Tricare Claims Forms

Select the type of claim you would like to submit to download forms and view instructions:

TRICARE DoD/CHAMPUS Claim Form-Patient's Request for Medical Payment (DD Form 2642)

Statement of Personal Injury-Possible Third Party Liability (DD Form 2527)

Medicare Health Insurance Claim Form (Form CMS-1500) and >>View CMS-1500 Fact Sheet

TRICARE DoD/CHAMPUS Claim Form-Patient's Request for Medical Payment (DD Form 2642)

Active Duty Dental Program Claim Form

TRICARE Retiree Dental Program Claim Form (United States)

TRICARE Retiree Dental Program Claim Form (Overseas)