Get Refund Request Form Beneficiary Enrollment Fees - Tricare

This guide provides a step-by-step approach to filling out the Refund Request Form for Beneficiary Enrollment Fees under Tricare. It is designed to help users navigate the form process easily and confidently.

Follow the steps to successfully complete your refund request form.

1. Click 'Get Form' button to obtain the form. This will allow you to access the refund request document and open it in your designated editor.
2. Fill in your coverage type by marking the appropriate box. Options include Prime, TRS (TRICARE Reserve Select), TRR (TRICARE Retired Reserve), or TYA (TRICARE Young Adult).
3. Enter the sponsor's name. Fill in the last name, first name, and middle initial, followed by the sponsor's Social Security Number (SSN) or Department of Defense Benefits Number (DBN).
4. If applicable, input the TYA beneficiary's name. Complete the last name, first name, and middle initial, and provide their Social Security Number or ID.
5. Provide your home address, including the street, apartment number, city, state, and ZIP code to ensure accurate correspondence.
6. Specify the dollar amount for the refund you are requesting in the allocated field.
7. Clearly indicate the reason for your refund request by entering the details in the designated area.
8. Include any supporting documentation required to support your request, such as active duty orders or, if applicable, a copy of the death certificate for a deceased beneficiary.
9. Authorize your request by signing in the field provided and date your signature to confirm your request.
10. Once completed, mail the form to the designated address for UnitedHealthcare Military & Veterans or fax it to the specified number.

Start your refund request process online today by filling out the form.