Tricare: Dental — Active duty and reserve - Getting out, military health issues - Navy Times

Tricare: Dental — Active duty and reserve

Active-duty family members and Selected Reserve and Individual Ready Reserve personnel and their family members worldwide are eligible for Tricare Dental Program coverage. United Concordia Cos. Inc. administers and underwrites the program for the Tricare Management Activity. Participation is voluntary, and costs vary.

Benefits

The annual maximum benefit is $1,200. Certain preventive and diagnostic services do not count against the enrollee’s annual maximum. The lifetime orthodontia maximum is $1,500. There is no deductible.

Covered services include diagnostic and preventive care, sealants, fillings, endodontics, periodontics, prosthodontics (crowns, dentures and bridges), orthodontics and emergency services. Also covered are dental anesthesia and associated costs specifically for beneficiaries with developmental, physical or mental disabilities and children age 5 and under.

If an active-duty, Selected Reserve or Individual Ready Reserve member dies on active duty, benefits continue for enrolled adult survivors for three years, with no premiums required.

Under a provision of the 2010 Defense Authorization Act, benefits for enrolled surviving children continue for three years or until they reach age 21 (age 23 if a full-time student), whichever is longer.

Cost

Family members of active-duty, Selected Reserve and IRR (Special Mobilization Category) members, and family members of reservists on active duty for more than 30 days have their premiums cost-shared. For these members, the enrollee pays 40 percent of the monthly premium and the government pays 60 percent. IRR members (other than Special Mobilization Category) and family members of IRR and Selected Reserve members not on active duty are responsible for 100 percent of the monthly premium.

For active-duty family members, monthly premiums through Jan. 31, 2011, are $12.69 for one family member (excluding the sponsor) and $31.72 for more than one family member (excluding the sponsor).

Selected Reserve and IRR personnel and their family members each have four levels of monthly premiums, depending on whether the sponsor, one family member excluding the sponsor, more than one family member excluding the sponsor, or the sponsor and his family enroll. The program has a civilian provider network. Enrollees can seek care outside the network, but they may incur additional costs.

Contact: (800) 866-8499; www.tricare dentalprogram.com.

Enrollment

Enrollment is voluntary and requires at least a 12-month service commitment (active duty, reserve or combination). Exceptions are made for reservists with fewer than 12 months left in service who are called to active duty for certain contingencies.

Members who live within the continental U.S. and are transferred outside it do not have to re-enroll. Sponsors can enroll family members by completing an enrollment form.

Overseas

Family members are seen in most military clinics overseas regardless of their enrollment in Tricare. Those enrolled in the dental program outside the continental U.S. are eligible for the same benefits, but policies and procedures vary depending on location and service provided.

For care from host-nation dentists, dental plan members who do not live in a remote area must get a statement of nonavailability and a referral form and use dentists on the provider list. Those in remote areas outside the U.S. without a fixed dental facility may get routine dental care without the referral form but will need a form for orthodontic care. Contact the local overseas lead agent for information.

There are exceptions to the cost-share requirements for selected members in the service area.

Contact: www.tricaredentalprogram .com/tdptws/enrollees/overseas/overseas .jsp; toll-free (888) 418-0466; commercial (717) 975-5017; fax: (717) 260-7367; e-mail: oconus@ucci.com