ECHO provides supplemental services beyond basic TRICARE — including ABA therapy, respite care, and assistive technology

The annual ECHO benefit cap is set by Congress and adjusts periodically — check TRICARE.mil for the current amount

ECHO can be used in combination with TRICARE Prime or Select

Military / TRICAREhardDoctor signature required

TRICARE Extended Care Health Option (ECHO)

DD-specific · Defense Health Agency

Application for TRICARE Extended Care Health Option providing supplemental benefits for active duty family members with qualifying disabilities. Covers services beyond standard TRICARE, including applied behavior analysis and institutional care.

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Where to Submit This Form

🌐

Contact your regional TRICARE contractor

https://tricare.mil/ContactUs

Call to initiate a request for extended care health option (ECHO) benefits.

🏢

Submit through your military treatment facility case manager or TRICARE Beneficiary Counseling and Assistance Coordinator (BCAC)

https://tricare.mil/bcac

📬

Mail completed ECHO application to your TRICARE regional contractor

Filing Deadline

Must register for ECHO before receiving covered services. No specific deadline to register, but services are only covered from the registration date forward.

Required Attachments

📎 Completed ECHO registration form
📎 Documentation of the qualifying condition (moderate or severe intellectual disability, serious physical disability, or extraordinary physical or psychological condition)
📎 Medical records and assessments documenting the condition
📎 Current TRICARE enrollment documentation
📎 DEERS registration showing active dependent status

Processing Time

30-60 days for initial ECHO registration and benefit determination.

What Happens Next

You will receive an ECHO benefit determination letter outlining covered services, annual cap, and authorized providers. A Homecare Case Manager may be assigned to coordinate services.

Tips for This Form

✓ ECHO provides supplemental services beyond basic TRICARE — including ABA therapy, respite care, and assistive technology
✓ The annual ECHO benefit cap is set by Congress and adjusts periodically — check TRICARE.mil for the current amount
✓ ECHO can be used in combination with TRICARE Prime or Select
✓ Transitioning from active duty to retired status? Re-register for ECHO under your new TRICARE plan

More Military / TRICARE Forms

TRICARE DoD/CHAMPUS Medical Claim

DD Form 2642 · Department of Defense

TRICARE medical claim form for beneficiaries seeking reimbursement when providers do not file claims directly. Must attach itemized bill on provider letterhead. Used by active duty, retirees, and family members.

TRICARE Enrollment (milConnect/DEERS)

Online enrollment · Defense Health Agency

Enrollment in TRICARE plan options (Prime, Select, etc.) through milConnect or DEERS update. Requires valid military ID.

DEERS Enrollment Application

DD Form 1172-2 · Department of Defense

Application for Department of Defense Common Access Card (CAC) or DEERS Enrollment. Establishes beneficiary status for TRICARE eligibility.

TRICARE Referral / Pre-Authorization Request

Contractor-specific · TRICARE managed care contractors

Referral or prior authorization for specialty care, certain procedures, and medications under TRICARE Prime. Not required for TRICARE Select.

TRICARE Pharmacy Prior Authorization

Express Scripts PA form · Express Scripts (TRICARE pharmacy contractor)

Prior authorization for non-formulary medications or formulary drugs with utilization management requirements under TRICARE.

Post-Deployment Health Assessment

DD Form 2796 · Department of Defense

Post-Deployment Health Assessment completed by service members within 30 days of returning from deployment. Screens for deployment-related health concerns including mental health, environmental exposures, and injuries.

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Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the Defense Health Agency or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.