TRICARE Dental Program (TDP)

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LD# L0312247371[exp0513]

2TDP Eligibility

• Active Duty Family Members

• Selected Reserves (SELSRES)

• Family members of the SELRES and IRR Sponsors

• Unmarried children under age 21 or age 23 if full time college student

• Enrollment Requirements for sponsor• 12 Months of service remaining

• DEERS/DOES is sole source for verifying eligibility

White Fillings

Coverage of posterior

resin fillings

Annual Maximum

increase per enrollee

To $1,300 (from

$1,200)

Lifetime Orthodontic

Maximum Increase

To $1,750 (from

$1,500)

Accidental Coverage

New Annual maximum of

$1,200 / year for services

related to dental

accident treatment

No cost shares for Diabetics*

For scaling and root planing

Additional 3rd cleaning

For women during

pregnancy

3TDP Highlights: Enhancements

• If an individual visits an out of network dentist, he or she may incur additional out of pocket expenses if the dentists’ charge exceeds the reasonable and customary fee.

4TDP Cost Shares

Covered Services CONUSE-1, E-2,

E-3, and E-4

CONUSAll Other Pay

GradesE-5 and above

OCONUSCommand-SponsoredEnrollees1

Diagnostic & Preventive2

(ie: Cleanings, oral evaluations, X-Rays)

0% 0% 0%

Sealants for children; •Permanent molars only (through age 18)Consultation/Office Visit,Post-Surgical Services & Basic Restorative•Composite fillings (white fillings)

20% 20% 0%

• Diagnostic & Preventive services have no cost shares

• If an individual visits an out of network dentist, he or she may incur additional out of pocket expenses if the dentists’ charge exceeds the reasonable and customary fee.

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Covered Services CONUSE-1, E-2,

E-3, and E-4

CONUSAll Other Pay

GradesE-5 and above

OCONUSCommand-SponsoredEnrollees1

Endodontic (root canals)Periodontic (gum surgery) Oral Surgery (Primarily extractions)

30% 40% 0%

General Anesthesia 40% 40% 0%

Other Restorative, Implant Services, Prosthodontic & Orthodontic3

(ie: inlays, onlays, crowns, bridges, partials, dentures)

50% 50% 50%

Intravenous Sedation & Miscellaneous Services(occlusal guard, athletic mouthguard)

50% 50% 0%

1.Selected Reserve and IRR family members and IRR (other than Special Mobilization Category) members are responsible for the applicable cost-share portion regardless of where the treatment is received.

2.Space maintainers are fully covered for patients under age 19 when involving posterior teeth. They are covered at a 20% cost-share for patients under age 19 when replacing anterior teeth only. Sealants are covered at 20% as noted above.

3.Orthodontic treatment is available for enrolled family members (non-spouse) up to, but not including, 21 years of age. A member who is enrolled as a full-time student at an accredited college or university is eligible up to, but not including, 23 years of age. Orthodontic treatment is also available for spouses and National Guard and Reserve members up to, but not including, 23 years of age. In all cases, coverage is effective until the end of the month in which the member reaches the applicable age limit.

TDP Cost Shares

6TDP Monthly Premiums

Single Premium (one family member) Family Premium (more than one family member)

$10.30 $30.89

Sponsor-Only Premium Single Premium (one family member, excluding sponsor)

Family Premium (more than one family member, excluding sponsor)

Sponsor and Family Premium

$10.30 $25.74 $77.22 $87.52

Sponsor-Only Premium Single Premium (one family member, excluding sponsor)

Family Premium (more than one family member, excluding sponsor)

Sponsor and Family Premium

$25.74 $25.74 $77.22 $102.96

Active Duty

Selected Reserve of the Ready Reserve and Individual Ready Reserve (Mobilization Only)

Individual Ready Reserve (Non Mobilization)

MetLife Dental Network (PDP)Preferred Dentist Program

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• 164,000 participating dentist locations

• Beneficiaries can go to any licensed civilian dentist

• Locate participating dentist on https://mybenefits.metlife.com/tricare

ADVANTAGE TO USING PARTICIPATING PROVIDERS:

• Complete DoD/Reserve Forces Dental Exam Screening Form (DD Form 2813) for service members, at no additional cost

• Submit claims

• Collect only Cost shares

• Cannot “balance bill” for covered services • If an individual visits an out of network dentist, he or she may incur additional out of pocket expenses if the dentists’ charge exceeds the

reasonable and customary fee.

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• 1st month premium sent to MetLife with enrollment application

• 12 month mandatory enrollment commitment

• HOW TO ENROLL

• Online: www.tricare.mil/bwe • Phone: CONUS – 1-855-MET-TDP1

OCONUS – 1-855-MET-TDP2Hearing Impaired 1-855-MET-TDP3

• Mail - download form www.tricare.mil/dental

***Applications must be received by the 20th of the month for coverage to be effective on the 1st of the following month.

TDP Enrollment

• Beneficiary calls for enrollment and general inquiries• (CONUS) 1-855-638-8371 or (OCONUS) 1-855-638-8372• Hearing Impaired: 1-855-638-8373

• MetLife website via https://mybenefits.metlife.com/tricare

• MetLife will begin paying claims for services rendered on 5/1/12 and later • Claim inquires for services rendered before 5/1/12 should be directed to

UCCI

• Enrolled members on payroll allotment Will be automatically enrolled with MetLife

• Enrolled members paying by credit card or EFT Must re-authorize with MetLife

• Update and confirm all information in DEERS

• MetLife recommends that you have your dentist submit a predetermination request when the cost is expected to be above $300.

Important TDP Information to Remember 9

10

QUESTIONS