If you have any health insurance other than TRICARE, it is called “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.”.” It can be through your employer or a private insurance program. By law, TRICARE pays after all other health insurance, except for:
- Medicaid
- TRICARE supplements
- State Victims of Crime Compensation Programs
- Other Federal Government Programs identified by the Director, Defense Health Agency (i.e. Indian Health Service)
This means your other health insurance processes your claim first. Then, you or your doctor files your claim with TRICARE.
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Do you have Medicare?
- Medicare is a federal entitlement
- TRICARE pays last after Medicare and your other health insurance
- Visit the Medicare website to see which plan—Medicare or your other health insurance—pays first
Keep Your Information Updated
It’s important to keep your other health information updated
- Tell your TRICARE contractors and doctors when you have other health insurance.
- If TRICARE gets your claim before your other health insurance processes it, TRICARE will deny it.
- If your other plan doesn’t cover the particular service at all and you think TRICARE might cover it, file a claim with TRICARE.
- If TRICARE pays first and then discovers you had other health insurance, TRICARE will take back any payments made. They will only reprocess your claim after your other health insurance does.
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Keep your doctor and your contractor updated on your other health insurance. They can coordinate your benefits and ensure your claims are paid quickly. >>Download and submit your region’s other health insurance form.
Coordination of Benefits
- Follow the rules of your other health insurance for getting care and filing claims.
- If your other plan doesn’t cover the entire cost, file a claim with TRICARE.
- If your other plan denies a claim for failure to follow their rules, TRICARE may also deny your claim.
Do you have other health insurance with prescription drug coverage? Your other plan pays first and TRICARE pays second at the pharmacy.
Claim Other Health Insurance Denials for Failure to Follow Rules of Your Other Plan
You, your doctor, your pharmacy, and your hospital must follow all the rules of your other health insurance. For example, your other plan might deny a claim for the following reasons:
- Its authorization requirements weren’t followed.
- You used a provider outside its network.
- Pharmacy prescriptions rules weren’t followed for brand name drugs or specialty drugs.
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If your other health insurance denied your claim because its rules weren’t followed, TRICARE may also deny the claim. Then you would be responsible to pay your providers, hospitals, suppliers, and pharmacies for the full amount of their billed changes.
You can contact your TRICARE regional or overseas contractor for additional information.
Ending Other Health Insurance Coverage
- If you lose your other health insurance, TRICARE becomes your primary payer.
- If you have TRICARE for Life, TRICARE becomes the second payer.
- You must inform your doctor and contractor by completing and returning this form.
- Failure to tell your doctor or contractor may result in TRICARE denying your claims.
Active Duty Service Members and OHI
As an active duty service member, can I use other health insurance?
Yes, but only under certain circumstances and when in compliance with DoD and Service regulations. If you decide to use OHI, remember the following:
- You’re responsible for all costs.
- TRICARE won’t be second payer. This means there’s no coordination of benefits with your OHI and TRICARE.
- Your OHI may have some exclusions for military duty status. This means they may not pay for your care or may recoup for paid claims for services you received while on active duty or line of duty status. You must disclose your military status to your OHI to avoid claim denials or recoupments. Failure to disclose raises issues of fraud and could lead to administrative or judicial consequences.
- You must comply with Service regulations if you decide to get care from a civilian provider. This includes providing all medical records to your current primary care manager.
- Unauthorized care may affect your fitness for duty status.
Note: You can still get all your medical care (including mental health and dental care) at no cost to you through TRICARE. If you have questions about how using OHI may affect you, talk to your Service Personnel.
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