Get the free TRICARE PLUS ENROLLMENT APPLICATION

This document is intended for individuals eligible for the TRICARE Plus program who wish to enroll and outlines the necessary information and procedures for completion.

How to fill out tricare plus enrollment application

How to fill out TRICARE PLUS ENROLLMENT APPLICATION

1. Obtain the TRICARE PLUS Enrollment Application form from the official TRICARE website or your local TRICARE office.
2. Read the instructions carefully to understand the eligibility requirements and necessary information.
3. Fill out your personal information, including your name, address, phone number, and military affiliation.
4. Provide your sponsor's details, including their Social Security number and military ID number.
5. Indicate your desired primary care manager, if applicable, or select 'any available' if you prefer.
6. Complete the demographic section for any eligible dependents you wish to enroll, providing their names and information.
7. Sign and date the application form to certify the accuracy of the information provided.
8. Submit the completed application via mail or in-person to your designated TRICARE office, and keep a copy for your records.

Who needs TRICARE PLUS ENROLLMENT APPLICATION?

1. Active duty service members and their families.
2. Retired service members and their families.
3. Surviving spouses and children of deceased service members.
4. Individuals who require a primary care manager and access to additional TRICARE benefits.

People Also Ask about

Who is eligible for TRICARE Plus?

You may be eligible to enroll in TRICARE Plus if you're: TRICARE-eligible and not enrolled in a TRICARE Prime plan, the US Family Health Plan, or a civilian or Medicare Health Maintenance Organization. A dependent parent or parent-in-law.

Where can I check my TRICARE eligibility?

You can check your eligibility easily in milConnect. Sign into milConnect and select the Benefits menu. If "Beneficiary Web Enrollment (BWE)" displays, you are listed as eligible in DEERS.

What is the difference between TRICARE Standard and TRICARE Extra?

With TRICARE Standard, you choose TRICARE-authorized providers outside of the TRICARE network and pay higher cost-shares. With TRICARE Extra, you choose providers within the TRICARE network, where available, and pay lower cost-shares.

How do I contact TRICARE enrollment?

Call your regional contractor: East Region — Humana Military: 800-444-5445. West Region — TriWest Healthcare Alliance: 888-874-9378.

Is TRICARE Prime the same as TRICARE Overseas?

TRICARE Prime Overseas works like the stateside TRICARE Prime program with similar benefits, requirements, and costs. ADSMs stationed overseas must enroll in TRICARE Prime Overseas or TRICARE Prime Remote Overseas and there are no enrollment fees.

What patients are eligible for TRICARE?

Those eligible for TRICARE include: Active duty service members and family members. National Guard and Reserve members and family members. Retired service members and family members. Retired Reserve members and family members. Beneficiaries eligible for TRICARE and Medicare. Survivors. Children. Former spouses.

Who is most eligible for TRICARE?

Who is eligible for TRICARE? Uniformed Service members and their families. National Guard and Reserve members and their families under federal orders more than 30 consecutive days or at the discretion of the state governor. Survivors. Certain former spouses. Medal of Honor recipients and their families.

What is form 2853?

Form SSA-2853 is a Social Security Administration form that provides an individual with proof that an application for a Social Security number (SSN) for a newborn occurred at the hospital through the enumeration at birth process.

For pdfFiller’s FAQs

What is TRICARE PLUS ENROLLMENT APPLICATION?

The TRICARE PLUS ENROLLMENT APPLICATION is a form used by eligible beneficiaries to enroll in the TRICARE Plus program, which provides access to primary care services at military treatment facilities.

Who is required to file TRICARE PLUS ENROLLMENT APPLICATION?

Eligible active duty service members, retirees, and their family members who wish to receive primary care services through TRICARE Plus are required to file the TRICARE PLUS ENROLLMENT APPLICATION.

How to fill out TRICARE PLUS ENROLLMENT APPLICATION?

To fill out the TRICARE PLUS ENROLLMENT APPLICATION, beneficiaries need to provide personal information, including name, contact information, and sponsor details. They must also indicate their preferred military treatment facility and sign the application.

What is the purpose of TRICARE PLUS ENROLLMENT APPLICATION?

The purpose of the TRICARE PLUS ENROLLMENT APPLICATION is to enroll beneficiaries in the TRICARE Plus program, allowing them to access enhanced primary care services at designated military treatment facilities.

What information must be reported on TRICARE PLUS ENROLLMENT APPLICATION?

The TRICARE PLUS ENROLLMENT APPLICATION requires reporting of information such as the beneficiary's full name, date of birth, contact information, family member details, and the selected military treatment facility.