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DD Form 2876-1 TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form (East)
What Is DD Form 2876-1?
This is a form that was released by the U.S. Department of Defense (DoD) on July 1, 2016. The form, often mistakenly referred to as the DA Form 2876-1 , is a military form used by and within the U.S. Army. As of today, no separate instructions for the form are provided by the DoD.
Form Details:
- A 5-page document available for download in PDF;
- The latest version available from the Executive Services Directorate;
- Editable, printable, and free to use;
- Fill out the form in our online filing application.
Download an up-to-date fillable DD Form 2876-1 down below in PDF format or browse hundreds of other DoD Forms compiled in our online library.
DD Form 2876-1 Instructions
TRICARE Prime enrollment is available year-round and only to those service members already registered in the Defense Enrollment Eligibility Reporting System (DEERS). Get in touch with your regional contractor directly through the TRICARE web page to confirm participation or submit a completed copy of the DD 2876-2 Form to the address provided below.
The DD 2876-1 filing process is mostly self-explanatory. Applicants must look through the various payment options provided and choose the TRICARE coverage that suits them best. All individuals filing the form must then provide their personal identifying information, information about their family members, their addresses, and information about their sponsor.
All applicants wishing to enroll in TRICARE are obligated to disclose any information regarding other health insurance they are participating in at the time of filing. Prime enrollment applications received on or before the 20th of each month are effective the first calendar day of the next one. All applicants except for active duty service members or those enrolling in TRICARE Overseas Prime or must confirm enrollment and PCM assignment before obtaining medical care.
The TRICARE Regional Contractor Address for the Eastern Region of the United States is at Humana Military, Attn: PNC Bank, PO Box 105838, Atlanta GA 30348-5838.
Other Revision
Download DD Form 2876-1 TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form (East)
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