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Defense Department form, series DD, number 2876-2. Full title: DD 2876-2, TRICARE Prime Enrollment, Disenrollment, and PCM Change Form. Function: TRICARE Prime Enrollment, Disenrollment and Primary Care Manager (PCM) Change Form (WEST). Edition in force: not stated. Publisher status: not stated.
Governing directive: not stated. Responsible office: not stated. The DD designation signals joint scope — all military departments, combatant commands and defense agencies draw on a single edition of the document.
Common users: service members regardless of branch, Defense civilian staff, and the offices that file, verify or retain the finished document.
Submission follows the schedule set by not stated and by local implementing procedures. This page provides the blank form for download and general orientation only.
Formats offered: PDF. Length: 5 pages. Fillable field count: roughly 152.
Pdf serves as the base format. In the fillable variant, each box is an interactive field that holds typed text inside the document. In the flat printable variant, no fields exist — the page prints as a blank to be completed by hand. Typed entries survive transmission; handwriting does not always survive scanning.
What the form asks for
- Contractor's website.
- TRICARE Prime option desired. Press space bar to mark X in first box if TRICARE Prime, second box if TRICARE Prime Remote, third box if TRICARE Overseas Program Prime, or fourth box if Uniformed Services Family Health Plan.
- Section I - Sponsor information. 1. Sponsor name (last, first, middle initial) (must match DEERS).
- Sponsor's social security number or DoD Benefits Number (DBN).
- 3. Sponsor is: X first box if active duty, second box if retired, third box if deceased, or fourth box if unremarried former spouse.
- 4. Sponsor's work telephone number (include area code/extensions).
- 5. Sponsor's email address.
- 7. Sponsor's residence address (street, apartment number, city, state, zip code, country).
- X if new address.
- 8. Sponsor's mailing address (provide APO or FPO if stationed overseas).
- X if same as residence address.
- X if new address.
- 9. Sponsor's military assignment. a. Unit.
- b. Unit identification code (if known).
- c. State, zip code and country of work address.
- 10. Requested action. X first box if none for sponsor (go to section II - family), second if enroll, third if transfer enrollment, fourth if PCM change, or fifth if disenroll.
- 11. Sponsor primary care preference. a. PCM, first choice. X first box if military treatment facility, second box if PRP (active duty only), third box if civilian.
- Primary care manager full name or MTF/clinic.
- b. Second choice. X first box if military treatment facility, second box if civilian.
- Primary care manager full name or MTF/clinic.
- c. PCM specialty. X first box if no preference, second box if family/general practice, third if internal medicine, or fourth if flight medicine.
- d. Preferred PCM gender. X first box if no preference, second box if male, third box if female.
- Section II - Enrolling family members. 12.a. First family member name (last, first, middle initial) (must match DEERS).
- b. Date of birth (4 digit year, 2 digit month, 2 digit day).
The document is filled from the top down. Identification precedes substance, substance precedes certification. Fields lower on the page are commonly keyed to entries made above them.
The current edition is not stated. Superseded editions of DD forms are frequently rejected at the receiving office, since Department-wide forms change centrally and older layouts lose their field correspondence. Edition date appears in the lower corner of the printed blank.
Certification requires a signature in the designated block — ink on paper, or a digital signature where the receiving office supports one. Typing a name into the field does not constitute execution. CAC-based signing is the usual digital method for Defense forms.
Where personal information is collected, a Privacy Act Statement appears on or with the form. It names the collection authority, the purpose, the routine uses of the data and the consequence of withholding it. Reading it precedes filling the form.
Frequent defects: obsolete edition, unfilled required boxes, handwriting that fails on reproduction, non-conforming date format, and certification without a corresponding date.
Instructions printed on the form or in not stated govern individual field entries. Where the two differ, the governing publication controls.
The completed document moves to the office named in not stated or in local guidance. A retained copy is conventional practice.
Cross-referenced forms are found through the numbering system. The DD sequence is Department-level and unified, which means a number cited on the page identifies one document across the whole Department.
Some procedures pair a DD form with a service form. The two numbering systems are separate — service forms answer to a service proponent, DD forms to not stated or another Department office — and a matching number in each system means nothing.
Revision occurs when the prescribing directive is reissued, when the data collected changes, or when statutory notice language is amended. Verification of the edition date at download addresses all three.
The material here is descriptive. Nothing on the page constitutes legal or procedural advice, and no statement here determines whether a submitted form will be accepted. Such questions go to not stated, a servicing administrative office, or the authority identified in not stated.
Questions and answers
- What is DD Form 2876-2?
- DD 2876-2, TRICARE Prime Enrollment, Disenrollment, and PCM Change Form
- Which edition is current?
- Not stated by the publisher
- Who is responsible for this form?
- Not stated
- In which formats can it be downloaded?