TRICARE For Life

Appeals

Appointment of Appeal Representative

This form designates a representative for the appeals process.

Authorization To Disclose Information

Authorization To Disclose Information

By filling out this form, you are giving authorization to the TRICARE For Life contractor to release information protected under the Federal Privacy Act. This form isn’t valid to designate a representative for the appeals process.

Estate Notification

Estate Notification

This form is used to notify TRICARE that your loved one is now deceased. In the instance no legal representative, spouse, next of kin, or parent is available to sign the claim, please provide a copy of the probate determination. If you have questions or if you need further assistance, contact WPS TRICARE Customer Service at 866-773-0404 (TDD: 866-773-0405).

Send all written correspondence to:

TRICARE For Life
P.O. Box 7889
Madison, WI 53707-7889

Other Health InsuranceHealth insurance you have in addition to TRICARE, such as Medicare or an employer-sponsored health insurance. TRICARE supplements don’t qualify as "other health insurance."

Other Health Insurance Questionnaire

If there has been a change or you have become eligible for insurance other than TRICARE, you can submit the information using this questionnaire.

WPS/TRICARE For Life
P.O. Box 7889
Madison, WI 53707-7889

Refund Information Request

Refund Information Request

If you’re returning an overpayment to TRICARE and you don’t have a copy of the TRICARE explanation of benefits, please include this information with your refund. Send all refunds to:

WPS/TRICARE For Life
P.O. Box 7928
Madison, WI 53707-7928