Tricare Help: If other health insurance is available, do we have to take it? - Getting out, military health issues - Navy Times

Tricare Help: If other health insurance is available, do we have to take it?

Q. My husband has Tricare Prime. He is considering a full-time job with full benefits. If health insurance is an optional benefit, does Tricare require that he take it?

A. No, Tricare neither requires nor forbids its beneficiaries from enrolling in other health insurance. It is completely up to the beneficiary. However, if he is enrolled in other health insurance, federal law requires that he file claims with that plan first.

After the other health insurance has processed the claim, paid its maximum amount and issued an explanation of benefits, the beneficiary or the provider may file a Tricare claim for all amounts the other insurance left unpaid. Usually, those will include the patient’s co-payment and, when applicable, the deductible. That is commonly called the “patient’s share” of the bill.

The Tricare claim must consist of:

• A properly completed Tricare Claim Form DD 2642.

• A copy of the bill that was sent to the other health insurance.

• A copy of the other insurance’s EOB reporting its actions on each of the charges on the provider’s bill.

Send the package to the proper Tricare claims processing contractor for your place of residence.

For help filing claims, to find claim filing addresses and phone numbers, and to download claim forms, click here or call the Tricare Service Center for your region.

Q. If a woman divorced from a retired military member is enrolled in Tricare under the 20-20-20 rule, does she remain eligible for Tricare if the sponsor dies?

A. If the sponsor dies, the former spouse’s Tricare eligibility will continue. The only thing that will end eligibility is if the former spouse remarries. You can confirm this by calling the Defense Enrollment Eligibility Reporting System, or DEERS, at 800-538-9552.

For readers unfamiliar with the 20-20-20 rule, it is the provision that grants benefits to former spouses who were married for at least 20 years to service members with at least 20 years of active duty, as long as there is at least 20 years of overlap between the marriage and the service.

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