How TRICARE Works with Other Health Insurance By Sharon Foster TRICARE Management Activity July 25, 2011 The coordination of benefits between TRICARE and other health insurance (OHI) can be confusing. If a beneficiary has health care coverage through an employer, public or private insurance program, including government programs such as Medicare, he or she is considered to have OHI. If a beneficiary has OHI, he or she should tell his or her provider and regional health care contractor. Beneficiaries should also fill out the OHI form located on their regional health care contractor's website (http://www.tricare.mil/contactus). Keeping the regional health care contractor informed about the OHI will allow TRICARE to better coordinate benefits and will help ensure that there is no delay in payment of claims. TRICARE is the secondary payer when a beneficiary has OHI. Before TRICARE considers the claim, the beneficiary's OHI must pay first. The exceptions are Medicaid and TRICARE supplemental plans. Please go to TRICARE's website to learn more http://www.tricare.mil/mybenefit/home/Medical/OHI. After the other insurer pays, TRICARE will pay what is left up to the TRICARE allowable charge, which is the maximum amount TRICARE will authorize for medical and other services furnished in an inpatient or outpatient setting. There is no change in benefit limits when TRICARE is the secondary payer. Beneficiaries need to be sure to submit all claims to TRICARE because deductibles may be applied to their annual catastrophic cap. The beneficiary's provider may submit secondary claims as well. To reduce pharmacy costs, a beneficiary's best option is to use a TRICARE retail network pharmacy that is also covered by their OHI. After the OHI pays, TRICARE may reimburse the beneficiary for part or all of their out-of-pocket costs, including copayments. Beneficiaries are not eligible to fill prescriptions via home delivery if they have OHI with a prescription plan, including a Medicare Part D prescription program, unless they meet one of the following requirements: . The medication they need is not covered by their OHI. . They have met their OHI's benefit cap. If the OHI provides only medical coverage, not pharmacy coverage, he or she still may be eligible to use home delivery (http://www.tricare.mil/homedelivery) as their prescription benefit. Beneficiaries can go to http://www.tricare.mil/mybenefit/home/Prescriptions/OHI for pharmacy questions or contact Express Scripts, Inc. at (877) 363-1303. Finally, active duty service members, including activated National Guard and Reserve members, cannot use OHI. TRICARE is their primary payer. ------- SOURCE: TRICARE News Release <http://www.tricare.mil/pressroom/press_article.aspx?fid=560> == HEALTH.MIL Mailing List == 1. The following options may be used to join\leave this mailing list: a. ONLINE OPTION: Online subscription\unsubscription options are available at: http://www.hostmtb.org http://www.hostmtb.org/hmil.html //www.freelists.org/list/health.mil b. E-MAIL OPTION: Subscription\unsubscription may be performed by sending an E-Mail message to the following address: (1) To subscribe to this mailing list, send an E-Mail message to HEALTH.MIL-request@xxxxxxxxxxxxx with 'subscribe' as the subject. (2) To unsubscribe, send an E-Mail message to HEALTH.MIL-request@xxxxxxxxxxxxx with 'unsubscribe' as the subject. 2. If the above subscribe or unsubscribe procedures don't work or if you have questions, comments, etc., about this mailing list, please contact Milton.Bell126@xxxxxxxxx