TRICARE Forms Guide: Claims, Enrollment & Privacy

*Disclaimer: TRICARE.com is an independent reference site and is not the official TRICARE program or the Defense Health Agency. For official policy and the most current forms, visit TRICARE.mil.*

## Quick answer Most TRICARE forms are used for three specific tasks: filing a claim for reimbursement, authorizing the release of medical information, or enrolling in a specific plan like TRICARE Prime or Select. While many updates can be done online via the Beneficiary Web Enrollment (BWE) portal, paper forms remain the "fail-safe" for complex claims and legal authorizations.

## In detail TRICARE documentation is categorized by how the form is submitted and who manages the benefit. Because the Department of Defense uses regional contractors, the form you need often depends on whether you live in the East or West region.

### 1. Claims and Reimbursement Forms If you see a non-network provider or pay out-of-pocket, you must file a claim. * **DD Form 2642:** The universal form for Patient Request for Medical Payment. This is the "master" form for TRICARE Prime, Select, and For Life beneficiaries to get paid back. * **Pharmacy Claims:** Use the **Express Scripts Prescription Drug Claim Form** for reimbursement if you used a non-network pharmacy (e.g., a compound pharmacy or an emergency fill while traveling).

### 2. Enrollment and Disenrollment While DEERS handles eligibility, specific plan enrollment requires formal documentation: * **DD Form 2876:** Used for TRICARE Prime enrollment, disenrollment, or primary care manager (PCM) changes. * **TRICARE Select Enrollment:** Often handled via the regional contractor's specific enrollment form or the BWE portal.

### 3. Medical Records and Privacy Because of HIPAA laws, your regional contractor cannot talk to your spouse or parents about your healthcare without these: * **DD Form 2870:** Authorization for Disclosure of Medical or Dental Information. * **Appointment of Representative (AOR):** Used if you want someone else to handle your claims appeals on your behalf.

## Who this applies to * **Active Duty Families:** Use enrollment forms when PCSing (moving) to a new region/PCM. * **Retirees:** Use forms for TRICARE Select enrollment and for setting up "Allotments" to pay monthly premiums (e.g., the $784.50 annual family premium for Select Group A in 2026). * **TRICARE For Life (TFL) Users:** Usually don't need forms for Medicare-covered services, but must use DD Form 2642 for services covered *only* by TRICARE. * **Young Adults:** Must fill out specific TRICARE Young Adult (TYA) enrollment forms to maintain coverage after age 21 (or 23 if a student).

## Common scenarios * **The Overseas Emergency:** An Army family on vacation in France spends $1,200 at an urgent care. They must download **DD Form 2642** and submit it to International SOS (the overseas contractor) with itemized English receipts to get reimbursed. * **Privacy for Adult Dependents:** A 22-year-old on TRICARE Young Adult wants their mother to help resolve a billing error. The 22-year-old must sign **DD Form 2870** (Release of Information) before the contractor will discuss the medical details with the mother. * **The West Region Transition:** A Navy retiree in San Diego needs to change their PCM in 2026. Because TriWest took over the West region in 2025, the retiree must use the **TriWest-specific PCM Change Form** available on the TriWest portal, not the old HNFS forms.

## Related terms * **DEERS:** The Defense Enrollment Eligibility Reporting System; the database that proves you are eligible to use TRICARE. * **DD Form 2642:** The standard "Patient Request for Medical Payment" used for almost all medical claims. * **BWE (Beneficiary Web Enrollment):** The online portal used to avoid paper forms for plan changes. * **Allowed Amount:** The maximum amount TRICARE will pay for a service, regardless of what the form says the doctor charged. * **EOB (Explanation of Benefits):** Not a form you fill out, but the document you receive *after* a claim form is processed.

## Sources 1. TRICARE Official Forms Page: https://www.tricare.mil/forms 2. Humana Military (East): https://www.humanamilitary.com 3. TriWest Healthcare Alliance (West): https://www.triwest.com 4. Express Scripts TRICARE Pharmacy: https://www.express-scripts.com/tricare