The new year is here, so it’s important to take stock of your family’s overall health plan coverage. This is especially true when it comes to other health insurance (OHI). You may have had OHI last year, but now no longer. Or perhaps you’ve recently gained or changed OHI. In any of these cases, make sure your OHI information is current with TRICARE, so your health care claims are processed accurately.
“It’s important to tell your doctor and other health care providers if you have coverage in addition to TRICARE,” said Shane Pham, TRICARE Health Plan policy and programs analyst at the Defense Health Agency. “This will help them send your bills to the correct payer and avoid delays.”
Have OHI? Learn what’s required of you and how your two plans work together. Here are a few Q&As to help.
Q: What kind of health insurance is OHI?
HAS: OHI is any insurance you have other than TRICARE. It can be through your employer, a spouse’s employer, or a private insurance program. But TRICARE supplemental plans don’t count as OHI.
Q: Do you have to report your OHI?
HAS: Yes. You must disclose other health insurance coverage you carry in addition to TRICARE. Updating your OHI information with your TRICARE contractors and providers will ensure claims process promptly and accurately. You can report your OHI using any of the options below:
Q: Does OHI or TRICARE pay first?
HAS: By law, TRICARE pays after all OHI. The exceptions to this are:
- TRICARE supplemental plans
- State victims of crime compensation programs
- Other federal government programs identified by Defense Health Agency
After your OHI processes your claim, you or your doctor files a claim with TRICARE. Keep in mind that if TRICARE receives your claim before your OHI, TRICARE will deny the claim. If TRICARE pays first and later learns that you had OHI, TRICARE will take back any payments it made and will reprocess the claim after your OHI processes it.
Q: How does other dental insurance work with the TRICARE Dental Program?
HAS: If you’re an active duty family member with dental coverage through the TRICARE Dental Program (TDP) and have other dental insurance, be sure to complete and submit the Other Dental Insurance Coverage Questionnaire to United Concordia, the TDP contractor. This will ensure your claims process appropriately. United Concordia will work with your other insurance company to determine the coordination of benefits. Depending on the situation, TDP may act as primary or secondary payer.
If you have dental coverage through the Federal Employees Dental and Vision Insurance Program (FEDVIP) and have other dental insurance, contact your FEDVIP dental carrier, or other insurance provider, if you have questions about the coordination of your benefits.
Q: What if you have OHI with pharmacy benefits?
HAS: If you have OHI with prescription drug coverage, be sure to tell the pharmacy contractor, Express Scripts. Complete a TRICARE Other Health Insurance (OHI) Form and mail it to Express Scripts. Tell Express Scripts if you’ve lost or changed OHI, as well. When you have OHI with pharmacy benefits, your OHI country first and TRICARE country second. Read How to Use TRICARE and OHI at the Pharmacy to learn more about OHI and your pharmacy benefit.
Q: How does TRICARE For Life and OHI coordinate benefits?
HAS: How Medicare coordinates with your OHI depends on whether you have OHI based on your current employment. Regardless, TRICARE always pays last. You can look up more info about OHI in the TRICARE For Life Handbook and Medicare website.
Q: What else is important to know about OHI?
HAS: When you have OHI, keep in mind:
- If you’re active duty, you can’t use OHI; TRICARE is your only coverage.
- Losing or gaining OHI is a Qualifying Life Event.
- If you lose OHI, TRICARE becomes your primary payer.
- You must follow all requirements of your IHO plan.
- Services you receive must be from a TRICARE-authorized provider, whether they’re network or non-network.
- The IHO must process the claim before TRICARE can consider the charges.
Start 2023 off right by notifying your TRICARE contractors and providers that you have OHI. Also notify them if your OHI status has changed. Following this important step will make managing your health care easier throughout the year.
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