TRICARE Select Enrollment, Disenrollment, and Change Form – OMB Control Number
0720-0061
Screenshot #1 – BWE Dashboard
S creenshot #2 – Select Family Members to Enroll
S creenshot #3 – Select QLE
Screenshot #4 – Confirm Address
Screenshot #5 – Check Compliance Boxes
Screenshot #6 – Select A Plan
Screenshot #7 – Verify Plan and Contractor Information
S creenshot #8 – Collect Premiums
Screenshot #9 – Confirm Premium Information
Screenshot #10 – Confirm Enrollment Information
Screenshot #11 – Print Enrollment Form
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Natt, Kuljinder S CTR DMDC |
File Modified | 0000-00-00 |
File Created | 2024-09-26 |