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About Our Plans
How the Standard/ Extra
High Option II
How To Enroll
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TRICARE Official Site
Do You Need a CHAMPVA Supplement ?
It's Easy to Enroll
To start, you need to:
- CLICK HERE for your online enrollment form.
Enrollment form is in PDF format. If you don't have Adobe Acrobat Reader,
click on this link.
- Next, print out and complete the enrollment form.
- IF you plan to pay your premiums monthly, you will need to print the Checkomatic Payment Plan form.
CLICK HERE for your Checkomatic form.
- Then, print out and complete the Checkomatic form.
- IF you are paying monthly, also include a voided check from the account you are having your premiums drafted from.
- Now, CLICK HERE for your AMRA membership form.
- And, print the AMRA membership form and complete it.
- Write a check for your initial premium, payable to:
AMRA Group Health Program
(Please note: Initial premium required is the same as the mode of payment.
One month - Checkomatic, one quarter - quarterly, etc.)
CLICK HERE to review the rate schedule.
So, you should now have:
- A completed enrollment form
- A check for your initial premium, payable to: AMRA Group Health Program
- A completed AMRA membership form
- A check for your AMRA membership, payable to: AMRA
- A completed Checkomatic form, IF you are paying monthly
- A voided check, IF you are paying monthly
- Additional documentation, IF you are applying for a waiver of the
Pre-existing Condition Limitation Clause
or IF you are affected by the PRIME PSA Change.
Finally, all you need to do is:
- Place all of the above in an envelope
- And, mail it to:
Tricare Supplement Plan
P.O. Box 3246
Pensacola, FL 32516
If you have any questions, email us at:
We appreciate you choosing our AMRA TRICARE Supplement.
We look forward to helping you with your TRICARE supplemental coverage.