Are you a TRICARE beneficiary? Do you have other health coverage in addition to your TRICARE plan? You may have employer-sponsored coverage or government health plans. Or you may have purchased additional coverage through private providers. Students may have health coverage through their school. These additional plans are known as Other Health Insurance (OHI). If you have OHI, it’s important to know how you can use it with TRICARE.
“TRICARE beneficiaries with other health insurance should learn how it works in tandem with your TRICARE benefits,” said Shane Pham, TRICARE policy and program analyst at the Defense Health Agency. “Using your OHI and TRICARE correctly can save you time and money.”
Here are some facts about OHI that you should know.
Why it is important to report your OHI
If you add, remove, or change OHI, you must notify TRICARE and all assigned providers to prevent future claims problems. Notifying both TRICARE and your provider of any OHI updates before each scheduled appointment will help your claims be processed faster. It will also reduce the possibility of rejections later. The more information you provide about your OHI, the more accurate and timely the response to your claim will be.
Also, make sure you follow the rules of your OHI. If your OHI doesn’t pay on your claim because you didn’t follow their rules, TRICARE may not pay on your claim. If TRICARE receives your claim before your OHI processes it, TRICARE will deny it.
How to report your OHI
You can report your OHI using one of the options below:
Remember to keep your OHI information up to date. This will help you get the most out of your benefit.
How changes to your OHI may affect your enrolment
Gaining or losing an OHI counts as a Qualified Life Event (QLE). QLE allows you to enroll in TRICARE Prime or TRICARE Select outside of TRICARE Open Season. This does not apply to you if you are an Active Duty Service Member (ADSM) or if you have TRICARE For Life. Keep in mind that you have 90 days after you lose or get OHI to change your TRICARE health plan.
Which plan pays first
TRICARE and your OHI work together to coordinate your benefits payment. By law, TRICARE pays after your OHI. If you have health cover through an employer, private insurer or school, your OHI is always your main insurance. It pays all claims before TRICARE. If TRICARE receives your claim before your OHI processes it, TRICARE will deny it. The only exceptions to this rule are if you have:
- TRICARE Supplements
- State crime victim compensation programs
- Other federal government programs as determined by the Defense Health Agency
Also, if you have exhausted your OHI benefits, then TRICARE becomes the primary payer. In this case, you may need additional referrals or prior authorization. And a TRICARE-authorized provider, network or non-network, must be the one providing the services. ADSMs cannot use OHI as primary insurance. If you are on active duty, TRICARE is your only coverage.
OHI and Medicare
TRICARE pays after Medicare and your OHI for TRICARE-covered services. As noted in TRICARE Handbook for Life, how Medicare coordinates with OHI depends on whether you have OHI based on current work. But in both cases, TRICARE pays last. Visit the Medicare website for more information on how Medicare works with other insurances.
OHI with pharmacy benefits
When you have OHI with pharmacy benefits, your OHI pays first and TRICARE pays second. You can avoid higher costs by picking up your prescriptions at a TRICARE network pharmacy that is also in your OHI network.
OHI and unmarried ex-spouses
As an unmarried ex-spouse, you may lose your TRICARE eligibility if you purchase and are covered by an employer-sponsored health plan.
For more information about TRICARE and OHI, review the information on the TRICARE website. You can also contact your TRICARE contractor with questions.
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