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TRI CARE PRIME DISENROLLMENT Requestor Approved OMB No. 07200008AGENCY DISCLOSURE NOTICE The public reporting burden for this collection of information is estimated to average 5 minutes per response,

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How to fill out tricare prime disenrollment request

How to Fill out Tricare Prime Disenrollment Request:

01

Obtain the tricare prime disenrollment request form. You can get this form from the Tricare website or by contacting your regional Tricare office.

02

Fill out the personal information section completely. This includes your name, address, phone number, and any other required information.

03

Indicate the reason for your disenrollment. Tricare prime disenrollment requests are typically approved for reasons such as relocation, change in eligibility status, or dissatisfaction with the program.

04

Provide any necessary documentation to support your disenrollment request. This may include proof of relocation, change in employment status, or any other relevant documents.

05

Review your completed form to ensure all information is accurate and complete. Make sure you have signed and dated the form before submitting it.

Who Needs Tricare Prime Disenrollment Request?

01

Military personnel who are transitioning to a new duty station or are no longer eligible for Tricare prime due to a change in their military status may need to submit a tricare prime disenrollment request.

02

Dependents of military personnel who are no longer eligible for Tricare prime due to a change in their sponsor's military status or relocation may also need to submit a disenrollment request.

03

Individuals who are dissatisfied with the services or coverage offered by Tricare prime may choose to submit a disenrollment request to switch to a different Tricare program or seek alternative healthcare options.

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What is tricare prime disenrollment request?

Tricare Prime disenrollment request is a formal request to cancel or terminate enrollment in the Tricare Prime health care program.

Who is required to file tricare prime disenrollment request?

Tricare Prime beneficiaries who wish to switch to a different health care program or insurance provider are required to file a disenrollment request.

How to fill out tricare prime disenrollment request?

To fill out a Tricare Prime disenrollment request, beneficiaries can contact their regional Tricare office or visit the Tricare website for instructions and forms.

What is the purpose of tricare prime disenrollment request?

The purpose of Tricare Prime disenrollment request is to officially end enrollment in the Tricare Prime program and switch to a different health care option.

What information must be reported on tricare prime disenrollment request?

The Tricare Prime disenrollment request may require information such as the beneficiary's name, date of birth, social security number, reason for disenrollment, and desired effective date of disenrollment.

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