Civilian Employer Coverage with TRICARE
Many military families have access to civilian employer-sponsored health insurance through a spouse's job or the service member's civilian employment (for Reserve/Guard members). When you have Other Health Insurance (OHI), TRICARE acts as the secondary payer after your employer plan pays first. This coordination of benefits can significantly reduce your out-of-pocket costs, as TRICARE may cover remaining copayments, deductibles, and coinsurance from your primary plan. You are not required to use your employer insurance, but using both together can provide more comprehensive coverage. TRICARE must be informed of any OHI through DEERS.
Timeline
Enroll in employer-sponsored health insurance during open enrollment or QLE
Update DEERS with Other Health Insurance (OHI) information
Understand coordination of benefits (employer pays first, TRICARE second)
Provide both insurance cards to providers at each visit
File claims with employer insurance first, then TRICARE
Review Explanation of Benefits from both plans
Action Checklist
- Evaluate whether employer insurance is worth the premium cost alongside TRICARE
- Update DEERS with OHI information
- Understand which plan is primary and which is secondary
- Carry both insurance cards to all appointments
- Inform providers about dual coverage at each visit
- File claims with employer insurance first
- Review EOBs from both plans to ensure proper coordination
- Consider TRICARE Select for more flexibility with dual coverage
- Monitor annual changes to both plans during open enrollment periods
Plan Impact
TRICARE coverage continues unchanged but acts as secondary payer when OHI exists. You must still maintain TRICARE enrollment. TRICARE Select often works better with OHI since it does not require PCM referrals. TRICARE Prime members with OHI can still use their employer plan providers without Prime referrals when using OHI as primary.
Cost Impact
Having OHI with TRICARE can reduce out-of-pocket costs to near zero. Your employer plan pays first, and TRICARE covers most of the remaining balance. You still pay employer insurance premiums but may save significantly on copayments and deductibles. TRICARE enrollment fees (for retirees) still apply. Pharmacy benefits coordinate similarly with OHI covering first.
Required Forms & Documents
- DD Form 1172-2 (DEERS update with OHI information)
- Employer insurance card and policy details
- Coordination of Benefits form from employer plan
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