If you have any health insurance other than TRICARE, it is called Other Health Insurance (OHI). It can be through your employer or a private insurance program. By law, TRICARE pays after all OHI, except for:

• Medicaid
• TRICARE supplements
• State victims of crime compensation programs
• Other federal government programs identified by the Defense Health Agency (DHA)

This means your OHI processes your claim first. Then, you or your provider files your claim with TRICARE. Your provider MUST be TRICARE-certified for TRICARE to pay up to the TRICARE Maximum Allowable Charge (TMAC) on covered services. If TRICARE receives your claim before your OHI processes it, TRICARE will deny it. If TRICARE pays first and later discovers you had OHI, TRICARE will take back any payments made and will reprocess the claim after your OHI has processed it.

Are you active duty?

• You can not use OHI
• TRICARE is your only coverage

Do you have Medicare?

• TRICARE will pay after Medicare and your OHI for TRICARE-covered services. Learn more
• Visit the Medicare website to see which plan - Medicare or your OHI - pays first

Enrolled in TRICARE's Autism Care Demonstration (ACD)?

• You are required to follow the referral and prior authorization requirements outlined in the ACD in addition to following the requirements of your OHI.

Do you have a newborn?

• If you have a newborn and the birthing parent has OHI, your OHI provider may automatically extend the newborn 30-days of coverage. Be sure to notify Defense Enrollment Eligibility Reporting System (DEERS).

Are you 26 or younger and still on your parents’ insurance?

• Confirm with your parent who is the plan sponsor if they have OHI before calling customer service to change your OHI status. This will avoid delays and denials in processing of claims.

Keep your OHI information up-to-date!

If you are adding, removing or changing OHI, you will need to notify TRICARE and all assigned providers to prevent future claims issues. If you only contact TRICARE to remove your OHI and don’t notify your provider, your provider will submit a claim with OHI which will cause your OHI information to automatically be added back to your account when the claim processes and the claim will deny for OHI.

Notifying both TRICARE and your provider of any OHI updates prior to any scheduled appointment should prevent claim delay or denial due to OHI.