TRICARE Dental Program

Army National Guard: Federal Active Duty

Benefit Fact Sheet

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Summary:

The TRICARE Dental Program (TDP) is a voluntary, high-quality, cost-effective dental care benefit for eligible Family members of all active duty Soldiers as well as Reserve Component Service members and/or their Families. TDP is offered by the Department of Defense (DoD) through the TRICARE Management Activity (TMA). The Metropolitan Life Insurance Company (MetLife) administers and underwrites TDP for the TMA.

Eligibility:

Family members of Active National Guard Soldiers - including current spouses and unmarried children (including stepchildren, adopted children, and wards) under the age of 21 - are eligible for enrollment in the TDP. Active duty Soldiers are not eligible for TDP since they obtain all dental care from military dental treatment facilities. To be eligible for the TDP, the sponsor must have at least 12 months remaining on his or her service commitment at the time of enrollment. Unmarried children will be eligible up to the end of the month in which they turn 21, and they may be eligible after age 21 if they fit the following requirements:

Full-time Student:

A Family member over age 21 may be eligible for TDP benefits through the end of the month in which he or she turns age 23 if he or she is:

  • enrolled full-time at an accredited college or university
  • more than 50 percent dependent on the sponsor for financial support

If the student terminates his or her education prior to turning 23, eligibility ends at the end of the month in which education terminates.

Disabling Illness or Injury:

A Family member over age 21 may be eligible for TDP benefits if he or she suffered a disabling illness or disabling injury before his or her 21st birthday, or if he or she suffered a disabling illness or disabling injury between the ages of 21 and 23 while enrolled as a full-time student and more than 50 percent dependent on the sponsor for financial support.

Benefit Highlights:

The following chart provides an overview of the TDP covered services and their respective cost-shares. TDP benefits are the same for the CONUS service area as they are for the OCONUS service area.

Covered Services:
See the table below for a description of covered services and their associated cost shares:

COVERED SERVICES - Cost Share for Soldiers

Type of Service

CONUS

OCONUS**

E1-E4

E-5 and above

Command-Sponsored Beneficiaries*

Diagnostic

0%

0%

0%

Preventive**

0%

0%

0%

Sealants

20%

20%

0%

Consultation/ Office Visit

20%

20%

0%

Post Surgical Services

20%

20%

0%

Basic Restorative

20%

20%

0%

Endodontic

30%

40%

0%

Periodontic

30%

40%

0%

Oral Surgery

30%

40%

0%

General Anesthesia

40%

40%

0%

Intravenous Sedation

50%

50%

0%

Miscellaneous Services (occlusal guard, athletic mouth guard)

50%

50%

0%

Other Restorative

50%

50%

50%

Implant Services

50%

50%

50%

Prosthodontic

50%

50%

50%

Orthodontic***

50%

50%

50%

*The cost shares for OCONUS command-sponsored beneficiaries do not apply to Selected Reserve and IRR Family members and IRR (other than Special Mobilization Category) members. Beneficiaries in this category are subject to CONUS cost share arrangement as noted in the two middle columns.

** 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.

*** Orthodontic treatment is available for enrolled Family members:

  • Children are covered up to age 21 or 23 (based on student status, learn more)
  • Spouses are covered up to age 23
  • National Guard/Reserve sponsors are covered up to age 23

Maximums:

The TDP limits how much can be paid per enrollee for dental services. Only the allowed fee (or the dentist's actual charge if lower) less your cost share is applied against the maximum. Services received from non-network providers do not apply toward your plan maximums. The following outlines the TDP maximum amounts:

Annual Maximum

  • $1,300 per contract year (May 1 - April 30) for non-orthodontic services

  • Payments for certain diagnostic and preventive services are not applied against the annual maximum.

  • In the OCONUS service area, the government pays for any valid costs in excess of the allowed amount up to the billed charge for all enrollees except Selected Reserve and IRR Family members, IRR (other than special mobilization category) members, and/or those who are not command-sponsored.

Lifetime Maximum for Orthodontic Treatment

  • $1,750 for orthodontic services.
  • Orthodontic diagnostic services are applied to the annual maximum.

Accidental Annual Maximum

  • $1,200 for costs associated with dental care provided due to an accident (injury to the teeth and/or supporting hard and soft tissues from external blunt forces and not due to chewing or biting)
  • After accidental maximum is met, additional costs are applied to the $1,300 annual maximum

Please view the TRICARE Dental Program Benefit Booklet for a complete list of services that do not apply to your plan maximums.

Enrollment Process:

There are three convenient enrollment options. You can call MetLife, by mail online. The initial premium payment is required upon enrollment. Please retain this transaction. Only sponsors-or an individual with a valid Power of Attorney can enroll active duty Family members in the TRICARE Dental Program

1. Call MetLife:

  • CONUS: 1-855-MET-TDP1(1-855-638-8371)
  • OCONUS: 1-855-MET-TDP2 ( 1-855-638-8372)
  • TDD/TTY: 1-855-MET-TDP3 (1-855-638-8373)

2. Mail it to MetLife:

Download the TRICARE Dental Program Enrollment/Change Authorization document and mail it along with your initial monthly premium payment (check, money order or credit card) to MetLife:

MetLife TRICARE Dental Program
Enrollment and Billing Services
P.O. Box 14185
Lexington, KY 40512

3. Online:

Log into the Beneficiary Web Enrollment Web site. A Common Access Card or DS Logon is required to access the Beneficiary Web Enrollment Web site. Note: This option is not available overseas.

For technical assistance when using the Beneficiary Web Enrollment Web site, call the Defense Manpower Data Center at 1-800-477-8227

Premiums

TRICARE Dental Program (TDP) premiums are determined by the TDP enrollment plan (single or Family) and the military status of the sponsor. For enrolled active duty Family members (ADFMs), the Government assumes 60 percent of the cost of the TDP premium while participants pay 40 percent. If the military status of the sponsor changes from active duty to National Guard/Reserve, the premiums will change accordingly.

Premium Amounts
TDP premium amounts change annually on February 1st.

The following chart indicates the monthly premium responsibility as an ADFM. Premium rates will be adjusted annually on February 1.

Plan

Enrollment Year

February 1, 2014 - January 31, 2015

Monthly Single Premium (one Family member)

$10.96

Monthly Family Premium (more than one Family member)

$32.89

*The Single and Family rates do not include the sponsor

The following chart indicates the monthly premium responsibility as a National Guard/Reserve memeber and mobilized IRR Soldier. The Premium rates will be adjusted annually on February 1.

Plan

Enrollment Year

February 1, 2014 - January 31, 2015

Monthly Sponsor Only

$10.96

Monthly Single Premium (one Family member, excluding sponsor)*

$27.40

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

$82.23

Monthly Sponsor & Family Premium*

$93.19

*The Single and Family rates do not include the sponsor

The following chart indicates the monthly premium responsibility as a non mobilized IRR Soldier. Premium rates will be adjusted annually on February 1.

Plan

Enrollment Year

February 1, 2014 - January 31, 2015

Monthly Sponsor Only

$27.40

Monthly Single Premium (one Family member, excluding sponsor)*

$27.40

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

$82.23

Monthly Sponsor & Family Premium*

$109.63

*The Single and Family rates do not include the sponsor

Additional Information:

For more information, please visit the TRICARE Dental Program webpage maintained by TRICARE Management Activity:
http://www.tricare.mil/Dental.aspx

TRICARE Dental Program MetLife:
https://mybenefits.metlife.com/tricare

TRICARE DEERS Information:
http://www.tricare.mil/Welcome/Eligibility/DEERS.aspx

Document Review Date: 4 March 2014