What is the Third Party Collections/OHI/Compliance card Program?

The Third Party Collections/OHI/Compliance Card is our way of easily ensuring that the DD Form 2569 has been completed without the inconvenience of having you, our patients, fill out a new form each time a visit is made within the facility. The form is filled out once a year, or more often if you have an inpatient stay, any ambulatory procedure visit (outpatient surgery) or a change in insurance status. Per DoD Instruction 6010.1 5m Chapter 4, all non- active duty beneficiaries are required to fill out a DD Form 2569, whether or not they have Other Health Insurance.

Please present your card at the time of check-in at each patient intake area where you are seeking health care services. The OHI card is valid for one year, if information remains the same. A new DD Form 2569 will need to be completed when your expiration date is reached. This expiration information is listed on the card for your convenience. Compliance Cards can be issued by the TPC Representative at the facility where you receive your health care.

The Third Party Collection (TPC) Program was legislated by Congress in 1986. It obligates Department of Defense (DoD) Military Treatment Facilities (MTFs) to bill private health insurance carriers such as Blue Cross/Blue Shield, Mail Handlers, Aetna, etc., for the cost of medical care furnished to retirees and family members covered by their own health insurance policies. This includes all medical benefits such as inpatient care, outpatient care, and ancillary services such as pharmacy items.

Private health insurance policies are billed, that is why we use the term “Third Party”. MTFs can only collect for services covered by your third party health insurance plan according to your benefits with the plan.

By law, your insurance policy rates cannot go up or be canceled just because a claim is filed. Health insurance is not like automobile insurance, your rates will not go up when you file a claim. Your Tricare Benefits stay the same no change is made when reporting your Other Health Insurance to your MTF.

Health care is expensive and costs are continuously rising. The law requires all MTFs to recover some of these costs if you are covered by a civilian insurance company. We understand that health care is an earned service benefit. Billing your private insurance carrier will help us offset the cost of care and allow for improvements to the quality of care you receive at the MTF.

How do I get a card?

Items 1 – 6b:  Complete with patient’s information. 

• DoD Regulations require that one form be completed for each non-active duty family member.

Items 7a, b, and c: Check the appropriate item that applies. 

• If your answer is 7a, indicating other health insurance proceed with instructions for completing items (DOES NOT INCLUDE MEDICARE, MEDICAID OR TRICARE COVERAGE IN ITEMS)  You may also bring your OHI card to Laura Reynolds at Andrew Rader US Army Health Clinic and she can make a copy of your OHI Card.
• If your answer is 7b, indicating that you have only TRICARE, Medicare or Medicaid coverage proceed with instructions for completing items 12-13 a & B. 
•  If your answer is 7c, ONLY PATIENTS THAT DO NOT HAVE TRICARE (NOT DOD BENEFICIARIES) SHOULD COMPLETE THIS SECTION proceed with instructions for completing items 11 – 16b.

Items 12a – 12f: Please read item 12 for an understanding of certification, release and assignment.

Items 13a – 13b: If the patient is a minor under 18 years of age and you are their parent or legal guardian, please sign your name in item 13a and indicate your relationship to the patient.  Patients over 18 years of age  MUST SIGN AND DATE the DD Form 2569 themselves.  If you are legally authorized to sign on behalf of the patient example: Power of Attorney, Guardian, Conservator etc, you must sign your name and indicate your legal title on the signature line.

Items 14a – 14b: This is for Military Treatment Facility use only.

Items 15 – 17c: Used for annual re-certification of information on the DD Form 2569.   Do not sign in item 16a unless directed to do so.

Once you've completed the DD Form 2569, you can turn it in to the Specialty Clinic front desk, the Medical Records window or the Primary Care Clinic front desk at which time you'll be given your new OHI Card.