Certification of Non-Contributory TRICARE Supplement Insurance

OMB 0720-0044

OMB 0720-0044

Employers may no longer offer TRICARE supplemental insurance plans as part of an employee benefit package unless the plan is not paid for in whole or in part by the employer (i.e., is non-contributory). If such plans are offered, the employer must certify in writing that they did not provide any payment for the benefit, nor receive any direct or indirect consideration or compensation for offering the benefit; their only involvement is providing the administrative support.The employer shall provide this certification via letter to the DoD only upon request The certification document will be used to verify regulatory compliance.

The latest form for Certification of Non-Contributory TRICARE Supplement Insurance expires 2020-09-30 and can be found here.

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