Use this form to enroll in or disenroll from TRICARE Prime, or to change your primary care manager. New enrollment applications must be received in our offices by the 20th of the month to be effective on the first day of the following month. Portability (transfers) to this region are effective the day the application is received in our offices.
TRICARE Prime beneficiaries should use this form to start, change or stop automatic deduction of enrollment fees from their military retirement pay.
Beneficiaries who have to drive for more than an hour to reach a military treatment facility (MTF) should complete this form to request eligibility for TRICARE Prime Remote (TPR).
If you live or work within 50 miles of an MTF, you will generally not be eligible for TPR.
Use this form to request TRICARE Prime automatic monthly payments by electronic funds transfer (EFT) or recurring credit card (RCC).