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Forms & Claims

Find the form you need or information about filing a claim.

Other Health Insurance

Complete this form to notify your contractor that you have other health insuranceClick to closeHealth insurance you have in addition to TRICARE, such as Medicare or an employer-sponsored health insurance. TRICARE supplements don’t qualify as "other health insurance." (OHI). When you do, TRICARE is the second payer.

Download Form Submit To:

East OHI Questionnaire

TRICARE East RegionClick to closeUnder the new regional contracts, the East Region is a merger of the North and South Regions and includes: Alabama, Arkansas, Connecticut, Delaware, the District of Columbia, Florida, Georgia, Illinois, Indiana, Iowa (Rock Island area), Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri (St. Louis area), New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas (excluding El Paso area), Vermont, Virginia, West Virginia, and Wisconsin.
P.O. Box 7981
Madison, WI 53707-7981

Fax: 608-221-7536 

West OHI Questionnaire 

Health Net, LLC
P.O. Box 202102
Florence, SC 29502-2102

Overseas OHI Questionnaire 

 

TRICARE Overseas
P.O. Box 7992
Madison, WI 53707-7992 (USA) 

TRICARE For Life OHI Questionnaire

WPS/TRICARE For Life
P.O. Box 7889
Madison, WI 53707-7889 

Last Updated 6/8/2018