TRICARE is the primary payer for active duty service members (ADSMs). For all other beneficiaries, TRICARE is the secondary payer to all health benefits and insurance plans, except for Medicaid, TRICARE supplements, the Indian Health Service, and other programs and plans as identified by the TRICARE Management Activity (TMA).

If you have other health insurance (OHI), you need to follow the OHI’s rules for filing claims and file the claim with them first. If there is an amount your OHI does not cover, you can file the claim with TRICARE for reimbursement. It is important to follow the requirements of your OHI. If your OHI denies a claim for failure to follow its rules, such as obtaining care without authorization or using a non-network provider, TRICARE may also deny your claim.

Keep Humana Military and health care providers informed about your OHI so they can better coordinate your benefits and help ensure that there is no delay (or denial) in the payment of your claims.

Note: Many employers, including state and local governments, offer TRICARE-eligible employees a TRICARE supplement as an incentive not to enroll in the employer’s primary group health plan. Please inform your employers of the illegality of this practice and report any continued noncompliance to the TRICARE Program Integrity unit at:

TRICARE Program Integrity
16401 East Centretech Parkway
Aurora, CO 80011

You may also report noncompliance to Humana Military's Program Integrity Unit online or the TRICARE Fraud and Abuse web site.
         

Pharmacy Claims and Other Health Insurance

When you have OHI, your OHI is the first payer for pharmacy coverage, and the rules of that insurer apply. After your OHI has paid, your TRICARE coverage may reimburse you for part or all of your out-of-pocket costs, including copayments. Your best option with OHI is to use a retail pharmacy that is covered by your OHI and is also a TRICARE retail network pharmacy to avoid using the POS option.

You are not eligible to use the Mail Order Pharmacy if you have OHI with a prescription plan, including a Medicare Part D prescription program, unless you meet one of the following requirements:

• Your OHI does not include pharmacy benefits.
• The medication you need is not covered by your OHI.
• You have met your OHI’s benefit cap (i.e., you have met your benefit’s maximum coverage limit).

Once you have met one of these requirements, you may submit your prescription to the Mail Order Pharmacy. See “Mail Order Pharmacy” in the Covered Services, Limitations, and Exclusions section for instructions on how to use the Mail Order Pharmacy program.

Contact Express Scripts at 1-877-363-1303 with questions about filing pharmacy claims with OHI.

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