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TRICARE For Life

Appointment of Appeal Representative

This form designates a representative for the Appeals process.

Authorization to Disclose Information

By filling out this form, you are giving authorization to the TRICARE For Life contractor to release information protected under the Federal Privacy Act. This form is not valid to designate a representative for the Appeals process.

Estate Notfication

This Form is used to notify TRICARE that your loved one is now deceased.  In the instance no legal representative, spouse, next of kin or parent are available to sign the claim, please provide a copy of the probate determination. If you have any other questions or if you need further assistance, please contact WPS TRICARE Customer Service at our toll free number 1-866-773-0404.

For those with a Telecommunications Device for the Deaf (TDD) call our toll free line at 1-866-773-0405.

Please send all written correspondence to:

TRICARE For Life
P.O. Box 7889
Madison, WI 53707-7889

Other Health Insurance Questionnaire

If there has been a change or you have become eligible for insurance other than TRICARE, you can submit the information using this questionnaire.

WPS/TRICARE For Life
P.O. Box 7889
Madison, WI 53707-7889

Refund Information Request

If you are returning an overpayment to TRICARE and do not have a copy of the TRICARE Explanation of Benefits, please include this information with your refund. Send all refunds to:

WPS/TRICARE For Life
P.O. Box 7928
Madison, WI 53707-7928

Last Updated 5/1/2014