Uhcmv0895 form 2025

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The document is a TRICARE Prime Reconsideration Request Form, which allows sponsors to request reinstatement, reenrollment, or retroactive enrollment of their health coverage. It includes sections for sponsor information, the specific action requested, detailed explanations for reconsideration, and supporting documentation requirements. Additionally, it provides instructions for submitting the form and emphasizes the importance of privacy under the Privacy Act of 1974.

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