For Many, TRICARE is a secondary health plan

Many Service Members are covered by health care plans other than the TRICARE program because their spouses have coverage through civilian employers. But that doesn’t always mean that both plans will pay all the bills.

TRICARE pays second to "Other Health Insurance" (OHI) in most cases, except for Medicaid, TRICARE supplements, the Indian Health Service, or other programs and plans identified by the TRICARE Management Activity.

Medical bills for all health care services provided outside of a military treatment facility (MTF) must be submitted to the OHI company first before TRICARE benefits can be applied. A beneficiary who is not sure if his or her OHI is primary to TRICARE should call 1-888-TRIWEST (1-888-874-9378).

TRICARE beneficiaries with OHI must complete a TRICARE Other Health Insurance (OHI) Form and submit it to TriWest. A beneficiary who cancels OHI must also submit the same OHI form to inform TriWest of the cancellation. Forms are available at www.triwest.com ("Find a Form") or by calling 1-888-TRIWEST (1-888-874-9378).

Beneficiaries must follow the OHI company’s rules, including referral and authorization requirements, when receiving services outside of the MTF. Failure to do so could result in their TRICARE coverage being restricted or denied.

Once OHI has covered its portion of the claim, the beneficiary or provider may submit a TRICARE claim, which TriWest will review.

If the OHI doesn’t pay the entire bill or doesn’t pay at all, the beneficiary should send the bill and a copy of the OHI’s explanation of benefits to West Region Claims, P.O. Box 77028, Madison, WI 53707-1028. TRICARE does not guarantee to pay the entire remaining bill. The total payment cannot be more than TRICARE allows.

For help contacting the OHI company or filing a secondary claim, call 1-888-TRIWEST, or visit www.triwest.com for more information.