Get the free DD Form 2947, TRICARE Young Adult Application, November 2012 - hopkinsmedicine

TRI CARE YOUNG ADULT APPLICATION OMB No. 0720-0049 OMB approval expires Mar 31, 2015 DESIRED SERVICING CONTRACTOR SHOWN BELOW. The public reporting burden for this collection of information is estimated

How to fill out dd form 2947 tricare

How to fill out dd form 2947 tricare:

1. Start by entering the necessary personal information. Provide your full name, including your last name, first name, and middle initial.
2. Indicate your Social Security Number (SSN) in the designated field. Make sure to provide the accurate and current SSN.
3. Next, fill in your date of birth in the required format: month, day, and year.
4. Specify your beneficiary category by marking the appropriate box. The options include active duty service member, National Guard/Reserve service member or Line of Duty Care (LOD) sponsor, Medal of Honor sponsor, or other (specify).
5. Provide the name of your TRICARE sponsor, who is usually the active duty service member or primary reserve sponsor. Include their last name, first name, and middle initial.
6. Enter your sponsor's SSN in the designated field. Ensure the accuracy of the SSN provided.
7. Indicate your sponsor's date of birth in the required format: month, day, and year.
8. If applicable, specify your relationship to the sponsor by marking the appropriate box. Options include spouse, child, ward/dependent, parent, former spouse, or other (specify).
9. Fill in the address of your sponsor. Include the current mailing address with the street, city, state, and ZIP code.
10. If you have any other health insurance coverage, mark the appropriate box and provide the details requested.
11. Specify your contact information, including a daytime phone number with the area code, an email address (if applicable), and a fax number.
12. Sign and date the form in the designated areas. Ensure that you have accurately completed all the necessary sections.

Who needs dd form 2947 tricare?

Any eligible TRICARE beneficiaries who have a sponsor or are dependent on a sponsor for their healthcare coverage may need to fill out dd form 2947 tricare. This form is typically required in situations where the sponsor's information and other necessary details are needed for official TRICARE paperwork and documentation. It helps ensure accurate and up-to-date information for processing healthcare claims and managing TRICARE benefits.

For pdfFiller’s FAQs

What is dd form 2947 tricare?

DD Form 2947 Tricare is a form used by military members, retirees, and their dependents to request medical services under the Tricare program.

Who is required to file dd form 2947 tricare?

Military members, retirees, and their dependents are required to file DD Form 2947 Tricare when requesting medical services.

How to fill out dd form 2947 tricare?

To fill out DD Form 2947 Tricare, you must provide personal and medical information, such as name, contact details, beneficiary category, and specific medical request details.

What is the purpose of dd form 2947 tricare?

DD Form 2947 Tricare is used to request medical services and ensure proper documentation for Tricare coverage.

What information must be reported on dd form 2947 tricare?

The information reported on DD Form 2947 Tricare includes personal details, beneficiary category, medical request details, and contact information.

When is the deadline to file dd form 2947 tricare in 2023?

The deadline to file DD Form 2947 Tricare in 2023 is usually specified by Tricare and may vary. Please refer to the official Tricare guidelines for the specific deadline.

What is the penalty for the late filing of dd form 2947 tricare?

The penalty for the late filing of DD Form 2947 Tricare may vary and depend on Tricare regulations. It is recommended to consult the official Tricare guidelines or contact Tricare directly for information regarding penalties.

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