|
|
| |
TRICARE: Summary of Beneficiary Costs
|
 |
 |
|
Previous Page Table of Contents Next Page
|
| |
TRICARE Dental Options
Tri-Service Remote Dental Program
TRICARE Dental Program
TRICARE Retiree Dental Program |
|
|
| |
TRICARE Dental Options |
| |
This section highlights your dental costs when you are using the Tri-Service Remote Dental Program (RDP), the TRICARE Dental Program (TDP), or the TRICARE Retiree Dental Program (TRDP). These dental options are separate from TRICARE health care program options. Your out-of-pocket expenses for any of the costs listed in this section are not included in the TRICARE catastrophic cap.
|
| |
Back to Top
|
| |
Tri-Service Remote Dental Program |
| |
If you are an ADSM, you’ll receive most care from military dental treatment facilities at no cost. But, if enrolled in TPR, you’re automatically covered by the Tri-Service Remote Dental Program (RDP). The RDP augments military dental care by providing for routine, specialty, and emergency dental services. There are no out-of-pocket costs for using the RDP. For additional information about the RDP, contact the Military Medical Support Office |
| |
Back to Top
|
| |
TRICARE Dental Program |
| |
The TRICARE Dental Program (TDP) is available to ADFMs, National Guard and Reserve members, and National Guard and Reserve family members. Note: This section only highlights costs for the CONUS program. Limitations apply to certain services based on your beneficiary category. For more information about the TDP, contact United Concordia Companies, Inc. |
| |
TDP Monthly Premiums |
| |
Monthly premium amounts are based on your beneficiary category and type of plan (single or family). Note: If National Guard, Reserve, or Individual Ready Reserve (IRR) sponsors and family members sign up together, the amounts listed are added together to determine the total premium amount.
|
| |
|
|
|
Enrollment Year
|
|
|
Type of Plan
|
Feb. 1, 07-Jan. 31, 08
|
Feb. 1, 08-Jan. 31, 09
|
|
ADFM
|
Single
|
$ 11.05 |
$ 11.58 |
|
|
Family |
$ 27.63 |
$ 28.95 |
|
National Guard or
Reserve Member1
|
Single (sponsor only) |
$ 11.05 |
$ 11.58 |
|
National Guard or
Reserve Family Member1
|
Single |
$ 27.63 |
$ 28.95 |
|
National Guard or
Reserve Family Member1
|
Family (not including sponsor) |
$ 69.07 |
$ 72.37 |
|
IRR Member1
|
Single (sponsor only) |
$ 27.63 |
$ 28.95 |
|
IRR Family Member1
|
Single |
$ 27.63 |
$ 28.95 |
|
IRR Family Member1
|
Family (not including sponsor) |
$ 69.07 |
$ 72.37 |
|
| |
1. These amounts are only applicable when the sponsor is not on active duty orders. |
| |
TDP Cost-shares and Maximums |
| |
| |
Your Cost-share
(Amount you Pay)
|
| Type of Service |
Sponsor
Pay Grade
E-1 to E-4 |
All Other
Pay Grades |
| Diagnostic |
0%
|
0%
|
| Preventive (except sealants) |
0%
|
0%
|
| Emergency Services |
0%
|
0%
|
| Sealants |
20%
|
20%
|
| Basic Restorative |
20%
|
20%
|
| Consultation/Office Visit |
20%
|
20%
|
| Post-Surgical Services |
20%
|
20%
|
| Endodontic |
30%
|
40%
|
| Periodontic |
30%
|
40%
|
| Oral Surgery |
30%
|
40%
|
| General Anesthesia |
40%
|
40%
|
| Intravenous Sedation |
50%
|
50%
|
| Implant Services |
50%
|
50%
|
| Miscellaneous (occlusal guard, athetic mouthguard, bleaching) |
50%
|
50%
|
| Orthodontic |
50%
|
50%
|
| Other Restorative |
50%
|
50%
|
| Prosthodontic |
50%
|
50%
|
|
|
| TDP Maximums |
|
The TDP limits how much it will pay in dental benefits per
enrollee.
|
| Annual Maximum |
|
$1,200 per enrollee per enrollment year for non-orthodontic services. Many diagnostic and preventive services are not applied to the
annual maximum.
|
| Lifetime Maximum |
|
$1,500 per enrollee during your lifetime for orthodontic services.
Orthodontic diagnostic services
are applied to the $1,200 annual
maximum.
|
|
|
| |
Back to Top
|
| |
TRICARE Retiree Dental Program |
| |
The TRICARE Retiree Dental Program (TRDP) is available to retirees and their eligible family members in the United States, American Samoa, Canada, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands. |
| |
TRDP Monthly Premiums |
| |
TRDP monthly premiums vary depending on your location and type of plan (single, dual or family). To view the premium rate for your region, visit the TRICARE Retirees Dental Program website, click on “Premium Search” and enter your ZIP code. |
| |
TRDP Annual Deductible |
| |
You are required to meet an annual deductible each benefit year (May 1–April 30). The deductible amount is $50 per patient, per benefit year (not to exceed $150 per family). Any deductible balance remaining at the end of one benefit year does not carry over to the next year, nor do
deductibles carry over to other TRICARE programs. Diagnostic and preventive services covered at 100 percent of the programallowed amount are not subject to the annual benefit year deductible. |
| |
TRDP Cost-shares 1 |
| |
| Type of Service |
Your Cost-share (Amount You Pay) |
| Diagnostic |
0%
|
| Preventive |
0%-20%
|
| Emergency Services |
0%-20%
|
| Restorative |
20%
|
| Endodontic |
40%
|
| Periodontic |
40%
|
| Oral Surgery |
40%
|
| Medications |
40%
|
| Post-Surgical Services |
40%
|
|
| |
1 The percentage paid is based on the allowed amount for each procedure. Your out-of-pocket costs may be higher if care is received from a non-participating provider. |
| |
TRDP Maximums |
| |
TRDP maximums are based on which TRDP program you are enrolled in: Basic or Enhanced. |
| |
Basic Program |
| |
The annual maximum for the Basic Program is $1,000 per patient each benefit year (May 1–April 30). Any unused balance remaining at the end of one benefit year does not carry over to the next year. Diagnostic and preventive services covered at 100 percent of the program-allowed amount are not subject to the annual maximum. |
| |
Enhanced Program |
| |
The annual maximum for the Enhanced Program is $1,200 per patient each benefit year (May 1–April 30). Any unused balance remaining at the end of one benefit year does not carry over to the next year. Diagnostic and preventive services covered at 100 percent of the program-allowed amount are not subject to the annual maximum.
Also for the Enhanced Program, there is a separate lifetime maximum of $1,200 for orthodontic procedures for both children and adults, and a separate “emergency” annual maximum of $1,000 per enrollee for procedures provided as a result of a dental accident.
For more information about the TRDP, contact Delta Dental Plan of California.
|
| |
Back to Top
|
