Get Bprimeb Reconsideration Request Bformb - Uhc Military West

The BPrimeb Reconsideration Request BFormb is essential for users seeking to manage their TRICARE Prime enrollment and benefits. This guide will provide step-by-step instructions on how to complete the form online accurately and efficiently.

Follow the steps to effectively complete the BPrimeb Reconsideration Request BFormb.

1. Click the ‘Get Form’ button to obtain the form and open it in your browser.
2. Fill in the TRICARE Prime sponsor information section. This includes the sponsor's last name, first name, middle initial, Social Security Number (SSN) or Department of Defense Beneficiary Number (DBN), home address, and contact details including email and phone numbers.
3. In the next section, specify the action you are requesting. Choose one of the options: Reinstate coverage, Reenroll coverage, or Retroactively enroll coverage. Provide the requested effective date if applicable.
4. Provide a detailed explanation regarding your request in the specified section. Make sure to list each person to be reinstated, reenrolled, or retroactively enrolled. If you need more space, attach an additional page.
5. Submit supporting documentation relevant to your request, such as proof of payment or any other necessary documents.
6. Sign the request form using the sponsor's signature, spouse's signature, or the signature of a legal guardian for the beneficiary. Remember that the request will not be processed without a valid signature.
7. Finally, once all details are complete, you can save any changes, download, print, or share the form before mailing or faxing it to the provided address for UnitedHealthcare Military & Veterans.

Complete your BPrimeb Reconsideration Request BFormb online today to ensure timely management of your TRICARE Prime services.