Army Forms Archive

DD Form 2876-3 — DD 2876-3, TRICARE Prime Enrollment, Disenrollment, and PCM Change Form

TRICARE Prime Enrollment, Disenrollment and Primary Care Manager (PCM) Change Form (OVERSEAS)

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DD Form 2876-3 — a Department of Defense document. Title of record: DD 2876-3, TRICARE Prime Enrollment, Disenrollment, and PCM Change Form. Stated purpose: TRICARE Prime Enrollment, Disenrollment and Primary Care Manager (PCM) Change Form (OVERSEAS). Edition date not stated; status not stated.

Prescribing authority: not stated. Proponent: not stated. Unlike service-specific publications, DD forms carry Department-level authority and apply across the Army, Navy, Air Force, Marine Corps, Space Force and Coast Guard when operating under Defense jurisdiction.

The form reaches military personnel across the services, civilian employees of the Department, and the personnel and records specialists who receive it.

When the form is filed is a matter of not stated and local instruction. The description here covers the document itself and how to obtain a copy.

Available formats: PDF. The form runs 5 pages and contains approximately 152 fillable fields.

All formats download free of charge. Pdf files open in any modern reader; interactive fields behave most predictably in a desktop application, less so in browser viewers.

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).

Completion runs in the order printed on the page: identifying data at the head, the body of the entry next, certification at the foot. Header data frequently governs what belongs in the fields below it.

Edition in use: not stated. Because DD forms are revised at Department level and distributed to all services at once, an obsolete printing may not match the fields an office expects. The date is printed on the form face.

Instructions printed on the form or in not stated govern individual field entries. Where the two differ, the governing publication controls.

Once executed, routing follows not stated and the submitting organization's own instruction. Keeping a copy is standard.

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.

This page distributes a published Department of Defense document and describes it. It is not a source of legal advice and makes no representation about acceptance of any completed form. Questions of applicability, eligibility or procedure belong to not stated, the servicing personnel office, or the office named in not stated.

Questions and answers

What is DD Form 2876-3?
DD 2876-3, 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?
PDF

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