Reserve Component Health Coverage Request

DD Form 2896-1 “Reserve Component Health Coverage Request” is used by certain Reserve Component members and retired members to purchase or make changes to coverage under the TRICARE Reserve Select and TRICARE Retired Reserve (TRR) health plan. Please see 32 CFR 199.24(c) and 199.25(b) for a list of eligible beneficiaries. Eligible beneficiaries can complete this form using the online Beneficiary Web Enrollment (BWE) portal. Although the online BWE portal submission option is available, some beneficiaries will prefer using the physical form to document their enrollment date and preferences.

The latest form for Reserve Component Health Coverage Request expires 2027-07-31 and is listed under ICR 202405-0720-003.