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Other Health Insurance Questionnaire (2024 claims)

For claims with dates of service prior to Jan. 1, 2025 ONLY:
Use this document to update your other health insurance information (OHI).

Do NOT use this form to update your 2025 OHI. Instead, go to www.tricare.mil/west. 



  • Created: May 1, 2025
  • Modified: Jan 1, 2025
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