Tricare ohi form 2026

1. Click ‘Get Form’ to open the TRICARE Other Health Insurance (OHI) questionnaire in the editor.
2. Begin by indicating whether you or any family members have OHI coverage by selecting 'Yes' or 'No'. If 'Yes', proceed to complete the questionnaire for each insurance policy.
3. Fill in the coverage type by checking all applicable boxes such as HMO/PPO, Medicare, Medicaid, etc. Provide your policy number and policyholder's name in the designated fields.
4. Enter the group/plan number, SSN/DBN, and sponsor ID. Additionally, include the name of the insurance carrier along with their address and phone number.
5. Specify the effective and expiration dates of your policy. Check all benefits provided by this policy like pharmacy, dental, vision, etc.
6. List covered members under this policy including their relationship to the policyholder, gender, date of birth, and SSN/DBN.
7. Finally, review your entries for accuracy. Sign and date the form before submitting it via fax or mail as instructed on page one.

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