DDFORMS.ORG – DD Form 3043-3 – TRICARE Select Enrollment, Disenrollment, and Change Form (OVERSEAS) – If you’ve lost coverage with TRICARE Select Overseas, or are changing to a different TRICARE Select region, you must complete and submit a DD Form 3043-3. The form will be processed by your regional contractor.
To make your DD Form 3043-3 as easy as possible to complete, be sure to include all of the following items: Your street or P.O. Box address, checkmark the appropriate OHI block, and provide complete prescription medication details (including any Physiotherapy treatment).
Download DD Form 3043-3 – TRICARE Select Enrollment, Disenrollment, and Change Form (OVERSEAS)
| Form Number | DD Form 3043-3 |
| Form Title | TRICARE Select Enrollment, Disenrollment, and Change Form (OVERSEAS) |
| Edition Date | 9/30/2021 |
| File Size | 183 KB |
DD Form 3043-3 – TRICARE Select Enrollment, Disenrollment, and Change Form (OVERSEAS)
TRICARE Select Enrollment is the process by which new active duty family members (ADFMs) enroll into a TRICARE plan once registered in DEERS. ADFMs have 90 days to determine if they want to stay enrolled in Select or switch their coverage to TRICARE Prime.
Beneficiaries can make changes to their TRICARE Prime and/or TRICARE Select enrollment during a special enrollment period called “open season.” This period happens every fall and coincides with the Federal Benefits Open Season for retirees.
5.2.1 The contractor shall support one annual TRICARE Prime and TRICARE Select open enrollment period for all Non-Active Duty Service Members (NADSM) beneficiaries. Beneficiaries will automatically re-enroll each year unless they elect a different option or disenroll during the open enrollment period.
4.1.1 The contractor may continue to enroll TRICARE Prime beneficiaries in the Market/MTF until the Market/MTF capacity is optimized in accordance with Market Director/MTF Director determinations. However, if not feasible, the contractor shall allow payment of monthly TRICARE Prime enrollment fees via a monthly recurring electronic payment in the form of Electronic Funds Transfer (EFT) (which may include recurring credit and debit charges).
5.5.3 The contractor will use strict funds control processes for the collection, retention, and transfer of TRICARE Prime and TRICARE Select enrollment fees. These procedures are intended to prevent the contractor from generating excessive or unnecessary fees or other charges that may negatively impact a beneficiary’s ability to pay TRICARE Prime and TRICARE Select fees. The contractor will provide the beneficiary with a written notification of any fee changes at least 30 days before the implementation of such changes.
DD Form 3043-3 Example
