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US Family Health Plan Enrollment Forms

Use the TRICARE Prime Enrollment, Disenrollment and Primary Care Manager (PCM) Change Form (DD Form 2876) to enroll in US Family Health Plan. Select the form for you designated provider from the list below. Mailing addresses are found on Page 1 of the form:

If you're not sure which plan to enroll in or to enroll over the phone, contact a US Family Health Plan Customer Service representative by calling 1-800-748-7347.

Last Updated 4/1/2014