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.
Please note: The TDP provides selected services including endodontic, periodontic, and oral surgery at a reduced cost-share for members who are grades E-1 to E-4. For more detailed information about the TDP covered services, see the TRICARE Dental Program Benefit Booklet.
|Annual Benefit Maximum||>$1,500 per enrollee|
|>Orthodontic Lifetime Maximum (See age limitations in Orthodontics Section below)||>$1,750 per enrollee|
|>Dental Accident Coverage Annual Maximum||>$1,200 per enrollee|
|CONUS Service Area||OCONUS Service Area|
E-1 - E-4
E-5 and above
|Emergency Services ||0%||0%||0%|
|Consultation/Office Visit ||20%||20%||0%|
|Basic Restorative ||20%||20%||0%|
|Miscellaneous Services (occlusal guard, athletic mouth guard)||50%||50%||0%|
|Other Restorative ||50%||50%||50%|
- OCONUS cost shares only apply to command-sponsored enrollees receiving care in OCONUS service areas. These cost shares do not apply Selected Reserve (Sel Res) and Individual Ready Reserve (IRR) family members and IRR (other than special mobilization category) members. Beneficiaries in this category and/or non-command sponsored members are subject to CONUS cost-share arrangements as noted in the middle two columns above.
- Space maintainers for posterior teeth for patients under age 19 are fully covered.
- Orthodontic treatment is covered for the following enrolled family members:
- Children up to age 21 or 23, based on student status
- Spouses up to age 23
- National Guard/Reserve sponsors up to age 23
If a sponsor or covered family member has been diagnosed with a chronic illness and periodontitis (gum disease), TDP Wellness Program is available to provide additional dental benefits at no cost. Getting the proper treatment and maintenance for gum disease will have a positive effect on the beneficiary’s overall wellness as scientists continue to uncover connections between certain chronic conditions and gum disease.
TDP Wellness Program is for people with the following chronic medical conditions:
- Cerebral Vascular Disease (stroke)
- Coronary Artery Disease (heart)
- Oral Cancer
- Organ Transplant
- Rheumatoid Arthritis
- Pregnancy (additional, third cleaning in a consecutive 12-month period, only)
Beneficiaries can register to use TDP Wellness Program any time after their plan’s effective date. Here’s how:
- Visit uccitdp.com
- Sign into My Account using your DS Login
- Click Manage My Oral Health
- Add your medical condition
With TDP Wellness Program beneficiaries get full coverage for periodontal services, including surgical procedures, to remove the financial obstacles to total oral care.
The program also includes email outreach designed to educate and encourage beneficiaries to stay on track with their oral care to better manage their condition. Beneficiaries can request to receive regular monthly emails full of tips to keep them aware of the importance of oral health.
|Periodontal maintenance – an additional service per year||100%*|
|Scaling and root planing||100%*|
|Periodontal surgery – four procedures**||100%*|
* Standard frequency limitations apply
** Four procedures related to gingival flap or osseous surgeries
The program also includes email outreach designed to educate and encourage enrollees to stay on track with their oral care to better manage their condition. Enrollees can request to receive regular monthly emails full of tips to keep them aware of the importance of oral health.
The TRICARE Dental Program (TDP) is an affordable option for eligible beneficiaries. With Government-shared premiums and cost-shares, beneficiaries get the most coverage for minimal out-of-pocket costs.
Member cost-shares vary depending upon the sponsor's pay grade. A complete list of cost-shares and premiums is available in the sections below.
The TDP monthly premium is determined by the sponsor’s military status (Active Duty, Selected Reserve or Individual Ready Reserve [IRR]) and the enrollment plan (single or family).
For enrolled active duty family members (ADFMs), Selected Reserve and IRR members in the Special Mobilization category, the Government assumes 60 percent of the cost of the TDP premium while the sponsor pays 40 percent. IRR members in a category other than Special Mobilization, and all Selected Reserve and IRR family members, are responsible for the full amount (100%) of the monthly premium cost.
If the sponsor’s military status changes during TDP enrollment, the enrollment plan will automatically be updated accordingly.
Note that TDP premium amounts change annually on May 1st.
The following chart indicates the sponsor’s monthly premium responsibility for the enrollment period May 1, 2017 – April 30, 2018.
Your TDP premium amounts change annually on May 1st.
The following chart indicates your monthly premium responsibility for the enrollment periods of May 1, 2018 – April 30, 2019 and May 1, 2019 - April 30, 2020.
|Sponsor's Military Status||Type of Enrollment||Type of Enrollment|
|Active Duty||05/01/2018 - 04/30/2019||05/01/2019 - 04/30/2020|
|Single: $11.39||Single: $11.54|
|Family: $29.62||Family: $30.00|
|Selected Reserve and IRR (Mobilization Only)|
|Sponsor only: $11.39||Sponsor: $11.54|
|Single: $28.48||Single: $28.85|
|Family: $74.05||Family: $75.01|
|Sponsor and family: $85.44||Sponsor and Family: $86.55|
|Sponsor only: $28.48||Sponsor only: $28.85|
|Single: $28.48||Single: $28.85|
|Family: $74.05||Family: $75.01|
|Sponsor and family: $102.53||Sponsor and family: $103.86|
Premiums are paid on a monthly basis and must be paid in full. There are no circumstances when a partial premium can be paid. If a beneficiary fails to pay premiums during the mandatory 12-month enrollment period, the Government will not pay any portion of the premium for the remaining months. Failure to pay the required premiums may result in referral of the account to a collection agency.
PAYING TDP MONTHLY PREMIUMS
Initial Premium Payment
The sponsor will make the first premium payment (for the first month of coverage) during enrollment.
- If enrolling online, the sponsor should use a credit card
- If enrolling through the mail, the sponsor may pay with a credit card, check or money order. Sponsor Social Security number or DoD Benefits Number should be included in the memo area of a check or money order.
Automated Recurring Payments
The following types of ongoing automated payments are acceptable:
Sponsors can set up an allotment for recurring premium payments if a military payroll account and sufficient funds are available
- Electronic Fund Transfer (EFT)
- Credit/Debit Card
It’s easy to set up recurring payments:
- If enrolling online, the sponsor can set up any of the recurring payment types listed above at the same time.
- If enrolling by mail, the sponsor must complete Section IV of the TRICARE Dental Program Enrollment Form
- For credit or debit cards the sponsor must include the type of card, card number, expiration date and security code.
- Enrollees can also set up recurring payments at any time by logging in to My Account and clicking the "Billing" tab.
Beneficiaries can also elect to pay their bill monthly by choosing that option during enrollment. Monthly payments can be made by regular mail, over the phone, or online with a credit or debit card after logging into their account.
If the sponsor doesn’t pay the monthly premiums, TDP coverage will end. If coverage ends, the sponsor won’t be able to re-enroll for one year.
BENEFITS OF USING A NETWORK DENTIST
When TDP beneficiaries visit a United Concordia network dentist, they:
- Have access to an extensive network of dentists – With more than 331,000 office locations across the country, whether they’re home or away from home, finding a network dentist takes only a phone call or mouse click.
- Save money – Because there is no deductible and our network dentists accept our negotiated fees or "maximum allowable charges" (MAC) as payment-in-full for covered services, beneficiary out-of-pocket expense is lower. This means no balance-billing. See the sample savings chart below.
- Save time – Network dentists agree to file claims so it's one less thing to worry about.
- Stretch their benefit dollars – Paying less for care from a network dentist lets them receive more covered services before reaching the annual maximum.
- Enjoy peace of mind – All network dentists undergo rigorous review through our quality assurance process and routine verification of their credentials.
- Are in-the-know – Upon request, our network providers will submit predeterminations before performing a procedure. So beneficiaries can know up front if the treatment is covered and how much they can expect to pay out-of-pocket.
See How Much Beneficiaries Will Save...
Potential beneficiary savings1 for an average individual dental visit with United Concordia
Patient Payment Without Coverage
|1 Adult Cleaning (D1110)||$152||$0||$152||$74||$78|
|1 Exam (D0120)||$85||$0||$85||$45||$40|
|1 Set of Bitewing X-Rays (D0272)||$121||$0||$121||$65||$56|
|1 Filling (Amalgam) (D2140)||$250||$25||$225||$152||$98|
|1 Crown (D2752)||$985||$258||$727||$727||$258|
- For illustrative purposes only. Savings shown do not account for premium cost. Savings will vary by dentist, service and geographic region. Sample charges based on Pennsylvania ZIP Code 17110 as of August, 2016.
- Assumes all services are performed by a United Concordia TDP Network dentist.