficiary Waiver Request Forms and Beneficiary Waiver AppealThe action you take if you don’t agree with a decision made about your benefit. Forms to Global 24 Network Services by mail or fax:

Global 24 Network Services
P.O. Box #13892
Emerald Avenue, Ortigas Center Post Office
Pasig City, Philippines 1605

Fax: +63-2687-8609

Last Updated 8/31/2016