DD Form 2896-1, Reserve Component Health Coverage Request Form

DD Form 2896-1, Reserve Component Health Coverage Request Form
DD Form 2896-1, Reserve Component Health Coverage Request Form

What Is DD Form 2896-1? 

DD Form 2896-1, Reserve Component Health Coverage Request Form is a Department of Defense (DoD) form used for enrolling in TRICARE Reserve Select benefits. When enrolling for the first time, the coverage starts at the beginning of the next month or first calendar day of the second month from the day stated in the DD 2896-1 Form. If you had TRICARE coverage previously, a new period starts after canceling the former one. 

This DoD-issued form - sometimes mistakenly referred to as the DD Form 2896 or DA Form 2896 - is not available online or through the Executive Services Directorate forms database. A blank DD Form 2896-1 can only be downloaded from the Beneficiary Web Enrollment website after logging in to a verified account.

What Is TRICARE Reserve Select?

TRICARE Reserve Select is a health-insurance plan for members of the Select Reserve and their families. Based on premiums, this plan allows lowering the cost of payments for health services worldwide. TRICARE Reserve Select offers its services in accordance with the conditions of the Affordable Care Act.

Who Is Eligible for TRICARE Reserve Select? 

To enroll, a member of the Select Reserve must meet the three following criteria:

  • They must not be entitled to enroll in the Federal Employees Health Benefits (FEHB) program;
  • They must not be included in the Transitional Assistance Management Program;
  • They must not be on active duty.

Where Do I Send My DD Form 2896-1?

To obtain the form, you need to log on to the Beneficiary Web Enrollment Website using either the Common Access Card (CAC), a Defense Finance and Accounting Service (DFAS) MyPay Account or a DoD Self-Service Logon (DS Logon) Premium (Level 2) account. 

Users not meeting these criteria will not be able to complete and print the form. A filled DD Form 2896-1 accompanying the payment should be sent via fax or mail to the regional contractor in the prescribed time.

  1. If contacting from the East region, mail all paperwork to Humana Military, P.O. Box 105389, Atlanta, GA 30348-5389, Fax: 1-866-836-9535.
  2. If you are contacting from the West region, mail forms to Health Net, LLC, P.O. Box 9028, Virginia Beach, VA 23450-9028.
  3. If contacting from the Overseas region send forms to the International SOS Assistance, Inc., TOP TRS Enrollments, P.O. Box 11689, Philadelphia, PA 19116, Fax: +1-215-354-5015.