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  • Dd Form 2853 Feb 2014

Get Dd Form 2853 Feb 2014

TRICARE PLUS ENROLLMENT APPLICATION (Read Agency Disclosure Notice, Privacy Act Statement, and Instructions before completing form.) OMB No. 0720-0028 OMB approval expires Feb 28, 2017 AGENCY DISCLOSURE.

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How to fill out the Dd Form 2853 Feb 2014 online

This guide provides clear and concise instructions for completing the Dd Form 2853 online. Properly filling out this form is essential for eligible beneficiaries who wish to enroll in TRICARE Plus.

Follow the steps to successfully complete the form online.

  1. Click ‘Get Form’ button to access the Dd Form 2853 and open it in the appropriate online editor.
  2. Begin filling out Section I - Sponsor Information. Provide the sponsor's social security number or DoD benefits number, full name, and date of birth in the specified format (YYYYMMDD). Ensure that all information matches that in the Defense Enrollment Eligibility Reporting System (DEERS).
  3. Complete the mailing address, residence address (if different), and telephone numbers for the sponsor. Include both home and work contact numbers where indicated.
  4. Indicate your first and second choices for a primary care provider or military treatment facility (MTF) by marking the appropriate boxes. Ensure these providers are known and that the user is under their care, if applicable.
  5. In Section II, enroll any family members by providing their names, dates of birth, and addresses. Use the 'same as sponsor' option where applicable for ease.
  6. Review and understand the information in Section VI regarding the TRICARE Plus program, including its nature and limitations. Sign and date the application in Section III as confirmation of accuracy.
  7. After filling out all necessary fields and sections, save your changes, and review the form for any errors. Ensure all information is complete before final submission.
  8. Download or print the finalized form for your records. Submit the original completed form to the Military Treatment Facility where you are requesting enrollment.

Start completing your Dd Form 2853 online now to ensure a smooth enrollment process.

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Who can enroll? You may be eligible to enroll in TRICARE Plus if you're: TRICARE-eligible and not enrolled in a TRICARE Prime Plan, the US Family Health Plan, or a civilian or Medicare Health Maintenance Organization. A dependent parent or parent-in-law.

In general, TRICARE excludes services and supplies that are not medically or psychologically necessary for the diagnosis or treatment of a covered illness (including mental disorder), injury, or for the diagnosis and treatment of pregnancy or well-child care.

There are four types of TRICARE Plus health plan options available overseas: TRICARE Plus – with Direct Care Only. TRICARE Plus – with TRICARE For Life. TRICARE Plus – with Active Duty Select.

All others can choose to enroll in TRICARE Prime or TRICARE Select. TRICARE Prime offers fewer out-of-pocket costs than TRICARE Select, but less freedom of choice for providers. If you have other health insurance. TRICARE supplements don't qualify as "other health insurance.", TRICARE Prime might not be right for you.

DD Form 2853, "TRICARE PLUS ENROLLMENT APPLICATION"

Those eligible for TRICARE include: Active duty service members and families. National Guard/Reserve members and families. Retired service members and families. Retired Reserve members and families. Beneficiaries eligible for TRICARE and Medicare. Survivors. Children. Former spouses.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232