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TRICARE Dental Program
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The TDP is available to ADFMs and National Guard and Reserve members and their families. Note: This section only highlights costs for the continental United States program. Limitations apply to certain services based on your beneficiary category. For more information about the TDP, contact United Concordia Companies, Inc. (see the For More Information section). TDP Monthly Premiums
Monthly premium amounts are based on your beneficiary category and type of plan (single or family).
Beneficiary
Category
|
Type
of Plan
|
Enrollment Year
|
| February 1, 2009-January 31, 2010 |
February 1, 2010 - January 31, 2011 |
ADFM
|
Single (one family member) |
$12.12
|
$12.69
|
ADFM
|
Family (more than one family member) |
$30.29
|
$31.72
|
National Guard or Reserve Member1
|
Single
(sponsor only) |
$12.12
|
$12.69
|
National Guard or Reserve Family Member1
|
Single (one family member, excluding sponsor)2 |
$30.29
|
$31.72
|
National Guard or Reserve Family Member1
|
Family (more than one family member, excluding sponsor)
|
$75.73
|
$79.29
|
Individual Ready Reserve (IRR) Member1
|
Single
(sponsor only) |
$30.29
|
$31.72
|
IRR Family Member1
|
Single (one family member, excluding sponsor)2 |
$30.29
|
$31.72
|
IRR Family Member1
|
Family (more than one family member, excluding sponsor) |
$75.73
|
$79.29
|
IRR Family Member1
|
Single (sponsor only) and family plan |
$106.02
|
$111.01
|
1These amounts are only applicable when the sponsor is not on active duty orders.
2If both the sponsor and the single family member are enrolling, the premium due is the total of the sponsor's single premium and the family member's single premium.
Type of Service
|
Your Cost-Share (Amount you pay)
|
Sponsor Pay Grade
E-1 to E-4
|
All Other
Pay Grades
|
Diagnostic
|
0%
|
0%
|
Preventive (except sealants)1
|
0%
|
0%
|
Sealants
|
20%
|
20%
|
| Consultation/Office Visit |
20%
|
20%
|
Basic Restorative
|
20%
|
20%
|
Endodontic
|
30%
|
40%
|
Periodontic
|
30%
|
40%
|
Oral Surgery
|
30%
|
40%
|
General Anesthesia
|
40%
|
40%
|
Intravenous Sedation
|
50%
|
50%
|
Miscellaneous
(occlusal guard, athletic mouthguard, bleaching)
|
50%
|
50%
|
Other Restorative
|
50%
|
50%
|
| Implant Services |
50%
|
50%
|
| Prosthodontic |
50%
|
50%
|
Orthodontic2
|
50%
|
50%
|
1 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.
2 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.
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The TDP limits how much it will pay per enrollee for dental services.
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| Dental Program Annual Maximum Benefit |
$1,200 per enrollee per enrollment year for non-orthodontic services. Payments for certain diagnostic and preventive services are not applied to the annual maximum. |
| Orthodonic Lifetime Maximum Benefit |
$1,500 per enrollee during your lifetime for orthodontic services. Orthodontic diagnostic services are applied to the $1,200 dental program annual maximum. |
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