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Beneficiary Handbook
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TRICARE Prime POS option and the Catastrophic Cap
Other Health Insurance
Third Party Liability |
TRICARE Prime POS option and the Catastrophic Cap |
| The TRICARE Prime beneficiary’s out-of-pocket cost while utilizing POS is not accrued against the catastrophic cap. However, there is no cap on POS out-of-pocket expenses. The beneficiary cost-share will remain at 50 percent of the TRICARE allowable charge even after the catastrophic cap has been reached. |
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| Other Health Insurance |
| TRICARE is the secondary payer to all health benefits and insurance plans, except for Medicaid, TRICARE supplements, the Indian Health Service, and other programs/plans as identified by the TRICARE Management Activity (TMA). If you have other health insurance (OHI), you are not required to obtain referrals or authorizations for covered services, except for those that require pre-authorization. A former spouse covered by an employer-sponsored OHI plan is not eligible for TRICARE. |
Please inform your provider and Humana Military if you have OHI so that your benefits can be coordinated and so there is no delay in payment of claims. |
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| Third Party Liability |
| The Federal Medical Recovery Act allows TRICARE to be reimbursed for its costs of treating you if you are injured in an accident that was caused by someone else. The DD Form 2527 Statement of Personal Injury Third Party Liability Form will be sent to you if a claim is received that appears to have third party liability involvement. Within 35 calendar days, you must complete and sign this form and follow the directions for returning the form to the appropriate claims processor. |
Understanding Your TRICARE EOB
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