Humana Military Other Health Insurance Form

To be completed by member.

Humana military other health insurance form. Payment activities with other health insurance that may be available to you or members of your family. Overseas international sos country specific toll free numbers. If you have any health insurance other than tricare it is called other health insurance ohi. Third party liability claim form.

Public facility use certification form. Additional sheet with the additional insurance information and attach to this form. State victims of crime compensation programs. This includes your tricare doctor your contractor or a subcontractor.

East region humana military 1 800 444 5445. Tricare supplements don t qualify as other health insurance ohi. Tricare other health insurance questionnaire. You have any other non appealable issue.

99 other locations. Other health insurance complete this form to notify your contractor that you have other health insurance health insurance you have in addition to tricare such as medicare or an employer sponsored health insurance. This statement serves to inform you of the purpose for collecting personal information required by humana military automated information system and how your personal information will be used. Health benefits claim form.

Using other health insurance. For use with the humana family of health insurance and health plan companies. By law tricare pays after all other health insurance except for. The grievance may be against any member of your health care team.

Box 8968 madison wi 53707 8968 fax. Continued health care benefit program chcbp chcbp is a premium based plan that offers temporary transitional health coverage for 18 to 36 months after tricare eligibility ends. It can be through your employer or a private insurance program. When you do tricare is the second payer.

Download and submit your region s other health insurance form. It acts as a bridge between military health benefits and your new civilian health plan. Box 740061 louisville ky 40201 7461. Employee member name last first m i 2.

Tricare other health insurance ohi questionnaire. Release of information if payment is to be sent directly to provider. Request authorization for disclosure of health information. Provide the same information as given in 2.

Appointment of representative form for appeals and grievances. Tricare east region attn. Send third party liability form to. Third party liability p o.

Claim form dd2642 other health insurance ohi coverage questionnaire. West region health net federal services 1 844 866 9378.