TRICARE and other health insurance can be a balancing act Published Dec. 30, 2008 By Ric Carlson 21st Medical Group PETERSON AIR FORCE BASE, Colo. -- Understanding one insurance plan may be a little confusing. Understanding two can be even harder. Many TRICARE beneficiaries are eligible for Other Health Insurance (OHI) and balancing the plans is key to seeking care and filing claims. OHI is health care coverage offered to a TRICARE beneficiary. It may be available through an employer, an association, a private insurer, school health coverage for students or an entitlement program such as Medicare. It is essential beneficiaries understand their OHI so they know how the provider network, referral, prescription and claims process works. To clarify some specifics on how OHI works with TRICARE, check out TRICARE's web page on OHI at www.tricare.mil/OHI. Although there are a few exceptions, federal law requires TRICARE to be the secondary payer to OHI. Beneficiaries could experience denials or delays in processing if they do not inform the appropriate managed care support contractor, TRICARE for Life, Pharmacy contractors or the claims processor about their OHI. Beneficiaries must file with their OHI provider before filing with TRICARE. A copy of the beneficiaries OHI payment determination and a copy of the itemized bill, at a minimum, should be included with the TRICARE claim form. If their provider doesn't file TRICARE claims on their behalf, beneficiaries must remember to submit claims to TRICARE after their OHI pays. TRICARE beneficiaries may choose to purchase a TRICARE supplemental insurance policy offered, for example, by some military associations and private companies. Unlike OHI, which pays for health care services before TRICARE pays, these supplemental programs pay after TRICARE. For details see the "supplemental insurance" under www.tricare.mil/OHI. Knowing OHI policies is critical to making choices in healthcare plans and TRICARE officials urge all beneficiaries to become more familiar with OHI and how it can affect their TRICARE benefit. Beneficiaries with OHI who need more information on how to file claims can visit www.tricare.mil/claims or stop by their local TRICARE Service Center for details and forms.