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

Beneficiaries can enroll in or disenroll from TRICARE Prime, or to change your primary care manager online through Beneficiary Web Enrollment (BWE) or you can print, complete and mail this form to Health Net Federal Services, LLC for processing.

Note: ADSMs must have their orders or unit identification code (UIC) available when enrolling to ensure assignments to local military hospitals or clinics are accurate.

Tip! You may need to right click on the form link and "save as" to download depending on your browser.

  • Created: Dec 20, 2010
  • Modified: Aug 8, 2023
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