DDFORMS.ORG – DD Form 3043-2 – TRICARE Select Enrollment, Disenrollment, and Change Form (WEST) – Whether you’re a Service member or beneficiary, it’s important to know what DD forms are available for you to download. Some may require you to right-click and select “save as” to save them to your computer.
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Download DD Form 3043-2 – TRICARE Select Enrollment, Disenrollment, and Change Form (WEST)
| Form Number | DD Form 3043-2 |
| Form Title | TRICARE Select Enrollment, Disenrollment, and Change Form (WEST) |
| Edition Date | 9/30/2021 |
| File Size | 182 KB |
What is a DD Form 3043-2?
DD Form 3043-2 is a document that has been designed by the Department of Defense (DoD) to be used to capture the consent to release medical information about an individual’s treatment. It is also known as a TRICARE Select Enrollment, Disenrollment, and Change Form (west). This is an important document that needs to be filled out and signed by each person who is currently enrolled in TRICARE. It can be easily found on the Internet and downloaded free of charge from the DoD website.
It is an essential form that every military service member should fill out. It helps to protect the privacy of your health information, while also helping the military treatment facility and TRICARE understand how to handle the medical records you provide them.
DD Form 3043-2 – TRICARE Select Enrollment, Disenrollment, and Change Form (WEST)
TRICARE Select (formerly TRICARE Standard and Extra) is a self-managed, preferred provider network plan. It is available for most service members and their families who are eligible for TRICARE Prime.
DD Form 3043-2 – TRICARE Select Enrollment, Disenrollment, and Change Form (WEST) are used to enroll in TRICARE Select, to disenroll from TRICARE Select, or to change your enrollment information. It is also used to submit a request for a fee refund.
To enroll in TRICARE Select, fill out the form and send it to your regional contractor. Your contractor will enroll you in a plan that is right for your needs.
You can also change your TRICARE Select benefits or coverage, like adding or dropping medical providers, by using the Beneficiary Web Enrollment website. You will need a Common Access Card (CAC) or DoD Self-Service Logon to log in.
In addition, you can change your address and other details, like whether you are covered by Medicare or another health insurance, or whether you are covered by a spouse’s or family member’s plan. It’s a good idea to let your contractor know of any changes so that they can make those updates in DEERS.
Alternatively, you can use the online Make a Payment tool to determine your payment amount and set up future automatic payments. If you have any questions, call your contractor or visit their website.
DD Form 3043-2 Example
