The new year is upon us, so it’s important to review your family’s overall health plan. This is especially true when it comes to other health insurance (OHI). You may have had OHI last year, but now you don’t. Or you may have recently acquired or changed OHI. In any of these situations, make sure you have current OHI information with TRICARE, so your health care claim can be processed correctly.
“It’s important to tell your doctor and other health care providers if you have insurance 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.”
Is there an OHI? Learn what is required of you and how your two plans work together. Here are some Q&As to help.
Q: What type of health insurance is OHI?
A: OHI is any insurance you have other than TRICARE. This can be through your employer, your spouse’s employer, or a private insurance plan. But TRICARE supplement plans do not count as OHI.
Q: Do you have to report your OHI?
A: Yes. You must disclose any other health insurance you carry in addition to TRICARE. Updating your OHI information and your TRICARE contracts and services will ensure that claims are processed quickly and accurately. You can report your OHI using any of the options below:
Q: Does OHI or TRICARE pay first?
A: By law, TRICARE pays all OHI. The exceptions to this are:
- TRICARE supplement plan
- States of victims of criminal compensation programs
- Other federal programs were announced by the Defense Health Agency
After your OHI processes your claim, you or your doctor file a claim and TRICARE. Remember that if TRICARE receives your claim before your OHI, TRICARE will deny the claim. If TRICARE pays first and later finds out you have OHI, TRICARE will take back any payment made and resume the claim after your OHI has processed it.
Q: How do other dental insurances work with the TRICARE Dental Program?
A: If you are a family member who has dental insurance through the TRICARE Dental Program (TDP) and have other dental insurance, be sure to fill out and submit the Other Dental Insurance Insurance Reviews yes United Concordia, the TDP contract. This will ensure the smooth processing of your claims. United Concordia will work with your other insurance company to determine the coordination of benefits. Depending on the situation, the TDP can act as a first or second payment.
If you have dental insurance through the Federal Employees Dental and Vision Insurance Program (FEDVIP) and other dental insurance, contact your FEDVIP dental caror other insurance companies, if you have questions about coordinating your benefits.
Q: What if you have OHI and pharmacy benefits?
A: If you have OHI with your prescription, be sure to tell the pharmacy contract, Informational Information. Complete a TRICARE Other Health Insurance (OHI). and mail to Express Scripts. Contact Express Scripts if you have lost or changed your OHI. When you have OHI with prescription benefits, your OHI pays first and TRICARE pays second. Read How to Use TRICARE and OHI in Pharmacy to learn more about OHI and your pharmacy benefit.
Q: How do TRICARE For Life and OHI benefits coordinate?
A: How Medicare is coordinated with your OHI depends on whether you have OHI related to your current job. Regardless, TRICARE pays last. You can find more information about OHI at TRICARE For Life Handbook and Medicare website.
Q: What else is important to know about OHI?
A: If you have OHI, remember:
- If you work hard, you can’t use OHI; TRICARE is your only insurance.
- The loss or acquisition of OHI is a Standard of Living.
- If you lose OHI, TRICARE becomes your primary payment.
- You must follow all the requirements of your OHI plan.
- The services you get must come from a TRICARE-authorized provider givenwhether they are connected or not connected.
- OHI must process the claim before TRICARE can review the charges.
Start 2023 off right by informing your TRICARE contract and the services you have OMG. Also let them know if your OHI status changes. Following this important step will make it easier to manage your health care throughout the year.
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