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TRICARE For Life Executor/Executrix of Estate Notification:

Used to inform TRICARE For Life of the unfortunate passing of a loved one and to notify us who is handling the deceased estate.

TRICARE For Life must have this form on file to release information on the deceased estate. The information that you are asked to provide on the form is as follows. You must have this information available to complete the form properly.

  • Name and sponsor number of the deceased (the social security number of the family member who served)
  • Who is the legally appointed representative of the estate
  • If you are not the legally appointed representative please provide your name, address, signature, the deceased name, date of death and relationship to the deceased
  • Name and address of any additional representatives

TRICARE For Life Executor of Estate Notificiation.pdf | 68 KB

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