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      To update eligibility status for a family member, contact the Defense Enrollment Eligibility Reporting System (DEERS) at (800) 538-9552 and verify what documentation is required for the change. It is the responsibility of the TRICARE beneficiary, parent or legal representative to report a change in status.

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Beneficiary forms

Automatic payments

  • Allotment form
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  • Electronic Funds Transfer (EFT) from banking account
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Claims

  • Appointment of representative
  • Claim form (DD2642)
  • Other Health Insurance (OHI) coverage questionnaire
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  • Third party liability claim form
  • Send third party liability form to:
    TRICARE East Region
    Attn: Third party liability
    PO Box 8968
    Madison, WI 53707-8968
    Fax: (608) 221-7539

    Subrogation/Lien cases involving third party liability should be sent to:
    Humana Military
    PO Box 740062
    Louisville, KY 40201-7462
    Fax: (800) 439-7482
    Email: HMHSRoutineCorrespondence@humana.com

Enrollment

  • Continued Health Care Benefit Program (CHCBP) enrollment form
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The following beneficiary types are considered ineligible to pay by allotment and must choose another form of payment:

 
  • Beneficiary whose sponsor is deceased
  • Beneficiary who receives pay by the VA
  • Beneficiary who is a former spouse

If you are one of the above, please either set up your payment by EFT or RCC. All other beneficiary types should set up allotment payments.

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