Dynamic Duo: Using TRICARE with Other Health Insurance

For family members covered by both a TRICARE plan and other health insurance (OHI), knowing how to use the two together will help ensure that claims are processed quickly and correctly.

TRICARE, in most cases, will pay second to the OHI. However, TRICARE is the primary payer if you are also entitled to a public program like Medicaid, the Indian Health Service or if you have TRICARE supplementary coverage. TRICARE beneficiaries with OHI who are unsure of how the two plans relate should visit the TRICARE Web site or contact TriWest Healthcare Alliance.

Keep your information up-to-date
If your OHI information is not up-to-date, TRICARE may delay or deny claims. Beneficiaries with OHI must complete and send in the TRICARE Other Health Insurance (OHI) Form. The OHI form is also used to report any changes to your existing OHI coverage.

Registered beneficiaries can log into the secure Beneficiary portal and find a link to monitor and update OHI information under the "Update" heading.

Submitting claims
Between your OHI and TRICARE coverage, your medical bills may be covered. In order to have TRICARE pay for care when you are also using other health insurance, follow these steps:

• First, submit medical bills (except for those from a military treatment facility) to your other health insurance company
• After the other insurance company pays part of the claim, you can submit a claim to TriWest with your OHI explanation of benefit letter showing what was paid—TRICARE does not guarantee payment of the entire remaining bill and will not pay more than the TRICARE allowable charge*
• If you follow TRICARE’s rules for obtaining care, including getting the necessary pre-authorizations and referrals, TRICARE may cover services not covered by your OHI

Know the rules
If the entire bill is not paid by OHI, you or your provider may submit a claim to be paid by TRICARE with a copy of your OHI Explanation of Benefits to:

WPS
West Region Claims
P.O. Box 77028
Madison, WI 53707-1028

Following the rules for both the OHI coverage and TRICARE coverage will help you avoid difficulties when submitting claims.

* The maximum amount TRICARE will pay for services.