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					       TRICARE
 Your Military Health Plan

         Dental
TRICARE Fundamentals Course
         Module Objectives
• Describe the Active Duty Dental Program
• Explain the TRICARE Dental Program
  and who is eligible
• Explain the TRICARE Retiree Dental
  Program and who is eligible
• State how premiums are determined for
  the TRICARE Retiree Dental Program


                                            2
Active Duty Dental Program (ADDP)
• Provides private sector/civilian dental care for ADSMs
• Available in the U.S. and U.S. territories
• Has two components:
   • Military Dental Treatment Facility (DTF) Referred
     Care
   • Remote Active Duty Dental Care
• Designed to augment dental care provided in military
  DTFs


                                                           3
                   Eligibility
ADSMs of the following Uniformed Services are eligible:
• Air Force
• Army
• Coast Guard
• Marine Corps
• Navy
• NOAA
• Certain Guard/Reserve members and LOD service
  members

                                                          4
               ADDP Enrollment
• Automatic enrollment for all ADSMs assigned to
  remote stateside locations
• DMDC mails ADDP enrollment cards
    There is no military DTF enrollment card




                                                   5
            DTF Referred Care
• Authorizes civilian dental care for non-remote ADSMs
• DTF initiates the referral online
    ADSMs should not receive care without a referral number and
     an ACN

• ADSMs may only receive services listed on the referral
• ADDP contractor should schedule appointments




                                                                   6
  Remote Active Duty Dental Care
• Allows remote ADSMs to coordinate their own routine dental
  care
• Treatment must be less than:
     $750 per procedure or appointment or
     The cumulative total of $1,500 within a consecutive
      12-month period

• Offers options for accessing routine dental care
• Requires ADSMs to receive prior authorization before
  specialty dental care
• Emergency dental care does not require an authorization or an
  ACN


                                                                  7
      TRICARE Dental Program
• Voluntary, premium-based dental insurance plan

• Provides worldwide dental coverage for:
    Active duty family members
    Non-active duty Guard/Reserve members and their eligible
     family members




                                                                8
              TDP Enrollment
• Enrollment is required for TDP coverage
• 20th-of-the-month rule applies
• Sponsor’s rank determines cost share
• Two enrollment plans:
    Single
    Family

• Guard/Reserve sponsor enrolls independent of
  his/her family members



                                                 9
               TDP Monthly Premiums
                               Rates listed are effective through Sep 1, 2011

Plan Type                      Active Duty     Nat’l Guard /         IRR
                                                   SELRES

Sponsor Only                       N/A            $12.69           $31.72

Single (one family member,       $12.69           $31.72           $31.72
excluding sponsor)


Family (more than one family     $31.72           $79.29           $79.29
member, excluding sponsor)


Sponsor and Family                 N/A            $91.98           $111.01



                                                                                10
          TDP Survivor Benefit
• Provides continued TDP coverage for surviving family
  members
• Coverage expires three years from the month following
  the sponsor’s death
• The government pays 100 percent of TDP survivor
  benefit premium for three years
• Surviving family members are eligible for the TRICARE
  Retiree Dental Program once the three-year TDP
  survivor benefit period ends


                                                         11
                  TDP Portability
• Enrollees can seek care from any TDP-participating
  dentist when traveling/moving within the U.S.
• Stateside TDP Enrollees
    Covered while traveling overseas
      • Responsible for all cost shares and the difference between
        TDP maximum allowable charge and provider’s actual charge
        for covered services
      • Enrollees should not disenroll prior to overseas relocation

• Overseas TDP Enrollees
    Covered while traveling stateside
      • Subject to stateside benefits program procedures regarding
        claims

                                                                      12
Annual & Lifetime Maximum Benefit
• Annual Maximum
   $1,200 per enrollee/per contract year
      • Non-orthodontic services (i.e., orthodontic diagnostic
        services)

• Lifetime Maximum
   $1,500 per enrollee for orthodontic treatment




                                                                 13
          Dental EOB Exercise
• How many procedures did the dentist perform on
  02/01/06?
• What are the procedure codes for the prophylaxis and
  the comprehensive evaluation?
• How much did the dentist charge for each procedure?
• What are the TDP allowable charges for each
  procedure performed?
• What is stated in remark Q1030?


                                                         14
TRICARE Retiree Dental Program
• Voluntary, premium-based group dental benefit plan

• Provides worldwide dental coverage for:
      Uniformed service retirees
      Uniformed service retiree family members
      Unremarried surviving family members
      Other select individuals




                                                       15
                    TRDP Enrollment
•   Enrollment is required for TRDP coverage

•   Three enrollment plans:
       Single
       Two-party
       Family

•   Enrollees must fulfill an initial 12-month enrollment period

•   Provides 30-day grace period for voluntary disenrollment if
    benefits were not used

•   New retiree enrollment opportunity

                                                                   16
Annual & Lifetime Maximum Benefits
• Annual Maximum
   $1,200 per enrollee/per contract year
      • Preventive and diagnostic services are not counted

• Dental Accident Annual Maximum
   Separate from TRDP annual maximum
   $1,000 per enrollee/per benefit year

• Lifetime Maximum
   $1,500 per enrollee for orthodontic treatment


                                                             17
              TRDP Premiums
• Premium rates vary depending upon:
    Where the enrollee lives
    Number of family members enrolled




                                         18
          Module Summary
• Describe the Active Duty Dental Program
• Explain the TRICARE Dental Program
  and who is eligible
• Explain the TRICARE Retiree Dental
  Program and who is eligible
• State how premiums are determined for
  the TRICARE Retiree Dental Program


                                            19
Questions?




             20
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