Home
Forms Library
DD Form 2876, TRICARE Prime Enrollment Application and PCM Change Form, March 2004 2009 Deputy Regis

DD Form 2876, TRICARE Prime Enrollment Application and PCM Change Form, March 2004 2009 Deputy Regis-2025

DD Form 2876, TRICARE Prime Enrollment Application and PCM Change Form, March 2004 2009 Deputy Regis Preview on Page 1

See details

4.8 out of 5

57 votes

The document provides an overview of the Supplemental Security Income (SSI) program, which offers financial assistance to individuals who are aged, blind, or disabled with limited income and resources. It outlines eligibility criteria, the application process, required documents, and additional Medicaid programs available in New Jersey for eligible individuals. The document also addresses common questions regarding Medicaid and SSI coverage, including what to do if denied benefits or if circumstances change affecting eligibility.

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out DD Form 2876, TRICARE Prime Enrollment Application and PCM Change Form, March 2004 2009 Deputy Regis with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open it in the editor.
Begin by filling out your personal information in Section I. This includes your name, address, and contact details. Ensure all entries are accurate to avoid processing delays.
In Section II, indicate your desired Primary Care Manager (PCM) by selecting from the provided options. If you have a specific PCM in mind, include their details.
Section III requires you to provide information about your eligibility for TRICARE Prime. Review the criteria carefully and check the appropriate boxes.
Finally, review all sections for completeness and accuracy before signing at the bottom of the form. Use our platform’s tools to add your signature electronically.

Start using our platform today to fill out your DD Form 2876 easily and for free!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Can you switch to TRICARE Prime at any time?

Besides TRICARE Open Season, Qualifying Life Events, such as getting married, moving, and retiring from active duty, are the only times you can make enrollment changes for TRICARE Prime and TRICARE Select plans. You can learn more in the TRICARE Qualifying Life Events Fact Sheet.

What is the change form for TRICARE Prime enrollment?

How to change PCM with TRICARE Prime?

Use the TRICARE Prime Enrollment, Disenrollment and Primary Care Manager Change Form (DD Form 2876) to enroll in one of the TRICARE Prime options: TRICARE Prime. TRICARE Prime Remote.

What are the different forms of TRICARE?

Providers must verify TRICARE eligibility for beneficiaries at the time of service. Providers should ensure the patient has a valid Common Access Card (CAC), uniformed services ID card or eligibility authorization letter.

What form is used to verify TRICARE eligibility?

Tricare prime you have a list of s. Tricare Select you can go to the provider of your choice. If traveling, prime may not have a provider in your area. You will then have a higher copay. With select you just go to any provider that accepts tricare.