Navigating your health benefits can be tricky. It gets even more complex when you have more than one health plan. TRICARE beneficiaries that have another health plan besides TRICARE need to make sure that they notify TRICARE, and in the process can save themselves valuable time and money.
Other health insurance, known as OHI, is alternate or additional insurance that is usually through an employer or a private insurance program. This does not include Medicare or a supplement to TRICARE. If your OHI isn’t recorded, TRICARE can’t coordinate your benefits and make sure that your claims are paid accurately and quickly. This creates more hassle for you in the end.
To save yourself an OHI headache, it is important to let your provider and regional contractor know once you get OHI. When you notify TRICARE about your OHI status, you are reducing the amount of paperwork when you receive care, and will help your provider submit claims with more accuracy. By law, TRICARE is required to be the second payer when you have OHI. So, it is important that beneficiaries keep TRICARE and their provider informed when they have and if they lose OHI.
Since TRICARE pays after any other health insurance plan, when filing a claim, make sure to file with your OHI first. If your other health insurance doesn’t cover the entire cost of your claim, file a claim with TRICARE and include a copy of your OHI’s explanation of benefits. The same rules apply to TRICARE’s pharmacy coverage. If you have other prescription drug coverage, that plan will pay first and TRICARE pays second. Often, this will cover the entire cost of your care or prescription. Keep in mind that you can avoid higher pharmacy costs by getting your prescriptions filled at a TRICARE network pharmacy that is also in your other plan’s network.
Even if you get your medical care at a military hospital or clinic at no cost to you, it is important that TRICARE know about your OHI. When your other insurance company pays their fair share of your health care costs it helps the military hospital provide better care for you and other patients. Keeping TRICARE informed of your additional benefits ensures the lowest cost for you, and allows TRICARE to improve the claims process while reducing fraud and abuse. To learn more about using OHI with TRICARE please visit www.TRICARE.mil/OHI.