Dd Form 2947 1 Use the TRICARE Young Adult Application DD Form 2947 to purchase TRICARE Young Adult Select the form for the region where you live East If you want to select the Prime Option at a US Family Health Plan site call 1 800 748 7347 Last Updated 12 23 2024 Patient Resources Submenu for Patient Resources Filing Claims
DD FORM 2947 BACK SEP 2012 UNIFORMED SERVICES SPONSOR THROUGH WHOM APPLICANT QUALIFIES FOR COVERAGE 12 NAME Last First Middle Initial 13 SOCIAL SECURITY NUMBER SSN OR DoD BENEFITS NUMBER If known 14 DATE OF BIRTH YYYYMMDD 15 STATUS X one Active Duty Retired Selected Reserve Retired Reserve Transitional Assistance Management Online Go to the milConnect website and click on the Benefits tab and then click on Beneficiary Enrollment BWE By Phone Call your regional contractor to enroll and set up your payment East 1 800 444 5445 West 1 888 TRIWEST 874 9378 US Family Health Plan Visit US Family Health Plan Overseas Call your regional call center select option 4
Dd Form 2947 1
Dd Form 2947 1
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Fillable Dd Form 2947 Tricare Young Adult Application Printable Pdf
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https://tricare.mil/PatientResources/Forms/Enrollment/TYA
Use the TRICARE Young Adult Application DD Form 2947 to purchase TRICARE Young Adult Select the form for the region where you live East If you want to select the Prime Option at a US Family Health Plan site call 1 800 748 7347 Last Updated 12 23 2024 Patient Resources Submenu for Patient Resources Filing Claims
https://tricare.mil/m/~/media/Files/TRICARE/Forms/USFHP/TYA_Application_CH.pdf
DD FORM 2947 BACK SEP 2012 UNIFORMED SERVICES SPONSOR THROUGH WHOM APPLICANT QUALIFIES FOR COVERAGE 12 NAME Last First Middle Initial 13 SOCIAL SECURITY NUMBER SSN OR DoD BENEFITS NUMBER If known 14 DATE OF BIRTH YYYYMMDD 15 STATUS X one Active Duty Retired Selected Reserve Retired Reserve Transitional Assistance Management
DD Form 2947 2 Download Fillable PDF Or Fill Online TRICARE Young Adult
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DD FORM 2947 1 JAN 2023 TRICARE YOUNG ADULT APPLICATION OMB No 0720 0049 OMB approval expires January 31 2025 The public reporting burden for this collection of information 0720 0049 is estimated to average 15 minutes per response including the time for reviewing instructions searching DLA Official Forms Agency forms will satisfy a valid need and be properly designed using plain language and standardized data for easy collection processing analysis and retrieval of information
DD Form 2947 is received by the 20th of the month coverage begins on the first day of the next month e g an enrollment received by December 20 would become effective January 1 If it is received after the 20th of the month coverage becomes DD Form 2947 and submitting it to your regional contractor If you decide to end TYA coverage you will be locked out from purchasing TYA coverage for one year from the date of termination There will be no lockout if the coverage is terminated because you gain access to an employer sponsored health plan or you regain TRICARE coverage
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Fillable Dd Form 2947 3 Tricare Young Adult Application Printable Pdf
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DD Form 2947 1 Page 1 Free Online Forms
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DD Form 2947 1 Fill Out Sign Online And Download Fillable PDF
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Young Adult Application Form DD FORM 2947 This memorandum is written to satisfy the requirement established by Department of Defense Instruction DoDI 1000 30 Reduction of Social Security Number SSN Use within DoD dated August 1 2012 that requires justification for the collection and use of the SSN on department Forms DD FORM 2947 20111006 DRAFT Adobe Professional 8 0 The public reporting burden for this collection of information is estimated to average 15 minutes per response including the time for reviewing instructions searching existing data sources gathering and maintaining the data needed and completing and reviewing the collection of information
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Dd Form 294 Fill Out Printable PDF Forms Online
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DD Form 2947 Fill Out Sign Online And Download Fillable PDF
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Fillable Dd Form 2947 Tricare Young Adult Application Printable Pdf
Dd Form 294 Fill Out Printable PDF Forms Online
DD Form 2947 3 Fill Out Sign Online And Download Fillable PDF
DD Form 2947 4 Fill Out Sign Online And Download Fillable PDF
DD Form 2947 1 TRICARE Young Adult Application EAST DD Forms
Fillable Dd Form 2947 1 Tricare Young Adult Application Printable Pdf
Fillable Dd Form 2947 1 Tricare Young Adult Application Printable Pdf
Dd Form 2947 Fill Out Printable PDF Forms Online
Fillable Dd Form 2947 Tricare Young Adult Application Printable Pdf
DD Form 2947 2 Fill Out Sign Online And Download Fillable PDF
Dd Form 2947 1 - DD Form 2947 and submitting it to your regional contractor If you decide to end TYA coverage you will be locked out from purchasing TYA coverage for one year from the date of termination There will be no lockout if the coverage is terminated because you gain access to an employer sponsored health plan or you regain TRICARE coverage