Title 10, United States Code (U.S.C.), Section 1095 authorizes military treatment facilities (MTFs) to recover the cost of providing health care services to covered DOD beneficiaries from third party payers. The Third Party Collection Program (TPCP) is the military program established to accomplish this task.
All beneficiaries, excluding active duty, are required to provide information regarding other health insurance (OHI) coverage annually, or when there is a change in their coverage status. MTF business offices bill OHI, or third party payers, directly for reasonable charges for care, minus the beneficiary's applicable deductible or copayment amount. DOD beneficiaries are not responsible for deductibles or copayments. The rates used for billing are included in the Inpatient Adjusted Standardized Amounts (ASA) and Outpatient rate packages, approved annually by the Assistant Secretary of Defense for Health Affairs. Funds collected through the TPCP are used to enhance health care delivery at the MTF providing the care.
Frequently Asked Questions
Read the following questions and answers to learn more about collection and verification of other health insurance information.
Q1:
What is other health insurance (OHI)?
A:
Other health insurance (OHI) is any health insurance policy covering medical, dental, or pharmacy that you may have through your employer or private insurance company. TRICARE, TRICARE Supplemental plans, Medicare, Medicaid, and certain government-sponsored programs are not OHI. If you have OHI and are covered by TRICARE, federal law requires military treatment facilities (MTFs) to collect reasonable payments from third party payers (unless you are active duty). The money collected (commonly referred to as “reimbursement” or “remittance”) supports the operation and maintenance budget of the MTF where you receive your care. OHI reimbursements help your MTF improve the quality of health care.
Q3:
Who has to complete this form?
A:
All DOD beneficiaries, except active duty, are required to complete the DD Form 2569. This includes active duty family members, retirees, and family members of retirees.
Q4:
How often do I have to complete the DD Form 2569?
A:
At every visit, you are required to inform DOD about any OHI you have or any changes since your last appointment. A DD Form 2569 must be completed annually and when your insurance coverage or information changes. Health plan information (see below) can change between appointments and from year to year. Please verify that you have the most up-to-date health insurance information from your insurance provider and report it on the DD Form 2569.
Q5:
What are my responsibilities?
A:
Provide information about your OHI coverage. This information includes:
- Policy name and number
- Coverage type
- Patient relationship to insured
- Policy effective dates
OHI will not limit your access to care. But if you intentionally fail to provide information about your OHI, you could be disqualified for health care services from MTFs.
Q6:
Will I get a bill if OHI does not pay or pays only a portion of the MTF bill?
A:
No. You will not be billed for care at an MTF (except for subsistence costs related to inpatient care or co-pays for TRICARE services provided downtown). In every case in which payment from a third party payer is received, it will be considered as satisfying the normal medical services or subsistence charges, and you will not have to make any further payment.
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