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Form 2854-2026
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- Click ‘Get Form’ to open it in the editor.
- Begin with Section I, where you will enter the Sponsor Information. Fill in the Sponsor's Social Security Number, Name, and Date of Birth accurately.
- Move to Section II for Individual(s) Requesting Disenrollment. Provide the names and dates of birth for each individual disenrolling. Select a reason for disenrollment by marking the appropriate box.
- In this section, also include the requested disenrollment date and contact information such as telephone numbers and email address if applicable.
- Finally, navigate to Section III. Ensure you sign and date the application to certify that all provided information is true and complete.
- Once completed, save your form and submit it to your Military Treatment Facility while keeping a copy for your records.
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This form collects the information necessary to process your request to disenroll from TRICARE Plus. DD FORM 2854,