2025 Printable Template
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Form last updated: 03/2024. Please verify this is the current version before use.
Easily complete & submit your DD 2642 form
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What is a DD 2642 used for?
The DD Form 2642 is used by TRICARE beneficiaries to submit claims for reimbursement of medical expenses incurred outside the TRICARE network. It is essential for verifying eligibility and authorizing payment for healthcare services received.
Who needs to fill out a DD 2642 form
TRICARE beneficiaries or their authorized representatives who have received care outside the TRICARE network.
How to fill out a DD 2642 online?
Follow these steps to complete your DD 2642 form online.
Frequently Asked Questions
Find quick answers to common questions about our PDF editor.
It is used to file claims for medical care received outside the TRICARE network.
TRICARE beneficiaries or their authorized representatives must complete the form.
If your healthcare provider files the claim for you or if you receive care within the TRICARE network.
Generally, claims must be submitted within one year from the date of service.
Check with your TRICARE regional contractor for online submission options.
