Civilian Employer Health Insurance & TRICARE Guide | TRICARE.com

Getting a job with health benefits doesn't mean you have to give up TRICARE. In most cases, TRICARE becomes your **secondary payer**, meaning your employer’s insurance pays first, and TRICARE covers many remaining out-of-pocket costs. This is considered a Qualifying Life Event (QLE) that allows you to change your TRICARE plan outside of the annual Open Season.

*Note: TRICARE.com is an independent reference site and is not affiliated with the Department of Defense. For official policy and enrollment, visit [TRICARE.mil](https://www.tricare.mil).*

## What changes When you gain civilian employer-sponsored insurance (ESI), TRICARE rules transition to "Other Health Insurance" (OHI) protocols. By law, your employer plan is the primary payer, and TRICARE pays second for covered services. This often results in $0 out-of-pocket costs for healthcare, but it requires diligent coordination between your doctor and both insurance companies.

## What to do — checklist 1. **Report Other Health Insurance (OHI):** Notify TRICARE that you have new coverage within 30 days of the start date. You can do this online via the [milConnect](https://milconnect.dmdc.osd.mil/) portal or by calling your regional contractor (Humana Military in the East; TriWest in the West). 2. **Evaluate Your TRICARE Plan:** Within 90 days, decide if you want to stay on your current plan or switch (e.g., from TRICARE Prime to TRICARE Select). Many find Select easier to manage with OHI because it doesn't require referrals, and the employer plan usually satisfies the Select deductible. 3. **Update Your Providers:** Give your doctor’s office your new insurance card and your Military ID. Tell them explicitly that the employer plan is primary. 4. **Coordinate Pharmacy Benefits:** If your employer plan includes pharmacy coverage, you must use it first. Inform Express Scripts of your new coverage. 5. **Check TYA/TRS Eligibility:** If you were using TRICARE Young Adult (TYA) or TRICARE Reserve Select (TRS), gaining access to an employer plan usually makes you **ineligible** for these specific TRICARE programs. You must disenroll to avoid a recoupment of benefits. 6. **Verify DEERS Information:** Ensure your contact information is current in the Defense Enrollment Eligibility Reporting System (DEERS).

## Timeline * **Day 0:** New employer coverage begins. This is the date of your Qualifying Life Event (QLE). * **Day 1–30:** Update OHI information in milConnect and notify Express Scripts. * **Day 1–90:** Window to change your TRICARE plan (e.g., moving Prime to Select) due to the QLE. * **Ongoing:** Ensure all medical claims are sent to your employer insurance first. TRICARE will deny claims if they haven't been processed by the primary insurer first.

## Common pitfalls * **Not reporting OHI:** If TRICARE pays as primary and later discovers you had an employer plan, they will "claw back" (recoup) the payments, leaving you with large bills to settle with your provider. * **Forgetting Pharmacy Coordination:** Using a TRICARE pharmacy (Home Delivery or Retail) without telling Express Scripts about your employer’s drug plan can lead to coverage rejection at the point of sale. * **Keeping TRICARE Reserve Select (TRS):** If you are a Reservist and become eligible for a Federal Employees Health Benefits (FEHB) plan or certain other employer plans, you are legally barred from using TRS. Failure to disenroll results in debt to the government. * **Assuming TRICARE Prime works the same:** If you stay on Prime, you still need referrals from your Primary Care Manager (PCM) for specialty care, even if your employer insurance doesn't require them.

## Sources * TRICARE - Using Other Health Insurance: [https://www.tricare.mil/ohi](https://www.tricare.mil/ohi) * Humana Military (East Region): [https://www.humanamilitary.com/](https://www.humanamilitary.com/) * TriWest Healthcare Alliance (West Region): [https://www.triwest.com/](https://www.triwest.com/) * TRICARE Pharmacy - Other Health Insurance: [https://www.tricare.mil/Pharmacy/OHI](https://www.tricare.mil/Pharmacy/OHI)