Understanding TRICARE Retiree Dental Program

04 Sep Understanding TRICARE Retiree Dental Program

The TRICARE Retiree Dental Program (TRDP) has been designed to provide dental services to retirees since 1998. This program is available

The TRICARE is everywhere though most people do not know what it is. There are many basics of the TRICARE program that can be adderessed. The TRICARE Retiree Dental Program (TRDP) has been designed to provide dental services to retirees since 1998. This program is  available to the family members of the military retirees also.

Benefits of the Program

• Dental care necessary for accidents. Care for teeth will be available from the effective date of the  TRICARE coverage plan.
• Coverage for dental implants, bridges, dentures, crowns, and orthodontics will available only after completion of 12 months in the dental coverage plan.

Coverage for dental emergencies while traveling in areas outside the Enhanced TRDP area is described below:

• Offers an optimum cost savings by giving enrollees the chance to select from a list of participating network dentists located in more than 150,000 locations in the country. These dental professionals have consented to provide treatment to TRDP enrollees at reduced fees. (Enrollees can also choose any licensed dentist within the service area who is not in the TRDP network)
• A new, expanded list of dentists is provided for enrollees who live or travel abroad
• Reduces monthly premiums with low deductibles, maximum allowances, and a lifetime maximum of $1,500 per person for orthodontics

Service Area

The TRDP offers services worldwide with benefits specific to the program that members are enrolled in such as the Enhanced TRDP or the Enhanced Overseas TRDP. All 50 states in the United States are included in the Enhanced TRDP coverage. Puerto Rico, U.S.Virgin Islands, Guam, American Samoa, Canada, Columbia, and the Common Wealth of the Northern Mariana Islands are also included in the service area for Enhanced TRDP services. Enhanced TRDP members are eligible for emergency services only while travelling in areas other than the above mentioned areas. However, dependents of Enhanced TRDP members who are studying overseas as students are eligible for full services after also verifying their overseas status.

Coverage for the Enhanced-Overseas TRDP is available to the enrollees who live outside the service area detailed above. The enrollees to Enhanced-Overseas TRDP will receive a guide which contains details of the provisions that are specifically applicable to the policy.

Eligibility to Enhanced-Overseas TRDP includes:

1. Member of  the United States Uniformed Services
2. A person who is eligible for retired pay applicable for Uniformed Services even if aged 65 and older
3. A person retired from National Guard/Reserve and is in the ‘gray area’ who will get their retired pay, but only after attaining the age of 60 years old
4. A spouse of an enrolled retiree
5. A child of a TRDP member until that child reaches the ages of 21 years old but if such a child is a full-time student, the dependent child is eligible up until the age of 23, though a student will need to be able to provide proof of records that the child of the military retiree is of ‘student’ status
6. A surviving spouse who has not remarried and the dependent child or children of a member who passed away while on duty or while in retired status
7. Any eligible family members of a serviceman who has received the Medal of Honor including a surviving spouse who has not remarried or qualified family members of the deceased recipient

A spouse or a qualified child of a non-enrolled person is eligible for enrollment if documentary evidence is produced that can prove any of the following conditions:

1. Eligibility to receive coverage from the Veteran’s Affairs Department.
2. Those who are enrolled in a plan which is not available for family members
3. Any of those who are unable to receive coverage through TRDP due to existing medical conditions
4. Former spouses and surviving spouses who are not remarried

 Enhanced Dental Care Program Overview

Benefits that will become available during the first 12 months of enrollment:

Diagnostic services such as an examination                                                 100%

Restorative services such as fillings                                                                  80%

Endodontics work like  root canals                                                                   60%

Periodontics care such as gum treatments                                                      60%

Oral surgeries such as extractions                                                                    60%

Emergency treatment for minor pain                                                             80%

Accident dental  coverage                                                                                 100%

Additional services are available for candidates who are enrolled continuously for 12 months or enrolled within four months from the date of retirement include: 

Cast crowns, bridge,s and onlays                                                                 50 %

Dentures (either full or partial)                                                                    50 %

Orthodontics                                                                                                     50%

Dental implants                                                                                               50%

Deductibles and maximum coverage under the TRDP policy are detailed below:

Annual deductibles: $150 per person with a family cap of $50 per year, per family

Annual maximum per person:   $ 1,200

Orthodontic maximum: $1,500 per person, per lifetime

Dental accident maximum: $1,000 per person, per year

The amount spent by TRDP is based on the total payable amount. The coverage available for all TRDP cases is the same. However, when services are completed by a non-network dentist, the amount to spent out-of-pocketwill be higher. This is because the rate of charges are high and the compensation payable by TRDP is limited by many factors. For detailed information regarding the exclusions, payment details for network dentists and overseas dentists, you may refer the TRDP booklet for program benefits.

Dentist Network

TRDP has a wide array of dentists in over 150,000 locations throughout the country. These dentists in the TRICARE network have been contracted to offer services to the TRDP members at a reasonable and affordable rate. If a member selects a dentist outside of this network, TRDP will pay partially as it is bound to pay its percentage of coverage only. The enrolled member is responsibile for paying the balance amount after the percentage is paid by the TRDP. Since non-network dentists are more expensive, members may want to look to opt for a dentist who is in the TRDP network.

For full-time students who are studying overseas, members or family members of the enrolled person may search through a database of dentists or dental clinics in any country which are provided by Delta Dental’s international referral to find a dentist. Members can also select dentists from the lists provided online at: www.trdp.org.

TRDP members also may select an overseas dentist from the overseas host nation provider search tool available on the website same website. Dentists listed with Delta Dental’s international dentist referral service and on the overseas host nation provider search tool are not contracted or otherwise affiliated with Delta Dental. The only possible drawback is that the dentist may or may not be contracted or affiliated with the TRDP program and the fees could vary.  This could result in a member having to pay a higher out-of-pocket rate at the time of service.

Enrollment

Enrollment in TRDP is voluntary and can be easily done. Every new enrollee has to fulfill the initial period of 12 consecutive months. After this initial period, the applicant becomes eligible for full benefits under the Enhanced TRDP. Afterwards the eligibility will continue on a month-to-month basis. There is a grace period of 30 days from the beginning of the coverage, during which period the applicant can opt to cancel the enrollment, provided the individual has not utilized any benefits from the program. If a person does not cancel within the 30-day grace period, a person becomes bound to continue the plan until the completion of the initial period of 12 months. Members are unable to cancel the plan during this 12-month period after the 30-day grace period has expired.

If an individual is a retiree who enrolls within 4 months of retirement or transferring to retired status, this makes the person eligible to receive a waiver and the member will not need to wait for 12 months before receiving the full benefits. Retirees from the U.S. National Guard or those who are entitled for Reserve pay after reaching the age of 60 years old are eligible for all benefits of this plan. In order to receive this waiver, the applicant is required to give a copy of his or her retirement order, or confirmation of the status change to retired reserve or history of drill points in chronological order. If members want to obtain coverage without any gap in coverage, it is advisable to go ahead and enroll before the last month of the current service so that the benefits begin on the first day after retirement begins.

A fee of two month’s of the program premium (USD) must be paid to ensure that the individual and all eligible family members are getting the coverage on the next day after the member’s retirement. Once enrollment is finalized, the unused portion of the payment will be refunded to the member within a few months of program enrollment. Coverage for overseas TRDP will begin on the first day of the next month of acceptance of the application and after the company has received two months of premium in full payment.

The enrollment process can be completed either online, via telephone, or via mail. To dodge avoidable delays which may be caused in processing mail, it is recommended that the application for enrollment may be made online or via  telephone.

After successful completion of the processing of the member’s application for enrollment, members will receive a welcome packet which will contain all necessary identification cards, booklets regarding the program benefits, and other important information. For those members who have provided a valid email address, the welcome packet may be sent via email. Whether or not a member receives their welcome kit does not matter as coverage will still begin on the first day of the succeeding month of plan enrollment.

Costs

This program has been specifically designed to give members and their families a comprehensive dental package at a very affordable cost. The cost of the monthly premium is dependent upon the area where a potential member lives and the number of members in the family who will also be enrolled in the plan. The monthly premium rate of the Enhanced-Overseas TRDP varies depending upon the region members are living. This is also based on the enrollment options which members have already selected.

The premium rates are subject to change every year. These changes will be effective on October 1 in the following year.Current premium rates and other fee information can be obtained by logging on to http://trdp.ort/pro/prmiumSrch.html. The federal law has made it mandatory that the monthly premium will be automatically deducted from Uniformed Serviceperson’s retirement pay.