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This version of the form is not currently in use and is provided for reference only. Download this version of
DD Form 3043-1
for the current year.
DD Form 3043-1 TRICARE Select Enrollment, Disenrollment, and Change Form (East)
What Is DD Form 3043-1?
This is a form that was released by the U.S. Department of Defense (DoD) on December 1, 2017. The form, often mistakenly referred to as the DA Form 3043-1 , 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.
FAQ
Q: What is the DD Form 3043-1?
A: The DD Form 3043-1 is the TRICARE Select Enrollment, Disenrollment, and Change Form (East).
Q: What is TRICARE Select?
A: TRICARE Select is a health care option for eligible beneficiaries.
Q: What does the DD Form 3043-1 allow you to do?
A: The DD Form 3043-1 allows you to enroll, disenroll, or make changes to your TRICARE Select coverage.
Q: Who should use the DD Form 3043-1?
A: Beneficiaries in the East region who want to enroll, disenroll, or make changes to TRICARE Select should use this form.
Form Details:
- A 4-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 3043-1 down below in PDF format or browse hundreds of other DoD Forms compiled in our online library.
Download DD Form 3043-1 TRICARE Select Enrollment, Disenrollment, and Change Form (East)
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