- Participating Physician Groups (PPG)
(does not apply to HSP)
The plan is primary in all instances when a member is covered by TRICARE or CHAMPVA.
Note that TRICARE/CHAMPVA takes the position that if a benefit is potentially available through an HMO, but the member does not comply with the requirements of the HMO that would enable the member to receive the benefit, such as in the case of a self-referral, TRICARE/CHAMPVA does not pay anything at all.
They do, however, cover services that the HMO excludes, but require that the member provide them with written documentation from the HMO that the service is excluded from the plan. Contact the Provider Services Department with any requests for this sort of documentation.