Bread Crumbs

Reconsideration Requests

Use these forms to request reconsideration of involuntary disenrollment, late initial enrollment, or late change to coverage.

  • Select the correct form for your region and plan.
  • Not sure which region you live in? Visit the TRICARE Regions page to find out.
  • Instructions and address/fax number to submit the forms are found on each form.

North Region

South Region

West Region


Last Updated 12/9/2013