PURPOSE: DD Form 2569 collects individual's information to assist the Department of Defense (“DoD”) in its recovery from third parties for medical care provided to an individual in a Military …

The DD Form 2569 is the way you tell DOD about your OHI. The information provided on the DD Form 2569 is used to properly route a health care claim to your OHI provider. Who has to …

Flight status, tracking, and historical data for Southwest 2569 (WN2569/SWA2569) including scheduled, estimated, and actual departure and arrival times.

Each Family member (other than the Active Duty sponsor) needs to have a DD 2569 Other Health Insurance Form completed annually, or when there are changes to your Other Health Insurance information.

PURPOSE: DD Form 2569 collects individual's information to assist the Department of Defense (“DoD”) in its recovery from third parties for medical care provided to an individual in a Military Treatment Facility.

DO FORM 2569 (BACK), NOV 2010 THIRD PARTY COLLECTION PROGRAM/MEDICAL SERVICES ACCOUNTI OTHER HEALTH INSURANCE (Read Privacy Act Statement before completing this form.)

RETURN COMPLETED FORM TO REQUESTING MILITARY TREATMENT FACILITY. AUTHORITY: Title 10 USC, Sections 1095 and 1079b; Executive Order 9397. PRINCIPAL PURPOSE(S): Information will be used to collect from private insurers for medical care provided to the Military Treatment Facility (MTF) patient.

The DD Form 2569 is the way you tell DOD about your OHI. The information provided on the DD Form 2569 is used to properly route a health care claim to your OHI provider.

Third Party Collection Program/Medical Services Account/Other Health Insurance DD Form 2569 Download Form