Other Health Insurance and TRICARE Overseas Claims

TRICARE is always the last payer. If the patient has any other health insurance, that insurance generally pays first and TRICARE pays after it, so TRICARE needs to know about it and needs to see what the other insurer did. Overseas, this most often means national health insurance, travel insurance, a Medicare Advantage plan or the VA Foreign Medical Program.

What counts as other health insurance

The DD Form 2642 asks about any other plan or program, including travel insurance and health coverage available through other family members. For patients overseas it says this includes national health insurance. Block 11b lists employment (group), private (non-group), Medicare, student plan, Medicare supplemental and prescription plans. Block 11c, for overseas claims, adds travel insurance, Medicare Advantage and the VA Foreign Medical Program.

Two details from the form:

• Do not report TRICARE supplemental insurance.
• Do report Medicare supplements.

TRICARE explains the new overseas options this way: travel insurance bought for a trip is primary to TRICARE, and some Medicare Advantage plans provide coverage when traveling overseas, which is also primary to TRICARE.

What to do, in order

1. Send the claim to the other insurer first. The form says all other health insurance except Medicaid and TRICARE supplemental plans must pay before TRICARE will.
2. Wait for its decision.
3. Attach its explanation of benefits (EOB) or work sheet to your TRICARE claim, showing what it paid or denied.
4. Complete block 11 on the DD Form 2642. It has room for two plans. If there are more, report them on a separate sheet of paper and attach it. Our form guide shows block 11 filled in.

For care overseas, the form says to include the EOBs for any portion a travel insurance or Medicare Advantage plan reimbursed. If the VA Foreign Medical Program reimbursed a portion of the services, include a copy of the FMP EOB. TRICARE says this keeps it from duplicating a payment the VA made for a service-connected disability. See TRICARE Overseas vs. the VA Foreign Medical Program.

Keep your record up to date

TRICARE’s overseas site says overseas claims cannot be properly processed if your other insurance is up to date but has not been declared. If you used to have other insurance and it ended, you need to tell TRICARE it was terminated. You can update your other health insurance in the secure claims portal under your Family Profile, or fill in the TRICARE Other Health Insurance Questionnaire and return it using the contact details on the TRICARE Overseas site.

Why it matters

The form states that the claims processor cannot process a claim until you provide the other health insurance information. Its fraud notice also lists, as an example of fraud, a beneficiary who fails to disclose other medical benefits or health insurance coverage. When in doubt, report it.

How PaidTrail helps

PaidTrail keeps a person’s other insurance plans on file, fills in block 11 from them, and reminds you to attach the other insurer’s EOB when a claim needs one.