TRICARE Young Adult Application

6/13/2018

Beneficiary Web Enrollment

Welcome to TRICARE's Beneficiary Web Enrollment
Alert: This site has been developed and optimized for Internet Explorer 6.0 and above. If you
are using a different browser that is having difficulties with this site, please use Internet
Explorer and try again.

LOG ON INSTRUCTIONS
Manage Medical and Dental Enrollments:
1. Click on the red "Log On" link above.
2. You are required to log on using either CAC, DS Logon or a DFAS account.
3. Once logged in, select the Medical tab to enroll or update your medical coverage, or the Dental tab to enroll or update
your dental coverage.
Print Enrollment Forms: Click on the "Get Enrollment Forms" link on the left-hand sidebar.

AGENCY DISCLOSURE NOTICE
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. Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing the burden, to the Department of Defense, Executive Services and
Communications Directorate (0720-0008). Respondents should be aware that notwithstanding any other provision of law, no
person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid
OMB control number.

PRIVACY ACT STATEMENT
AUTHORITY: 5 U.S.C. 552a, 10 U.S.C. 1079 and 1086, 58 FR 45318, 65 FR 30966, May 15, 2000.
PRINCIPAL PURPOSE(S): To evaluate eligibility for medical care provided by civilian sources to Military Health Services System
beneficiaries applying for coverage under the TRICARE Program (32 CFR 199.17).
https://www.dmdc.osd.mil/appj/bwe/indexAction.do;jsessionid=Kzn6hoNoH0Screjtx_Vfpto-pTYnlEenva3Ahq6qIoXiw7ftc164!923176617

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6/13/2018

Beneficiary Web Enrollment

ROUTINE USE(S): Information from application forms and related documents may be given to the Department of Health and
Human Services, and/or the Department of Transportation consistent with their statutory administrative responsibilities under
TRICARE; to the Department of Justice for representation of the Secretary of Defense in civil actions. Appropriate disclosures
may be made to other Federal, State, local, and foreign government agencies, private business entities, and individual providers
of care, on matters relating to entitlement, fraud, program abuse, program integrity, and civil and criminal litigation related to
the operation of the TRICARE Program.
DISCLOSURE: Voluntary; however, failure to provide information will result in the denial of enrollment.

This site provides Department of Defense personnel and their eligible family members the capability to manage their TRICARE
enrollments. You will be required to have the proper access methods such as Common Access Card (CAC), Defense Financial and
Accounting Services (DFAS) PIN, or Family PIN.
The Material / Information contained herein falls within the purview of the Privacy Act of 1974 and will be safeguarded in accordance
with the applicable system of records notice and DLAR S40021.

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For technical assistance or to report problems with this site please call 1-800-477-8227.
Version: 6.10.041, Build Date: 02-27-2018 15:48:33

https://www.dmdc.osd.mil/appj/bwe/indexAction.do;jsessionid=Kzn6hoNoH0Screjtx_Vfpto-pTYnlEenva3Ahq6qIoXiw7ftc164!923176617

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