Presentation on theme: "TRICARE Dental Program (TDP) 1 LD# L0312247371[exp0513]"— Presentation transcript:
TRICARE Dental Program (TDP) 1 LD# L [exp0513]
2 TDP 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 3 rd cleaning For women during pregnancy 3 TDP 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.
4 TDP Cost Shares Covered ServicesCONUS E-1, E-2, E-3, and E-4 CONUS All Other Pay Grades E-5 and above OCONUS Command- Sponsored Enrollees 1 Diagnostic & Preventive 2 (ie: Cleanings, oral evaluations, X-Rays) 0% Sealants for children; Permanent molars only (through age 18) Consultation/Office Visit, Post-Surgical Services & Basic Restorative Composite fillings (white fillings) 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.
5 Covered ServicesCONUS E-1, E-2, E-3, and E-4 CONUS All Other Pay Grades E-5 and above OCONUS Command- Sponsored Enrollees 1 Endodontic (root canals) Periodontic (gum surgery) Oral Surgery (Primarily extractions) 30%40%0% General Anesthesia40% 0% Other Restorative, Implant Services, Prosthodontic & Orthodontic 3 (ie: inlays, onlays, crowns, bridges, partials, dentures) 50% Intravenous Sedation & Miscellaneous Services (occlusal guard, athletic mouthguard) 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
6 TDP Monthly Premiums Single Premium (one family member)Family Premium (more than one family member) $10.30$30.89 Sponsor-Only PremiumSingle 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 PremiumSingle Premium (one family member, excluding sponsor) Family Premium (more than one family member, excluding sponsor) Sponsor and Family Premium $25.74 $77.22$ 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 7 164,000 participating dentist locations Beneficiaries can go to any licensed civilian dentist Locate participating dentist on https://mybenefits.metlife.com/tricarehttps://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.
8 1 st month premium sent to MetLife with enrollment application 12 month mandatory enrollment commitment HOW TO ENROLL Online: Phone: CONUS – MET-TDP1 OCONUS – MET-TDP2 Hearing Impaired MET-TDP3 Mail - download form ***Applications must be received by the 20 th of the month for coverage to be effective on the 1 st of the following month. TDP Enrollment
Beneficiary calls for enrollment and general inquiries (CONUS) or (OCONUS) Hearing Impaired: MetLife website via https://mybenefits.metlife.com/tricarehttps://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