DDFORMS.ORG – DD Form 2876-1 – TRICARE Prime Enrollment, Disenrollment and Primary Care Manager (PCM) Change Form (EAST) – TRICARE Prime is the healthcare program that serves active-duty military members, retirees, and their families. To enroll in TRICARE Prime, beneficiaries need to complete DD Form 2876-1, which is also known as the TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form (EAST). This form allows beneficiaries to choose a primary care manager for themselves and their family members.
In this article, we will explore the details of DD Form 2876-1 and explain how it works. We will discuss what information you need to provide on the form and how to submit it. Additionally, we will cover some common questions about TRICARE Prime enrollment and PCM changes that beneficiaries may have.
Download DD Form 2876-1 – TRICARE Prime Enrollment, Disenrollment and Primary Care Manager (PCM) Change Form (EAST)
| Form Number | DD Form 2876-1 |
| Form Title | TRICARE Prime Enrollment, Disenrollment and Primary Care Manager (PCM) Change Form (EAST) |
| Edition Date | 7/1/2016 |
| File Size | 84 KB |
What is a DD Form 2876-1?
The DD Form 2876-1 is a TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form that is used by eligible beneficiaries to enroll in the TRICARE Prime program or make changes to their enrollment. The form is also used for disenrollment from the TRICARE Prime program or to change their PCM. This form can be utilized by individuals who are active-duty military members, retirees, family members, and survivors.
This form is commonly referred to as “EAST” because it is exclusively used in the Eastern region of the United States. It collects personal information such as name, date of birth, Social Security Number (SSN), rank/grade, and contact information. After filling out this information on the form, individuals must sign it and provide additional documentation if necessary.
It’s important for beneficiaries to understand that completing this form does not guarantee enrollment in TRICARE Prime; there are certain eligibility requirements that must be met before enrollment can occur. However, once enrolled in TRICARE Prime using this form, beneficiaries will have access to comprehensive healthcare services through their designated PCM at little or no cost.
Where Can I Find a DD Form 2876-1?
If you’re searching for a DD Form 2876-1, there are several options available. Firstly, you can access the form online directly from the TRICARE website. Simply visit their website and search for “DD Form 2876-1” to download a printable PDF version of the form.
Alternatively, you can also obtain a DD Form 2876-1 through your local military treatment facility (MTF). MTFs usually have copies of all necessary forms on-hand and can provide assistance in filling them out correctly.
Another option is to reach out to TRICARE customer service via phone or email. They can help answer any questions about the form and may be able to provide additional resources for obtaining it.
Regardless of how you choose to obtain the DD Form 2876-1, it’s important to fill it out correctly and submit it on time in order to ensure that your TRICARE Prime enrollment, disenrollment, or PCM change is processed accurately.
DD Form 2876-1 – TRICARE Prime Enrollment, Disenrollment and Primary Care Manager (PCM) Change Form (EAST)
The DD Form 2876-1 is a crucial document for TRICARE Prime beneficiaries who want to enroll, disenroll or change their Primary Care Manager (PCM). The form is designed for those who reside in the Eastern Region of the United States and provides them with a straightforward process for managing their healthcare needs.
The TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager Change Form require individuals to provide basic personal information such as name, address, Social Security number, date of birth, and contact details. Additionally, beneficiaries must indicate whether they are enrolling in or disenrolling from TRICARE Prime and select a new PCM if applicable. The form also includes a section for military sponsors to sign off on the changes made by their dependents.
It’s important to note that timely submission of the DD Form 2876-1 can help avoid any lapses in health coverage during transitions between PCMs or enrollment status changes. Beneficiaries should be aware of all deadlines related to submitting this form and ensure that it is completed accurately before submitting it to their regional contractor’s office.
DD Form 2876-1 Example
