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TRICARE Select Enrollment, Disenrollment and Change Form

Beneficiaries can enroll in or disnenroll from TRICARE Select online through Beneficiary Web Enrollment (BWE) or you can print, complete and mail this form to Health Net Federal Services, LLC for processing.

Send completed forms to: 

Health Net Federal Services, LLC
TRICARE Select Enrollment
PO Box 8458
Virginia Beach, VA 23450-8458
Fax: 1-844-388-8282

  • Created: Jan 22, 2020
  • Modified: Jan 8, 2020
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