TRICARE is the primary payer for active duty service members. For active duty family members, 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.

If you have 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 their rules, such as obtaining care without authorization or use of 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.

When you have OHI, your OHI pays first 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 in the TRICARE retail network to avoid using the POS option.

You may not use TRICARE’s mail-order pharmacy if you have prescription drug coverage from OHI, unless the medication is not covered under your OHI, or you exceed the dollar limit of coverage under your OHI.

Contact ESI at 1-866-DoD-TRRX (1-866-363-8779) with questions about filing pharmacy claims with OHI.