dd1172 2 form
Enrollment Verification for Military Healthcare When Turning 21
The sponsor can fill out DD Form 1172-2 at any DEERS/ID Card facility ahead of the dependents visit. Please note that DD Form 1172-2 is only valid for 90 days
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DD Form 1172-2, Application for Identification Card/
Section IV of this form should only be completed if benefits or sponsorship is being requested for/by an eligible sponsor or their dependent. Instructions for
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CLAIMS
Claims must be submitted on the proper claim form, either a CMS-1500 or UB-04. Molina Healthcare will only process legible claims received on the proper claim
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