Beneficiary forms
Automatic payments
Claims
- Appointment of representative
- Claim form (DD2642)
- Other Health Insurance (OHI) coverage questionnaire
- Public facility use certification form
- Third party liability claim form
- Send Third Party Liability form to:
TRICARE East Region
Attn: Third Party Liability
P.O. Box 8968
Madison, WI 53707-8968
Fax: (608) 221-7539
