Fill and Sign DD 2876 Forms

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What Is the DD Form 2876 Series?

TRICARE - previously known as CHAMPUS - is a health care program managed by the Department of Defence (DoD) that provides civilian health benefits to U.S. military personnel, veterans, and dependents. The DD 2876 Series includes four forms used by service members to enroll, disenroll, or change their provider in TRICARE Prime, TRICARE Prime Remote, or Uniformed Services Family Health Plan. The four forms are identical except for the region-specific mailing addresses specified in each one.

The series includes four forms in total:

TRICARE Prime Enrollment

TRICARE is a program run by the Defense Health Agency - or DHA - that combines the resources of military clinics with civilian health care networks to offer high-quality health care, comprehensive health coverage, and free prescription drugs.

TRICARE Prime is an HMO-style plan available to active duty personnel, Active and Reserve Component retirees and their dependent family members. Under this plan, beneficiaries must choose a primary care physician and obtain referrals for specialty care while responsible for paying only a partial fee for each doctor’s visit. The plan comes with an annual enrollment fee for retirees and dependents but is free for active-duty military and their family members.

TRICARE Prime enrollment applications received on or before the 20th of each month are effective the first calendar day of the next one. All applicants except for active duty service members or those enrolling in TRICARE Overseas Prime must confirm enrollment and PCM assignment before obtaining medical care.

Documents

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DD Form 2876 "TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form"

Rate (4.8 / 5) 174 votes
Size: 1 MB
5 pages

This form is used for gathering information vital for permitting individuals to enroll, disenroll, or change their provider in TRICARE Prime, TRICARE Prime Remote, or Uniformed Services Family Health Plan.

DD Form 2876-1 "TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form"

Rate (4.6 / 5) 319 votes
Size: 1 MB
5 pages

This form is for gathering information needed for individuals to enroll or disenroll in the Uniformed Services Family Health Plan, TRICARE Prime or TRICARE Prime Remote specifically within the Eastern United States.

DD Form 2876-2 "TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form"

Rate (4.5 / 5) 305 votes
Size: 1 MB
5 pages

This form is for gathering information needed for individuals to enroll or disenroll in the Uniformed Services Family Health Plan, TRICARE Prime or TRICARE Prime Remote specifically within the Western Region of the United States.

DD Form 2876-3 "TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form"

Rate (4.8 / 5) 330 votes
Size: 1 MB
5 pages

This form is for gathering information needed for individuals to enroll or disenroll in the Uniformed Services Family Health Plan, TRICARE Prime or TRICARE Prime Remote specifically within the Overseas Region.