Dd2876 1 2025

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The document is a TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form, which provides instructions for individuals to enroll, disenroll, or change their PCM within the TRICARE Prime health plan. It includes details on the application process, privacy regulations, and options for submitting the form. The document also outlines the necessary information required from sponsors and family members, reasons for disenrollment or PCM changes, and payment options for enrollment fees.

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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 I have a civilian PCM with TRICARE Prime?

Getting Care With a TRICARE Prime Option Your PCM may be: At a military hospital or clinic. A civilian TRICARE network provider. A primary care provider under US Family Health Plan.

How do I change my PCM for TRICARE Prime?

You can mail a TRICARE Prime Enrollment, Disenrollment, and PCM Change Form with the new PCMs name and address to your regional contractor. You only need to complete the part of the form related to the PCM change.

Is there a difference between TRICARE and TRICARE Prime?

If youre on active duty, you have to enroll in TRICARE Prime. All others can choose to enroll in TRICARE Prime or TRICARE Select. TRICARE Prime offers fewer out-of-pocket costs than TRICARE Select, but less freedom of choice for providers.

Why was I disenrolled from TRICARE?

If you didnt set up your enrollment fees for TRICARE Select or TRICARE Overseas Program Select coverage last year, you were disenrolled from your plan effective Dec.

How to get a TRICARE disenrollment letter?

Voluntary Disenrollment Web: Log into the Beneficiary Web Enrollment Portal. Phone: Call your regional contractor. East: 1-800-444-5445. West: 1-888-TRIWEST (874-9378) Overseas: Call the Regional Call Center for your overseas area. Mail: Download your regions disenrollment form: East Disenrollment Form.

form 2876

DD2875 Humana Open Season TRICARE Prime active duty family members TRICARE East address ZIP Code TRICARE Prime vs standard Call TRICARE TRICARE East fax number TRICARE changes

How do I change my TRICARE enrollment?

If youre enrolling or simply want to change your TRICARE health plan, you can call us at (800) 444-5445. You can choose between Prime and Select. We expect high call volumes during this time, so please avoid calling us on the first and last days of Open Season.

What is the third party form for TRICARE?

Your regional contractor will send you the Statement of Personal Injury-Possible Third Party Liability (DD Form 2527) if a claim is received that appears to have third-party liability involvement. You must complete and sign this form within 35 calendar days.

What is the change form for TRICARE Prime enrollment?

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