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TRICARE Prime Enrollment Forms

Use the TRICARE Prime Enrollment, Disenrollment and Primary Care Manager (PCM) Change Form (DD Form 2876) to enroll in one of the TRICARE Prime Options: 

  • TRICARE Prime
  • TRICARE Prime Remote
  • TRICARE Prime Overseas
  • TRICARE Prime Remote Overseas 

To enroll, download, complete and mail your region's form to your regional contractor:

Not sure which region you live in? Visit the Regions Page to find out.

North Health Net Federal Services, LLC
P.O. Box 105146
Atlanta, GA, 30348-5146 
South  Humana Military
Attn: PNC Bank
P.O. Box 105838
Atlanta, GA 30348-9758
West  UnitedHealthcare Military & Veterans
TRICARE West RegionEnrollment Department
P.O. Box 105492
Atlanta, GA 30348-5492
Overseas  International SOS Assistance
TOP Prime Enrollments
P.O. Box 11520
Philadelphia, PA 19116

Other Enrollment Options

Enroll Online

Call Your Regional Contractor

  • North: 1-877-874-2273
  • South: 1-800-444-5445
  • West: 1-877-988-9378
  • Overseas: Telephonic enrollment not currently available overseas.

Last Updated 4/1/2014