**Required Attachments**

**If Applicable**

The Explanation of Benefits (EOB) from your other health insurance, if you have a primary insurance payer
A written Attestation by the Beneficiary for any paid amounts over $10,000 USD
Proof of payment is required by the government on all beneficiary submitted claims. This request for proof of payment is necessary to validate the claim in order for TRICARE to fulfill its responsibility in safeguarding benefit dollars. TRICARE may require proof of payment in accordance with federal regulations, which can be found in Title 32 Code of Federal Regulations (CFR) Section 199.4. Research has been established to show that proof of payment is routinely required for claims outside the United States for private plans as well as other Federal programs.

Forms