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Q. I’m a retiree who is eligible for Tricare but has other health insurance, to which Tricare acts as second payer. When I receive treatment and have a co-pay, can I bill Tricare for the deductible portion of my OHI cost?
A. Yes. In most cases, Tricare will pay some, if not all, out-of-pocket costs that OHI does not. And even if Tricare does not pay those costs, either in part or in full, it’s still worth filing a secondary claim with Tricare because the amounts billed may count toward meeting your Tricare annual catastrophic cap. Your health care provider can file such claims for you.
Humana Military, one of Tricare’s regional contractors, has a comprehensive brochure about how Tricare works with OHI. You can find it here: www.humana-military.com/library/pdf/coordinating-with-medicare-ohi.pdf.
Q. I am a few months pregnant, and my military husband is about to leave for Afghanistan. I know that if he dies while deployed, all my prenatal care and the birth will be covered. But will the baby be eligible for health care coverage?
A. You have no worries. If an active-duty member dies in service, his or her spouse and children are considered “transitional survivors” for the first three years after the death. During that time, spouses and children remain covered as active-duty family members, and their Tricare options and costs do not change.
Children continue to be covered as active-duty family members for as long as they remain eligible for Tricare as the surviving children of an active-duty member. But after three years, the status of the surviving spouse shifts to that of a retired family member. That change is automatically reflected in the Defense Enrollment Eligibility Reporting System, and the surviving spouse receives a letter detailing the change. At that point, the surviving spouse remains eligible for any Tricare option for which military retirees normally are eligible, and costs are the same as that of a retiree beneficiary.
Should your husband die before the baby is born, the baby will still be covered as outlined above.
Q. I’m a 42-year-old military retiree who has just been awarded 100 percent total and permanent VA disability compensation. I am covered as a retiree under Tricare Standard. I know I can get free care at a VA facility, but if I use Tricare through a civilian provider, will VA act as a second payer?
A. No, VA will not act as a second payer, for the simple reason that the VA medical system is not “health insurance”; it is direct care, delivered through hospitals and clinics owned and operated by VA. However, Tricare considers VA to be a Tricare-authorized network provider, so Tricare will act as second payer in covering VA co-pays and deductibles.
But as a 100 percent, service-connected disabled veteran, you are in a VA beneficiary category that is never charged co-pays or deductibles. So for any care you receive in a VA facility, Tricare would never have to enter the picture as a potential second payer.
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