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Other Health Insurance (OHI)

What is Other Health Insurance (OHI)?

If you have health insurance in addition to TRICARE, such as insurance through your employer or a private insurance program, it is called "other health insurance" or OHI. It is important to understand how your TRICARE pharmacy benefit works with your other insurance.

How does my TRICARE pharmacy benefit work with my other health insurance?

By law, your OHI will be the primary payer for your prescriptions, with TRICARE becoming the secondary payer.

TRICARE becomes the first payer when:

  • The drug is not covered by your OHI, but is covered by TRICARE, or
  • Coverage under your OHI is exhausted for the benefit year

Do I have to notify Express Scripts that I have OHI?

Yes. Full disclosure of OHI is a requirement under your TRICARE plan. It is important that Express Scripts has your current OHI information.

Please complete this form (PDF file) and follow the instructions (found in Section III) to mail the form to Express Scripts. If you have a question about the form or need assistance, please call Express Scripts at 877.363.1303.

How does my OHI work with TRICARE Pharmacy Home Delivery?

You are not eligible to use TRICARE Pharmacy Home Delivery if you have OHI with a prescription plan, including 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)

What should I do if I meet one of the above three requirements?

If you meet one of these three requirements, you may submit your prescription to TRICARE Pharmacy Home Delivery. Ask your doctor or provider to write a prescription for up to a 90-day supply of medication. (Read here for details on how to get started with Home Delivery.)

Important: If your medication is not covered by your OHI or if you have met your benefit maximum, you will need to include documentation, such as a copy of an explanation of benefits (EOB) that shows your OHI did not pay. This information must be sent with your prescription for it to be filled by TRICARE Pharmacy Home Delivery.

What do I need to know about OHI and using TRICARE retail network pharmacies?

When filling a prescription at a retail network pharmacy, you should tell your pharmacist if you have TRICARE coverage in addition to your OHI. Your pharmacist will submit your prescription to both insurance plans at the same time. Letting your pharmacist know you have two prescription plans means:

  • Minimal out-of-pocket expenses for you
  • Never paying more than the TRICARE copayment
  • No need to submit paper claims
  • Reduced or eliminated up-front costs

Is Medicare Part A, B, C or D coverages considered OHI?

Medicare A, B and C coverages are not considered OHI. Medicare Part D coverage is considered OHI.

Can I use TRICARE Pharmacy Home Delivery if I have Medicare Part A, B, or C?

Yes

Can I use TRICARE Pharmacy Home Delivery if I have Medicare Part D?

It depends. Since Medicare Part D is considered OHI, you are not eligible to use Home Delivery unless you meet one of the following requirements:

  • The medication you need is not covered by your OHI
  • You have met your OHI’s benefit cap (meaning that you have met your benefit’s maximum coverage limit)

Can I use a retail pharmacy if I have Medicare Part A, B, C or D*?

Yes. *Medicare Part D is considered OHI, so tell your pharmacist you have TRICARE coverage in addition to your OHI coverage. If you have OHI with pharmacy coverage, you’re required to use it for your prescriptions filled using TRICARE. By law, your OHI will be the primary payer for your prescriptions with TRICARE becoming the secondary payer.

Do supplemental and discount prescription drug programs, such as Senior Friends and AARP, count as OHI pharmacy coverage?

No

Should I keep my receipts to submit for reimbursement?

Yes. Once you’ve exceeded the dollar limit for your OHI or if the drug isn’t covered by your OHI, you can file a claim with TRICARE for reimbursement within one year from the date your prescription was filled. Fill out the Patient’s Request for Medical Payment (DD 2642) found on the TRICARE website here.

Submit this form along with your OHI explanation of benefits, and your receipt to:
Express Scripts, Inc. P.O. Box 52132 Phoenix, AZ 85082
Important: Both documents are necessary to process reimbursement.

What if I am a National Guard or Reserve member?

To obtain pharmacy reimbursement, National Guard and Reserve members with line-of-duty care should contact the Military Medical Support Office at 1-888-647-6676.

For help or more information, call Express Scripts at 877.363.1303 or visit tricare.mil/pharmacy/claims.


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