DD Form 2876-3 TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form

DD Form 2876-3 Instructions

TRICARE Prime enrollment is possible only for those registered in DEERS. You can do it by getting in touch directly with the contractor in your region through the TRICARE web page or by submitting the DD 2876-3 Form. Enrollment in TRICARE Prime is available year-round.

The DD 2876-3 filing process is self-explanatory. Applicants must choose the desired TRICARE option, submit their own and their relatives' names and addresses along with their sponsor information. All enrolling individuals are obliged to submit information regarding any other health insurance they have access to at the time of filing. Those filing are offered various payment options and need to choose the one that suits their needs best.

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 dutyservice 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 Overseas Region is at the International SOS Assistance, TOP Prime Enrollments, PO Box 11520, Philadelphia PA 19116

Fax number: 1-215-354-5015

Up-to-date toll-free numbers can be found on the TRICARE OVERSEAS Contact page and are different for each of the countries within the three main overseas contact regions:

• The Eurasia-Africa Region includes Africa, Europe, and the Middle East;
• The Latin America and Canada Region includes Canada, the Caribbean Basin, Central, and South America, Puerto Rico, and the U.S. Virgin Islands;
• The Pacific Region includes Asia, Australia, Guam, India, Japan, New Zealand, South Korea, and Western Pacific remote countries.