TRICARE Other Health Insurance Form - Express Scripts 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Section I: Personal Information. Fill in your DoD ID, date of birth, last name, first name, and middle initial. Ensure all details are accurate.
3. Next, provide the sponsor's information by entering their DoD ID, date of birth, last name, first name, and middle initial.
4. Complete your mailing address and contact numbers. Include your email address for any follow-up communications.
5. Move to Section II: OHI Information. Indicate if anyone in your family has other health insurance (OHI) and specify if it’s through the sponsor’s or spouse’s employer.
6. Fill in the OHI policyholder's full name and relationship to the sponsor. Provide details about the insurance company including its address and phone number.
7. In this section, also include prescription ID card information such as ID number, RxBIN, RxPCN, and effective date.
8. Finally, review Section III: Authorization. Sign and date the form before submitting it back to Express Scripts at the provided address.

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