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Beneficiaries
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Beneficiaries
TRICARE Overseas Program
TRICARE Overseas Program
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Beneficiary Forms
Click below to download TRICARE Overseas Program Beneficiary Forms:
TRICARE Overseas Prime
and Prime Remote Enrollment form DD 2876
TRICARE Overseas
Prime and Prime Remote Disenrollment form DD 2877
Estate Notification
Overseas Estate Notification
TRICARE Other Health
Insurance Questionnaire
Authorization to Disclose Information
TRICARE DoD/CHAMPUS Claim Form - Patient's Request for Medical
Payment (DD Form 2642)
Note: Effective June 1, 2012, TRICARE Overseas beneficiaries must submit proof of payment with all claims. When submitting your DD Form 2642, you should also include an itemized bill or invoice, diagnosis describing why you received medical care, and/or an explanation of benefits from your other health insurance, if applicable.
TRICARE Prime Enrollment Fees Increasing on October 1, 2011: Beginning October 1, 2011, beneficiaries who pay enrollment fees will see a modest increase in TRICARE Prime enrollment fees. Click here to learn more.
Click below to download TRICARE Overseas Program Beneficiary Forms:
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Forms DD2876 and DD2877 should be completed and mailed to the following address:
International SOS Assistance
PO Box 11520 Philadelphia, PA 19116 USA |
Payment (DD Form 2642)
Note: Effective June 1, 2012, TRICARE Overseas beneficiaries must submit proof of payment with all claims. When submitting your DD Form 2642, you should also include an itemized bill or invoice, diagnosis describing why you received medical care, and/or an explanation of benefits from your other health insurance, if applicable.
TRICARE Prime Enrollment Fees Increasing on October 1, 2011: Beginning October 1, 2011, beneficiaries who pay enrollment fees will see a modest increase in TRICARE Prime enrollment fees. Click here to learn more.