The new year is here, so it’s important to review 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 not now. Or perhaps you have recently acquired or changed OHI. In each of these cases, make sure your OHI information is current with TRICARE so that 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 program analyst at the Defense Health Agency. “This will help them send your bills to the correct payer and avoid delays.”
Do you have OHI? Learn what is required of you and how your two plans work together. Here are some questions and answers to help.
Q: What type of health insurance is OHI?
A: OHI is any insurance you have other than TRICARE. It can be through your employer, your spouse’s employer, or a private insurance program. But TRICARE supplemental plans do not count toward OHI.
Q: Do you have to report your OHI?
A: yes You must disclose any other health insurance coverage you have in addition to TRICARE. Keeping your OHI information up to date with your TRICARE contractors and providers will ensure fast and accurate claims processing. You can report your OHI using any of the options below:
Q: Does OHI or TRICARE pay first?
A: By law, TRICARE pays after all OHI. The exceptions to this are:
- Medicaid
- TRICARE Supplement Plans
- State crime victim compensation programs
- Other federal government programs identified by the Defense Health Care Agency
After your OHI processes your claim, you or your doctor submit a TRICARE claim. Note that if TRICARE receives your claim before your OHI, TRICARE will deny the claim. If TRICARE paid first and later learns you had OHI, TRICARE will take back any payments it made and process the claim again after your OHI processes it.
Q: How does other dental insurance work with the TRICARE dental program?
A: If you are an active family member with dental coverage through the TRICARE Dental Program (TDP) and have other dental insurance, be sure to complete and submit Other Dental Insurance Coverage Questionnaire of United Concordia, the TDP contractor. This will ensure your claims are processed correctly. United Concordia will work with your other insurance company to determine the coordination of benefits. Depending on the situation, TDP can act as primary or secondary payer.
If you have dental coverage through the Federal Employees Dental and Vision Insurance Program (FEDVIP) and you have other dental insurance, contact your FEDVIP dental carrier or other insurance provider if you have questions about coordinating your benefits.
Q: What if you have OHI with pharmacy benefits?
A: 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 have lost or changed your OHI. When you have OHI with pharmacy benefits, your OHI pays first and TRICARE pays second. Read it How to use TRICARE and OHI at the pharmacy to learn more about OHI and your pharmacy benefit.
Q: How do TRICARE For Life and OHI coordinate benefits?
A: How Medicare coordinates with your OHI depends on whether you have OHI based on your current job. Regardless, TRICARE always pays last. You can find more information about OHI at TRICARE Handbook for Life and the Medicare website.
Q: What else is important to know about OHI?
A: When you have OHI, keep in mind:
- If you are on active duty, you cannot use OHI; TRICARE is your only coverage.
- Losing or receiving OHI is a qualifying life event.
- If you lose OHI, TRICARE becomes your primary payer.
- You must comply with all the requirements of your OHI plan.
- The services you get must be from a TRICARE-authorized provider, whether they are in-network or out-of-network.
- OHI must process the claim before TRICARE can review the charges.
Start 2023 off right by notifying your TRICARE contractors and providers that you have OHI. Also let them know if your OHI status has changed. Following this important step will make it easier to manage your health throughout the year.
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