If you have health insurance coverage with a prescription plan in addition to TRICARE, such as coverage through an employer or a private plan you’ve purchased, it is known as other health insurance (or OHI). It is important to know what is required of you and how your two plans work together.
Federal law requires you to disclose other health insurance
Most importantly, you must disclose other health insurance you carry in addition to TRICARE. To avoid any delays and complications in processing your prescription claims, please download and complete a TRICARE Other Health Insurance Form and mail it to:
P.O. Box 60903
Phoenix, AZ 85082-0903
You may need to contact your insurance company directly to obtain some required information. Please note that supplemental and discount prescription drug programs do not count as OHI pharmacy coverage.
How do I know if I have OHI?
Use the information below to help determine if you have OHI. Once we know what kind of coverage you have, we can better coordinate your benefits and make sure prescription claims are paid on time.
|Type of Coverage||Do You Have OHI?|
|Private or employer insurance with a prescription drug benefit||Yes|
|Medicare A, B, C or D* only||No|
|Drug discount club membership only (for example, AARP, Senior Friends)||No|
|Medicare Supplement Program only (for example, USAA, TROP, AARP||No|
|*If you have Medicare Part D: You must submit claims to Medicare first, and then to TRICARE.|
Other health insurance and TRICARE Pharmacy Home Delivery
You are not eligible to use TRICARE Pharmacy Home Delivery if you have OHI with a prescription plan, including the 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 (meaning that you have met your benefit’s maximum coverage limit)
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. Click here for details on how to get started with Home Delivery.
You must include documentation, such as a copy of an explanation of benefits (EOB), which shows your OHI did not pay. This information must be sent with your prescription for it to be filled by TRICARE Pharmacy Home Delivery.
Other health insurance and TRICARE retail network pharmacies
By law, your OHI will be the primary payer for your prescriptions with TRICARE becoming the secondary payer.
TRICARE only 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
When filling your prescription at a retail network pharmacy, tell your pharmacist you have TRICARE coverage in addition to your OHI. Ask your pharmacist to 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
Keep your receipts to submit for reimbursement
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).
Submit this form, along with your OHI explanation of benefits and your receipt (both documents are necessary to process reimbursement) to:
Express Scripts, Inc.
P.O. Box 52132
Phoenix, AZ 85082
A note to National Guard & Reserve members with line-of-duty care:
National Guard and Reserve members with line-of-duty care should contact the Military Medical Support Office at 1.888.647.6676 for help with pharmacy reimbursement.