Get Dd 2876 Spouse Enrollment Application Form

Filling out the Dd 2876 Spouse Enrollment Application Form online is a straightforward process that ensures your partner's enrollment in TRICARE. This guide provides clear instructions to help you complete the form efficiently and accurately.

Follow the steps to fill out the Dd 2876 Spouse Enrollment Application Form.

1. Click 'Get Form' button to acquire the Dd 2876 and open it in your preferred online editing tool.
2. In Section I, provide the sponsor information. Select the appropriate enrollment type (e.g., Prime Enrollment, US Family Health Plan Enrollment) by marking the corresponding option. Complete the sponsor's social security number, name, date of birth, residence address, mailing address (if different), and telephone numbers.
3. Proceed to Section II to enroll family members. Include each family member's name, date of birth, residence address, relationship to the sponsor, and contact details. Repeat this step for additional family members by copying the section as necessary.
4. In Section III, indicate if any enrolling family members have other health insurance. If yes, provide the required details as instructed.
5. If applicable, complete Section IV to specify the reason for any changes to the Primary Care Manager (PCM). Explain the reasons as required.
6. In Section V, read and sign your acknowledgment of the access waiver if you are outside the service area, providing your relationship to the sponsor and the date signed.
7. Finally, sign in Section VI, confirming that all provided information is accurate. Enter your relationship to the sponsor and the date signed.
8. For retirees, fill out Section VII regarding payment options for TRICARE Prime enrollment fees. Choose the payment method that applies and provide the requested details.
9. Once all sections are completed, review your entries for accuracy. Save your changes, and download or print the form for submission as required.

Start completing the Dd 2876 Spouse Enrollment Application Form online today!