What is TRICARE Other Health Insurance (OHI)? | TRICARE.com

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## Definition Other Health Insurance (OHI) refers to any non-TRICARE health insurance coverage you have through an employer, a private plan, or another government program like Medicare.

## What it means in practice If you have Other Health Insurance, TRICARE legally acts as the secondary payer in most situations. This means your other insurance must process the claim first. Once they have paid their portion and sent you an Explanation of Benefits (EOB), the provider then submits the remaining balance to TRICARE. TRICARE will then pay the remaining out-of-pocket expenses (deductibles, cost-shares, or copayments) up to the TRICARE-allowed amount.

There are two primary exceptions to the "TRICARE Pays Last" rule: Medicaid and the Indian Health Service. In these specific cases, TRICARE pays before those programs. However, for standard employer-sponsored plans (including the Federal Employees Health Benefits or FEHB program) or student health plans, you must follow the OHI rules. If you fail to inform TRICARE about your other insurance, they may deny your claims or later demand a "recoupment" of funds paid in error.

Managing OHI requires proactive communication. You must report your OHI status to your regional contractor—**Humana Military** in the East Region or **TriWest Healthcare Alliance** in the West Region. For pharmacy benefits, you must notify **Express Scripts**. Because TRICARE is secondary, you generally do not need a TRICARE referral for specialty care if your primary insurance covers the visit, though you must still see a TRICARE-authorized provider to ensure the secondary payment is processed.

One specific strategy for 2026 beneficiaries is the use of TRICARE Supplement insurance. While technically a form of OHI, these are specific commercial plans designed to wrap around TRICARE coverage to pay for the 20% or 25% cost-shares. These are the only private plans where TRICARE still acts as the primary payer.

## Related terms * **Coordination of Benefits (COB):** The process of determining which insurance plan pays first and how much the secondary plan pays. * **Explanation of Benefits (EOB):** A document from your primary insurance showing what they paid and what you owe, which is required for TRICARE to process secondary claims. * **Double Coverage:** A general term used when a beneficiary is covered by both TRICARE and one or more other health insurance plans. * **T-5 Contract:** The fifth generation of TRICARE contracts (effective 2025/2026) that transitioned the West Region to TriWest Healthcare Alliance. * **Third Party Liability (TPL):** A legal claim TRICARE has against other insurance companies to recover costs for care related to accidents or injuries.

## Sources * TRICARE.mil: Using Other Health Insurance [https://www.tricare.mil/ohi] * TRICARE.mil: Filing Claims with OHI [https://www.tricare.mil/FormsClaims/Claims/OHI] * Defense Health Agency: Coordination of Benefits Guidelines [https://health.mil]