DDFORMS.ORG – DD Form 3043-1 – TRICARE Select Enrollment, Disenrollment, and Change Form (EAST) – Changes in your TRICARE health plan may affect your TRICARE Prime Primary Care Manager (PCM). If you need to change PCMs, you can print, complete and mail a TRICARE Select Enrollment, Disenrollment, and PCM Change Form.
If you’re a TRICARE Prime beneficiary, you can access your regional contractor’s TRICARE Select enrollment website. If you have a Common Access Card (CAC), DoD Self-Service Logon (DS Logon), or DFAS account, you can log in with your username and password to enroll in or disenroll from TRICARE Select online.
Download DD Form 3043-1 – TRICARE Select Enrollment, Disenrollment, and Change Form (EAST)
| Form Number | DD Form 3043-1 |
| Form Title | TRICARE Select Enrollment, Disenrollment, and Change Form (EAST) |
| Edition Date | 9/30/2021 |
| File Size | 182 KB |
What is a DD Form 3043-1?
A DD Form 3043-1 is a Department of Defense (DoD) form that was released on October 1, 2018. This form, which you can download for free here, is a military form used by and within the U.S. Army. It’s the largest form available on our website and the most important one to complete, which is why it’s included in our ‘Most Popular DoD Forms’ list.
You can also find hundreds of other fillable DoD forms right here in our library, and don’t forget to browse our collection of TRICARE Overseas forms and the TRICARE Select Enrollment Form. We are the leading provider of DoD forms and we have a large selection of forms for you to choose from.
Where Can I Find a DD Form 3043-1?
DD Form 3043-1 is a DoD form that allows for the release of medical records and photocopies in connection with a claim for TRICARE benefits. If you are interested in downloading a fillable DD Form 3043-1, you can find a copy here or by visiting the official DoD forms page. However, keep in mind that some DD forms may not be accessible through your web browser due to security settings. Therefore, if you are having difficulty viewing a DD Form, try right-clicking the link and selecting “Save as” to save it to your computer. You can then use your system’s default PDF program to open it.
If you are looking for other DD Forms, visit the DoD forms library for more information and to download an up-to-date fillable DD Form.
DD Form 3043-1 – TRICARE Select Enrollment, Disenrollment, and Change Form (EAST)
The DD Form 3043-1 – TRICARE Select Enrollment, Disenrollment, and Change Form (EAST) is a combined form used for enrolling beneficiaries in TRICARE Prime or TRICARE Select. It is also used for PCM changes, enrollment transfers, and disenrollments.
Beneficiaries must complete the DD Form 3043-1 and submit it to their contractor before they can be enrolled or disenrolled in a TRICARE Prime or TRICARE Select plan. If you need help with this form, contact your contractor.
You can find a copy of this form on the WHS Forms Page or by downloading it from your regional contractor’s website. You can also print it from your browser’s “File” menu.
During Open Season, retirees and their family members who are eligible for a TRICARE Prime option can enroll. They must pay the corresponding annual TRICARE Prime enrollment fee amount.
If you do not want to enroll in a TRICARE Prime option, do not sign up during Open Season. You can re-enroll in a TRICARE Prime option during the next open enrollment period or by experiencing a Qualifying Life Event.
ADFMs who enrolled in a TRICARE Prime option but did not live in a T-3 PSA on September 30, 2013, will be grandfathered into a TRICARE Prime option starting October 1, 2013. They must maintain a residence within 40 miles of the original T-3 PSA residence to retain their grandfathered status.
DD Form 3043-1 Example
