Humana-Military.com

Beneficiary Forms


Enrollment

Continued Health Care Benefit Program Enrollment form 
Prime Enrollment, PCM Change and Disenrollment Form  
 
For enrollment, PCM changes and disenrollment in TRICARE Prime/TRICARE Prime Remote, submit the completed Application/PCM Change Form to the address below:
 
Humana Military Healthcare Services
Attn. PNC Bank
P.O. Box 105838
Atlanta, GA 30348-5838

Fax number:  866-836-9535
 
 
Extended Care Health Option (ECHO) Application 
Extended Care Health Option (ECHO) Medical Application 
TRICARE Young Adult Application

Related Links

TRICARE Prime Travel Benefit Program 
TRICARE Forms  
All files are posted as PDFs unless otherwise noted.
 
Last Update: March 11, 2014