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DD Form 2876-1 TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form
What Is the DD Form 2876-1?
DD Form 2876-1 , TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form, is a form is for gathering information needed for individuals to enroll or disenroll in the Uniformed ServicesFamily Health Plan, TRICARE Prime, or TRICARE Prime Remote - specifically within the Eastern United States .
DD 2876-1 is a part of a series of three region-specific TRICARE enrollment-related forms issued by the Department of Defense (DoD) on July 1, 2016 , and is often referred to as the TRICARE Prime Form DD 2876 for short. The other forms are the TRICARE West DD 2876-2, TRICARE Overseas DD 2876-3, and the universally-used DD Form 2876.
An up-to-date fillable version of the DD Form 2876-1 is available for digital filing or download below or can be found on the Executive Services Directorate website.
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.
Download DD Form 2876-1 TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form
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