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TRI CARE PRIME ENROLLMENT APPLICATION AND PCM CHANGE FORM(Please read Agency Disclosure Notice, Privacy Act Statement, and Instructions before completing this form.)OMB No. 07200008 OMB approval expires

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How to fill out tricare prime enrollment application

01

Step 1: Obtain a copy of the Tricare Prime enrollment application form. You can either download it from the Tricare website or request a physical copy from your nearest Tricare office.

02

Step 2: Fill out your personal information accurately in the application form. This includes your full name, social security number, date of birth, and contact information.

03

Step 3: Provide your current health insurance information, if applicable. This is necessary to determine whether you are eligible for Tricare Prime.

04

Step 4: Indicate your chosen primary care manager (PCM) by providing their name, address, and phone number. Your PCM will be responsible for managing your healthcare needs.

05

Step 5: Sign and date the application form. Make sure to read the instructions carefully before signing.

06

Step 6: Submit the completed application either online or by mail to the designated Tricare office. Keep a copy of the application for your records.

07

Step 7: Wait for confirmation of your enrollment in Tricare Prime. You will receive a notification by mail or email once your application has been processed.

08

Step 8: Contact the Tricare office if you have any questions or need assistance with your enrollment application. They will be able to provide guidance and support.

Who needs tricare prime enrollment application?

01

Anyone who is eligible for Tricare healthcare benefits and wishes to enroll in Tricare Prime needs to fill out the enrollment application form. This includes active-duty service members, retired service members, their family members, and certain members of the National Guard and Reserve. It is particularly beneficial for individuals who prefer to have a designated primary care manager and a comprehensive healthcare network.

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What is tricare prime enrollment application?

Tricare Prime enrollment application is a form that eligible individuals must submit to enroll in the Tricare Prime healthcare program.

Who is required to file tricare prime enrollment application?

All eligible individuals who wish to enroll in the Tricare Prime healthcare program are required to file a Tricare Prime enrollment application.

How to fill out tricare prime enrollment application?

To fill out the Tricare Prime enrollment application, individuals must provide personal information, contact details, and any relevant healthcare history.

What is the purpose of tricare prime enrollment application?

The purpose of the Tricare Prime enrollment application is to collect necessary information to verify eligibility and enroll individuals in the Tricare Prime healthcare program.

What information must be reported on tricare prime enrollment application?

Information such as personal details, contact information, healthcare history, and any other relevant information must be reported on the Tricare Prime enrollment application.

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