Get the free DD Form 2876 TRICARE Prime Enrollment Disenrollment and PCM Change Form 20130321 dra...

OMB No. 07200008 OMB approval expires Feb 29, 2016 TRI CARE PRIME ENROLLMENT, DISENROLLMENT, AND PRIMARY CARE MANAGER (PCM) CHANGE From The public reporting burden for this collection of information

How to fill out dd form 2876 tricare

How to fill out DD Form 2876 Tricare:

1. Start by downloading DD Form 2876 Tricare from the official Tricare website or obtain a physical copy from the nearest Tricare office.
2. Begin filling out the basic information section of the form, including your full name, address, contact number, and email address.
3. Provide your sponsor's full name (if applicable) and ensure that all other dependent-related fields are accurately completed.
4. Indicate your relationship to the sponsor by checking the appropriate box (spouse, child, other).
5. If you are submitting the form for multiple dependents, ensure that each dependent's information is clearly stated and separated on the form.
6. In the "Beneficiary Information" section, provide all the necessary details about the dependent(s) you are enrolling, including their names, dates of birth, social security numbers, and relationship to the sponsor.
7. If any medical conditions or special circumstances exist, accurately describe them in the relevant sections of the form.
8. Fill out the "Other Health Insurance (OHI)" section if applicable, providing details about any other insurance coverage the dependents may have.
9. If you are a dependent who is unable to provide the sponsor's information, consult the instructions or seek assistance to ensure proper completion of the form.
10. Once you have completed filling out all the required sections of the form, review it thoroughly to ensure accuracy and completeness.
11. Sign the form and date it at the designated area.
12. Make a copy of the filled out form for your records before submitting it.
13. Submit the completed DD Form 2876 Tricare to the appropriate Tricare office or follow the instructions provided on the form regarding submission methods.

Who needs DD Form 2876 Tricare?

1. Active duty service members who wish to enroll eligible dependents in Tricare.
2. Retired service members who want to enroll eligible dependents in Tricare.
3. Survivors of deceased service members who are eligible for Tricare benefits.
4. Eligible dependents, such as spouses and children, seeking access to Tricare benefits and coverage.
5. Those who want to update or make changes to their existing Tricare enrollment.
6. Individuals undergoing life events, such as marriage, divorce, or the birth of a child, that affect their Tricare coverage.
7. Any individual required to provide proof of eligibility or dependency for Tricare benefits.
8. Those who wish to apply for Tricare Transitional Assistance Management Program (TAMP) coverage.
9. Individuals seeking to enroll in overseas Tricare coverage.
10. Those who need to report changes in their dependent status or insurance coverage that may affect their Tricare benefits.

Note: It is important to carefully review the specific eligibility requirements and instructions provided on the DD Form 2876 Tricare and consult Tricare officials or resources if there are any questions or uncertainties.

For pdfFiller’s FAQs

What is dd form 2876 tricare?

DD Form 2876 Tricare is a form used by Tricare beneficiaries to report any other health insurance coverage they may have.

Who is required to file dd form 2876 tricare?

Tricare beneficiaries who have other health insurance coverage are required to file DD Form 2876.

How to fill out dd form 2876 tricare?

DD Form 2876 can be filled out by providing information about the other health insurance coverage, policy number, and name of the insurance company.

What is the purpose of dd form 2876 tricare?

The purpose of DD Form 2876 is to inform Tricare of any other health insurance coverage a beneficiary may have in order to coordinate benefits.

What information must be reported on dd form 2876 tricare?

The information that must be reported on DD Form 2876 includes details about the other health insurance coverage such as policy number and insurance company name.

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