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How to fill out dd bformb 2877 btricare

How to fill out DD Form 2877, TRICARE DoD/CHAMPUS Prescription Form:

Step 1: Begin by entering your personal information in Section I. This includes your name, rank, Social Security number, address, and phone number.

Step 2: In Section II, indicate your relationship to the sponsor. Choose the appropriate option, such as "spouse," "child," or "other."

Step 3: If you are filling out the form on behalf of a minor or incapacitated person, provide their information in Section III.

Step 4: Proceed to Section IV and enter the sponsor's information, including their name, rank, Social Security number, address, and phone number.

Step 5: In Section V, specify the beneficiary's TRICARE program option by checking the appropriate box (e.g., Prime, Standard, Reserve Select).

Step 6: If applicable, provide the secondary insurer's information in Section VI. This step is mandatory when another health insurance plan is involved.

Step 7: Move to Section VII, where you will record the prescription details. Include the medication name, dosage, prescription number, and the provider's information.

Step 8: Indicate whether the medication is a compound drug, non-formulary drug, or third-tier benefit in Section VIII. Select the appropriate checkbox, if applicable.

Step 9: In Section IX, declare if you have any other health insurance. If you do, provide the details requested.

Step 10: Review all the information you have entered to ensure accuracy and completeness.

Step 11: Sign and date the form in Section X. If you are filling out the form on behalf of the beneficiary, check the box provided and include your relationship to the beneficiary.

Who needs DD Form 2877 (TRICARE DoD/CHAMPUS Prescription Form):

1. Active-duty military personnel who need to authorize prescription medications for themselves or their dependents.
2. Retired military personnel and their dependents who are eligible for TRICARE benefits.
3. Dependents of military personnel, including spouses and children, who require prescription medications through TRICARE.
4. Qualified National Guard and Reserve members and their dependents who are enrolled in TRICARE.
5. Civilian employees of the Department of Defense and their dependents who are covered by a TRICARE program.

It's important to note that the use and need for DD Form 2877 may vary depending on the specific circumstances and TRICARE program enrollment. It is recommended to consult with TRICARE officials or visit the official TRICARE website for any updated guidance or specific questions regarding the form's requirements.

For pdfFiller’s FAQs

What is dd Form 2877 Tricare?

Form 2877 is the TRICARE Prime Enrollment, Disenrollment and PCM Change

Who is required to file dd Form 2877 Tricare?

Active duty service members, retirees, and their eligible family members are required to file dd Form 2877 Tricare.

How to fill out dd Form 2877 Tricare?

To fill out dd Form 2877 Tricare, you need to provide personal information, PCM selection, and enrollment preferences.

What is the purpose of dd Form 2877 Tricare?

The purpose of dd Form 2877 Tricare is to enroll, disenroll or change the Primary Care Manager (PCM) for TRICARE Prime beneficiaries.

What information must be reported on dd Form 2877 Tricare?

Information such as personal details, PCM selection, and enrollment preferences must be reported on dd Form 2877 Tricare.

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