How TRICARE Works with Other Health Insurance
Active Duty Service Members
- Active duty service members (including activated National Guard and Reserve members) can't use other health insurance as their primary insurance. TRICARE is the primary payer and coordination of benefits with other insurance carriers does not occur.
- Active duty service members who have other health insurance (OHI) require an approval from Health Net Federal Service, LLC (HNFS) for all services.
All Other Beneficiary Categories
All other beneficiaries with OHI (excluding Medicare) only require a prior authorization for applied behavior analysis services.
The OHI must be used before TRICARE. Health coverage through an employer, association, private insurer, school health care coverage for students, or Medicare is always primary to TRICARE.
Exceptions are: Medicaid, State Victims of Crime Compensation Programs, Department of Veterans Affairs (DVA)/Veterans Health Administration (VHA), the Maternal and Child Program, the Indian Health Service, and plans specifically designated as TRICARE supplements.
Important Things to Know
- All requirements of the OHI plan must be followed. If the OHI denies a claim because OHI authorization requirements were not followed or because a network provider was not used, TRICARE will also deny the claim and the beneficiary will be responsible for the denied charges.
- The OHI must process the claim before TRICARE can consider the charges.
- If the OHI denies the claim for services not medically necessary, all appeal rights with the OHI must be used before TRICARE can process the claim.
- Services must be provided by a TRICARE network or non-network provider.
- If the OHI changes, TRICARE beneficiaries must update their OHI information.
Reimbursement
