Tricare Help: Does Tricare need to know about primary insurance? - Getting out, military health issues - Navy Times

Tricare Help: Does Tricare need to know about primary insurance?

Q. We’re using Tricare as our secondary insurance with United Health Care. Do I need to let Tricare know our primary insurance information? Also, I need the address that the claims should be mailed to — we are in the North Region.

A. It’s not necessary for you to advise Tricare of your other health insurance as long as you use that insurance first. There will be a space on its claim form for the name and address of your other plan, which is Tricare.

By federal law, Tricare is always last payer to all other sources of medical payments, including other health insurance, medical plans such as health maintenance organizations, or medical payments from insurance payments or a lawsuit.

The only time Tricare pays first is if the other coverage is a bona fide, specially written Tricare supplement or a welfare-related plan such as Medicaid (not Medicare).

As you correctly assumed, you must file all claims with your commercial plan first. After it completes processing and issues an Explanation of Benefits, it will probably forward the claim to Tricare as second payer. If it does not, you’ll have to do it yourself.

The Tricare claim must consist of:

• A properly completed Tricare Claim Form DD 2642.

• A copy of exactly the same bills that were submitted to the other plan.

• A copy of the other plan’s EOB reporting its actions (payment, denial, crediting to the deductible) on each of the charges submitted to the other plan.

For official information and instructions about filing the claim with Tricare, including the filing addresses for all regions, click here.

Q. My fiancé served three years on active duty and three years in the Army Reserve in the 1980s. Most recently, he served six years in the National Guard, and his enlistment was just up this past September. He is 40 percent disabled and has medical coverage from the Veterans Affairs Department. I am an independent contractor and not eligible for employer-sponsored health insurance. When we get married, would I be eligible for any health insurance, either through Tricare or another option?

A. It sounds like your fiancé did not serve long enough in uniform to be eligible for Tricare. In that case, neither would you, as his spouse, meet the legal criteria for Tricare eligibility. To confirm that, and for official information about your and his Tricare eligibility, call the Defense Enrollment Eligibility Reporting System support office at 800-538-9552.

Write to Tricare Help, Times News Service, 6883 Commercial Drive, Springfield, VA 22159; or click here to email us. In email, include the word “Tricare” in the subject line and do not attach files. Get Tricare advice anytime on our blog.