Welcome to the TRICARE Prime enrollment forms. Please note that enrollment is subject to your location, your TRICARE eligibility category, Primary Care Manager (PCM) availability, and other TRICARE policies. Upon completion of the enrollment process, a Prime enrollment welcome letter and identification card will be mailed to you. You will also receive other important information from your regional Managed Care Support Contractor (MCSC) and/or your Military Treatment Facility (if you are enrolling to an MTF).

• You must be eligible for TRICARE health benefits in order to enroll in TRICARE Prime or Prime Remote.
• TRICARE Prime is not available everywhere.
• You can be disenrolled from TRICARE Prime for nonpayment of fees.

Newborns or adoptees are automatically covered under TRICARE Prime/ Prime Remote for Active Duty Family Members (TPRADFM) for up to 120 days after the date of birth and/or adoption as long as one other person in the family is enrolled in Prime/Prime Remote/TPRADFM.

Within this 120 day window, you should:

• Register your newborn or newly adopted child in DEERS, through the unit personnel office or the nearest Uniformed Services ID card facility.
• Enroll him or her in TRICARE Prime or TPRADFM if you wish to continue the Prime benefit, with its enhanced preventive services and reduced costs.

On day 121, Prime and TPRADFM benefits end and future claims will process as TRICARE Standard (higher costs).

To access an enrollment form, click on a region to access the Managed Care Support Contractor Web site that contains regional enrollment forms and follow the instructions provided. Please complete all forms in ink. Follow the region-specific instructions on where to return the form. Please keep a copy of the completed form for your records. Please call the regional beneficiary number on the map below for questions or further information regarding TRICARE Prime enrollment applications or the enrollment process.

Click on the region to access enrollment forms.	Enter Your Zip Code

New Prime Enrollment

If you are enrolling in Prime for the first time or have not been enrolled in TRICARE Prime for some time, please download and/or complete the form and send it to your regional MCSC. If the MCSC receives your application by the 20th day of the month, you will be enrolled in TRICARE Prime effective the first day of the following month. If your application is received after the 20th day of a given month, your Prime enrollment will be effective the first day of the second month after the MCSC received your application. (For example, applications received on or before May 20, will have a Prime enrollment effective date of June 1. Applications received after May 20, will have an enrollment effective date of July 1.)

Transferring Prime Enrollment

If you have recently moved and are transferring your Prime enrollment, download and complete the form and send it to the MCSC in your new region. Your enrollment transfer is effective on the date your new regional MCSC receives your application.

Enrollment Fees/Allotments

Beneficiaries can visit their regional contractor's Web site or call them for enrollment and fee payment option information. If you are a retiree and interested in paying by allotment , please read the following:

Retirees who pay TRICARE Prime enrollment fees can pay these fees through monthly allotment only from their Service retirement pay. This retirement pay allotments may be deducted from one of the following pay agencies:

• Defense Financial Accounting System (DFAS);
• Coast Guard; or,
• Public Health.

Beneficiaries who get survivor benefits from either retired or active duty sponsors are paid through a separate pay account and are not eligible for setting up an enrollment fee allotment.

In order to start an allotment, a beneficiary must fill out an Enrollment Fee Allotment Authorization Letter and send it to the Regional contractor (North, South, or West) along with an initial quarterly payment. (Beneficiaries will not need to send a quarterly payment when transferring from one region to another once the allotment process has already been set up.) After the contractor receives the allotment authorization letter and initial quarterly payment, the contractor forwards a payment request to the designated pay agency. The pay agency in turn set up a monthly payment to the regional contractor on the beneficiaries behalf.

The Enrollment Fee Allotment Authorization Letter is used to start, stop, or change monthly allotment payments from the retiree pay account.