Coordination of Benefits

Coordination of Benefits (COB) is the process used to determine the order of payment when a TRICARE beneficiary has other health insurance (OHI) in addition to TRICARE. Federal law generally requires TRICARE to be the last payer, meaning other insurance plans pay their share before TRICARE covers remaining costs.

How COB works with TRICARE: • Other Health Insurance pays first (primary payer) • TRICARE pays second (secondary payer) up to the TRICARE-allowable charge • The beneficiary may owe any remaining balance • Total payments cannot exceed the provider's actual charges

Common situations involving COB: • Spouse has employer-sponsored health insurance • Beneficiary has Medicare and TRICARE • Auto insurance covers injuries from a car accident • Workers' compensation covers work-related injuries • Beneficiary has VA benefits for service-connected conditions

TRICARE as secondary payer: • Pays after most employer-sponsored plans • Pays after Medicare for eligible beneficiaries • Pays after auto and liability insurance • Pays after workers' compensation

Reporting other health insurance: • You must report OHI to your regional contractor • Update DEERS with OHI information • Failure to report OHI can delay claims processing • OHI information must be updated when changes occur

Having dual coverage can significantly reduce your out-of-pocket costs, as TRICARE often covers the remaining balance after your primary insurance pays.