DD 2876 2008 free printable template

TRICARE PRIME ENROLLMENT APPLICATION AND PCM/PCP CHANGE FORM Please read Agency Disclosure Notice Privacy Act Statement and Instructions before completing this form. X one Prime Enrollment Prime Remote US Family Health PCM/PCP Change 1. SPONSOR SOCIAL SECURITY NUMBER SSN 2. SPONSOR NAME Last First Middle Initial Must match DEERS 3. SPONSOR DATE OF BIRTH Active Duty 5. RESIDENCE ADDRESS 6. MAILING ADDRESS Retired Deceased Go to Section II. 4. SPONSOR IS SECTION I SPONSOR INFORMATION YYYYMMDD...

How to fill out DD 2876

How to fill out DD 2876

1. Obtain a copy of DD Form 2876 from the official Department of Defense website or your unit's administrative office.
2. Fill in your personal information in Section 1, including your name, Social Security number, and contact information.
3. In Section 2, indicate your current military status and the reason for completing the form.
4. If applicable, complete Section 3 with information regarding dependent status.
5. Sign and date the form in Section 4 to certify the information provided is accurate.
6. Review the completed form for any errors before submission.
7. Submit the form to the appropriate military personnel office or your commanding officer.

Who needs DD 2876?

1. Military service members who are applying for certain benefits or entitlements related to their service.
2. Members of the National Guard and Reserve components.
3. Individuals who have dependents and need to update their information in military records.

• What is the DD Form 2876 for?
• Who fills the DD Form 2876?
• What documents must accompany the DD Form 2876?

What is the DD Form 2876 for?

The DD Form 2876 is for the following: (a) to allow eligible beneficiaries to apply for enrollment in TRI CARE Prime, TRI CARE Prime Remote, or Uniformed Services Family Health Plan; (b) to allow enrolled to change to a new region for TRI CARE programs; (c) to allow enrolled to update their personal contact information to include addresses, phone numbers, and email within the same region for the TRI CARE programs.

Who fills the DD Form 2876?

Individuals who belong to the noted eligible categories fill the DD Form 2876 for the above-mentioned purposes. The eligible categories include: (1) guard and reserve component members as well as active duty members or those ordered or called to active duty for the period exceeding 30 days; (2) survivors of active duty and active duty family members; (3) family members of guard and reserve members ordered or called to active duty for a period exceeding 30 days; (4) qualified retirees, members of their families, survivors and eligible ex-spouses under the age of 65 who live in the USA; (5) retired family members, retirees, active duty family members, survivors and eligible former spouses who are entitled to Medicare Part A.

What documents must accompany the DD Form 2876?

If the applicant elects a monthly allotment from retired pay as the payment method for his enrollment fees, he must also complete and submit the allotment authorization letter.

How long does it take to fill the form out?

The public reporting burden for collection of this information averages about 15 minutes per response.

What sections should I fill?

The applicant should fill the following sections: (1) Sponsor Information; (2) Enrolling Family Member Information or PCM Change; (3) Other Health Insurance; (4) Reason for PCM Change; (5) Access Waiver; (6) Signature; and (7) Payment of TRI CARE Prime Enrollment Fees.

Where do I send the DD Form 2876?

The address where the applicant should submit the form depends on the region he lives in. You can find the address of the respective U.S. Family Health Plan at: www.tricare.mil

The applicant should retain a carbon copy of the form for his records.

People Also Ask about

Can I switch my TRICARE plan?

Change plans. If you're already enrolled in a TRICARE Prime option or TRICARE Select, you can switch plans and switch between individual and family enrollment.

Can I switch from TRICARE Prime to TRICARE Select?

If you're eligible, you can enroll in or change your enrollment in TRICARE Prime or TRICARE Select. You can only do this during the annual TRICARE Open Season or following a Qualifying Life Event (QLE). A QLE is a certain change in your life, such as moving, marriage, birth of a child, or retirement from active duty.

Can I have a civilian PCM with TRICARE Prime?

TRICARE can't assign you to a military hospital or clinic located more than 100 miles from your address without Defense Health Agency approval. Any civilian PCM must be a TRICARE network provider within a Prime Service Area.

Why was i disenrolled from TRICARE Prime?

If you don't pay your TRICARE Prime enrollment fees (if applicable), you'll be disenrolled. You have 90 days from the day you were disenrolled to catch back up on any missed payments without a break in coverage.

Can I change my TRICARE plan online?

Change your plan: If you're already enrolled in a TRICARE Prime or TRICARE Select plan, you can switch health plans. You can also switch between individual and family enrollment. You can change plans online, by sending in an enrollment form or by calling us.

How do I change my primary care provider with TRICARE?

How to Change Your PCM Go to the milConnect website. Click on the blue "Sign In" button at the top of the page. Go to the Family Members list and select whose PCM you want to change. On the Medical Enrollments tab, select the "Change PCM" button. On the “Change PCM” page, select the reason you want to change your PCM.

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What is DD 2876?

DD 2876 is a Department of Defense form used for reporting the results of a physical examination for enlistment and assignment purposes.

Who is required to file DD 2876?

Individuals seeking to enlist in the military, or those who need to update their medical records for duty assignment or transfer, are required to file DD 2876.

How to fill out DD 2876?

DD 2876 should be filled out by providing personal information, medical history, and relevant examination results as instructed on the form.

What is the purpose of DD 2876?

The purpose of DD 2876 is to evaluate an individual's fitness for military service and to ensure they meet the required health standards.

What information must be reported on DD 2876?

Information required on DD 2876 includes personal identification details, medical history, results from physical examinations, and any necessary medical documentation.