Get the free DD Form 2876, TRICARE Prime Enrollment Application and PCM ... - tricare

... is published at http://dpcld.defense.gov/Privacy/SORNsIndex/ BlanketRoutineUses.aspx. ... You may enroll, disenroll, or change your PCM by calling your Regional Contractor or US ... www.tricare.mil

How to fill out dd form 2876 tricare

How to fill out dd form 2876 tricare:

1. Start by obtaining a copy of the dd form 2876 tricare. This form is typically available online on the tricare website or can be obtained from your healthcare provider.
2. Begin by filling out the personal information section at the top of the form. This will include your full name, social security number, date of birth, and contact information.
3. Next, provide the information about your sponsor. This would typically be the person who is eligible for tricare benefits and is responsible for your healthcare coverage. Include their full name, social security number, and contact information.
4. In the next section, indicate your relationship to the sponsor. This could be a spouse, child, or other qualified dependent.
5. Moving on, provide information about your other health insurance coverage, if any. This could include information about any private insurance plans or coverage under another government program.
6. The form also requires you to provide information about any other tricare coverage you may have, such as through a different sponsor or as a dual eligible beneficiary.
7. In the next section, you will be asked to select the tricare plan you are applying for or wish to be enrolled in. This could be tricare Prime, tricare Select, or another available option.
8. Complete the remainder of the form by providing any additional requested information, such as your signature, date, and any supporting documentation that may be required.

Who needs dd form 2876 tricare:

1. Active duty military personnel who are enrolling their dependents in tricare coverage.
2. Military retirees and their families who are enrolling in or making changes to their tricare coverage.
3. National Guard and Reserve members and their eligible dependents who are applying for or modifying their tricare benefits.
4. Survivors of deceased military members who are seeking tricare coverage.
5. Certain Department of Defense (DoD) civilian employees and their families who are eligible for tricare benefits.
6. Other individuals who are eligible for tricare benefits through specific programs or circumstances.

Please note that the above information is a general guide and it is recommended to consult the official instructions provided with the dd form 2876 or seek assistance from a tricare representative for specific guidance on filling out the form.

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What is dd form 2876 tricare?

DD Form 2876 is a form used by Tricare beneficiaries to authorize payment to a health care provider.

Who is required to file dd form 2876 tricare?

Tricare beneficiaries who want to authorize payment to a health care provider are required to file DD Form 2876.

How to fill out dd form 2876 tricare?

DD Form 2876 can be filled out by providing the required information such as the beneficiary's details, the provider's information, and the authorization for payment.

What is the purpose of dd form 2876 tricare?

The purpose of DD Form 2876 is to authorize payment to a health care provider for services rendered to a Tricare beneficiary.

What information must be reported on dd form 2876 tricare?

Information such as the beneficiary's details, the provider's information, and the authorization for payment must be reported on DD Form 2876.