DD 2876 2011 free printable template

TRI CARE PRIME ENROLLMENT APPLICATION AND PRIMARY CARE MANAGER (PCM) CHANGE FORM (Please read Agency Disclosure Notice, Privacy Act Statement, and Instructions before completing this form.) AGENCY

How to fill out DD 2876

How to fill out DD 2876

1. Begin with the header section and fill out your name, Social Security number, and address.
2. Specify your military status by checking the appropriate box (active duty, reserve, etc.).
3. Indicate the type of application you are submitting by selecting from the provided options.
4. Provide details related to your medical history, such as previous injuries or illnesses.
5. Fill in personal information regarding emergency contacts.
6. Ensure all sections are signed and dated where required.
7. Review the entire form for completeness and accuracy before submission.

Who needs DD 2876?

1. Members of the military who are applying for a certificate of eligibility for educational benefits.
2. Veterans seeking to verify their educational benefits.
3. Dependents of military personnel who are applying for benefits.

• What is the DD Form 2876 for?
• Who fills the DD Form 2876?
• What documents must accompany the DD Form 2876?

What is the DD Form 2876 for?

The DD Form 2876 is for the following: (a) to allow eligible beneficiaries to apply for enrollment in TRI CARE Prime, TRI CARE Prime Remote, or Uniformed Services Family Health Plan; (b) to allow enrolled to change to a new region for TRI CARE programs; (c) to allow enrolled to update their personal contact information to include addresses, phone numbers, and email within the same region for the TRI CARE programs.

Who fills the DD Form 2876?

Individuals who belong to the noted eligible categories fill the DD Form 2876 for the above-mentioned purposes. The eligible categories include: (1) guard and reserve component members as well as active duty members or those ordered or called to active duty for the period exceeding 30 days; (2) survivors of active duty and active duty family members; (3) family members of guard and reserve members ordered or called to active duty for a period exceeding 30 days; (4) qualified retirees, members of their families, survivors and eligible ex-spouses under the age of 65 who live in the USA; (5) retired family members, retirees, active duty family members, survivors and eligible former spouses who are entitled to Medicare Part A.

What documents must accompany the DD Form 2876?

If the applicant elects a monthly allotment from retired pay as the payment method for his enrollment fees, he must also complete and submit the allotment authorization letter.

How long does it take to fill the form out?

The public reporting burden for collection of this information averages about 15 minutes per response.

What sections should I fill?

The applicant should fill the following sections: (1) Sponsor Information; (2) Enrolling Family Member Information or PCM Change; (3) Other Health Insurance; (4) Reason for PCM Change; (5) Access Waiver; (6) Signature; and (7) Payment of TRI CARE Prime Enrollment Fees.

Where do I send the DD Form 2876?

The address where the applicant should submit the form depends on the region he lives in. You can find the address of the respective U.S. Family Health Plan at: www.tricare.mil

The applicant should retain a carbon copy of the form for his records.

Instructions and Help about DD 2876

People Also Ask about

Does DEERS automatically enroll you in TRICARE?

What if I register my child in DEERS late? Your child is automatically enrolled in TRICARE Select when registered in DEERS.

Do I have TRICARE Prime or Select?

Are you enrolled in a plan, but not sure which one? If so, you can find out which plan you're enrolled in: By logging into your account in Defense Enrollment Eligibility Reporting System (DEERS) via milConnect, or. By calling your regional contractor.

How do I know if I am enrolled in DEERS?

Check your DEERS record You can do this online through the milConnect website. What are some things to check? As described in the TRICARE Qualifying Life Events Fact Sheet, your DEERS record lists your service status, family status, and other information like your TRICARE coverage.

How do I enroll my dependents in TRICARE?

Your spouse and step-child(ren) must be registered in Defense Enrollment Eligibility Reporting System (DEERS). Go to any ID card-issuing office to add your spouse to DEERS. You'll need the following documents (originals or certified copies): Marriage certificate. Spouse's birth certificate. Spouse's Social Security card.

What happens if you miss a TRICARE payment?

If your payment doesn't go through because of insufficient or unavailable funds, the contractor will mail you a past due notice. If you don't make a payment, your TRICARE Retired Reserve coverage will be suspended as of the last day of the last month paid. Your coverage will be suspended for 12 months.

Am I automatically enrolled in TRICARE?

You don't have to enroll to use TRICARE For Life—coverage is automatic as long as you are registered in the Defense Enrollment Eligibility Reporting System and have Medicare Part A & B.

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What is DD 2876?

DD 2876 is a form used by the Department of Defense (DoD) for reporting and documenting various financial transactions.

Who is required to file DD 2876?

Military members and relevant DoD employees who are involved in financial management or transactions, such as those related to military pay and benefits, are required to file DD 2876.

How to fill out DD 2876?

To fill out DD 2876, carefully follow the instructions provided on the form, ensuring to enter all required information accurately and completely, including personal identification details and transaction specifics.

What is the purpose of DD 2876?

The purpose of DD 2876 is to maintain accurate records of financial transactions and to ensure compliance with Department of Defense financial regulations.

What information must be reported on DD 2876?

DD 2876 must report information such as the name, social security number, details of the transaction, and any associated amounts or financial data relevant to the report.