TRICARE Select Enrollment, Disenrollment, and Change Form

TRICARE Select Enrollment, Disenrollment, and Change Form

BWE TSelect Enrollment Flow

TRICARE Select Enrollment, Disenrollment, and Change Form

OMB: 0720-0061

Document [docx]
Download: docx | pdf

TRICARE Select Enrollment, Disenrollment, and Change Form – OMB Control Number

0720-0061



Screenshot #1 – BWE Dashboard

Picture 1

SShape11 Shape10 Shape9 Shape8 Shape7 Shape6 Shape5 Shape4 Shape3 Shape2 Shape1 creenshot #2 – Select Family Members to EnrollPicture 2

SShape12 creenshot #3 – Select QLE

Picture 3

Screenshot #4 – Confirm Address

Picture 4 Shape27 Shape26 Shape25 Shape24 Shape23 Shape22 Shape21 Shape20 Shape19 Shape18 Shape17 Shape16 Shape15 Shape14 Shape13

Screenshot #5 – Check Compliance Boxes

Picture 5

Screenshot #6 – Select A Plan

Picture 6

Screenshot #7 – Verify Plan and Contractor Information

Picture 7

SShape28 creenshot #8 – Collect Premiums

Picture 14

Picture 10 Shape31 Shape30 Shape29

Screenshot #9 – Confirm Premium Information

Picture 11

Screenshot #10 – Confirm Enrollment Information

Picture 12

Screenshot #11 – Print Enrollment Form

Picture 13



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorNatt, Kuljinder S CTR DMDC
File Modified0000-00-00
File Created2024-09-26

© 2024 OMB.report | Privacy Policy