Other Health Insurance (OHI)

TRICARE is the secondary payer to all health benefits and insurance plans, except for Medicaid, TRICARE supplements, the Indian Health Service, or other programs/plans as identified by the TRICARE Management Activity TMA. TRICARE beneficiaries who have other health insurance OHI are not required to obtain referrals or prior authorizations for covered services, except in the case of the services listed below, which continue to require prior authorization even when OHI coverage exists.

• Adjunctive dental care
• Behavioral health services
  • All non-emergent inpatient admissions for substance use disorder or behavioral health
  • Partial hospitalization programs and residential treatment center programs
  • Psychotherapy after the initial eight outpatient visits
  • Psychoanalysis
• Extended Care Health Option (ECHO) services
• Home health services
• Hospice services
• Solid organ and stem cell transplants

Additionally, if the OHI benefits are exhausted, TRICARE becomes the primary payer and additional referral/prior authorization requirements may apply.
 
Providers are encouraged to ask the beneficiary about OHI so that benefits can be coordinated. Since OHI status can change at any time, it is important to obtain this information from the beneficiary on a routine basis, including from family members of activated National Guard/Reserve members. If a beneficiary’s OHI status changes, make sure to update patient billing system records to avoid delays in claim payments. If a provider indicates that there is no OHI, but DEERS or the contractor’s files indicate otherwise, a signed or verbal notice from the beneficiary will be required to inactivate the OHI record.
 
Payment Guidelines