How to File a Claim
1. Download and fill out a TRICARE claim form, the Patient's Request for Medical Payment (DD Form 2642).
2. Attach a readable copy of the provider's bill to the claim form, making sure it contains the following:
- Sponsor's Social Security Number (SSN) or Department of Defense Benefits Number (DBN) (eligible former spouses should use their SSN)
- Provider's name and address (if more than one provider's name is on the bill, circle the name of the person who treated you)
- Date and place of each service
- Description of each service or supply furnished
- Charge for each service
- Diagnosis (if the diagnosis is not on the bill, be sure to complete block 8a on the form)
3. Fill out all 12 blocks of the form correctly and sign it.
4. Make a copy of the paperwork for your records.
5. Mail your completed claim form to your claims processor.
Claims for Same-Sex Spouses
Once your spouse shows as eligible for benefits in the Defense Enrollment Eligibility Reporting System (DEERS), he or she can file claims for care received:
- On or after June 26, 2013—if married before June 26, 2013, or
- Back to the date of eligibility in DEERS—if married after June 26, 2013.