Get Dd Form 2876, Tricare Prime Enrollment, Disenrollment, And ... - Tricare

The DD Form 2876 is essential for users seeking to manage their TRICARE Prime health coverage, enabling enrollment, disenrollment, or changes to their primary care manager. This guide provides a clear and supportive walkthrough for completing the form effectively.

Follow the steps to fill out the DD Form 2876 accurately.

1. Press the ‘Get Form’ button to access the document and open it in your preferred editor.
2. Fill in the sponsor's information, including their name, social security number or DoD benefits number, and their contact details. Ensure that the name matches the information in the Defense Enrollment Eligibility Reporting System (DEERS).
3. Indicate the sponsor's status by selecting one of the checkboxes (active duty, retired, etc.) and provide their mailing and residential address.
4. Specify the action you wish to take by checking one of the options: enroll, transfer enrollment, change primary care manager (PCM), or disenroll. Note any effective date if applicable.
5. List your preferred primary care managers. You can indicate two choices along with their specialties and gender preference, keeping in mind that availability can vary.
6. If enrolling additional family members, repeat the relevant fields for each member, providing names, dates of birth, actions, and their PCM preferences.
7. In Section III, provide reasons for any disenrollment or PCM change, selecting the appropriate options for each family member.
8. Disclose any other health insurance coverage in Section IV by specifying the providers and details as necessary.
9. Review Section V regarding any waivers and ensure to sign and date the form, confirming the accuracy of the information provided.
10. Complete Section VI if applicable, detailing payment options for TRICARE Prime enrollment fees, if enrolling as a retiree or eligible former spouse.
11. Once all fields are filled out correctly, save your changes, download a copy if needed, print the form, or share it as required.

Complete your TRICARE enrollment documents online for a streamlined experience.