TRICARE®

Dental Program

HANDBOOK

A guide to understanding your dental beneft

Important Information

United Concordia www.uccitdp.com

844-653-4061 (CONUS)
844-653-4060 (OCONUS toll-free*)
+1-717-888-7400 (OCONUS toll)
711 (TDD/TTY)
*Must have AT&T access code to use toll-free option.
Visit “Contact Us” at www.uccitdp.com to learn more.

Beneficiary Web Enrollment Portal on milConnect https://milconnect.dmdc.osd.mil

Enrollment by Mail United Concordia

TRICARE Dental Program
P.O. Box 645547
Pittsburgh, PA 15264

Claim Submissions CONUS: United Concordia

TRICARE Dental Program
P.O. Box 69451
Harrisburg, PA 17106

OCONUS: United Concordia

TRICARE Dental Program
P.O. Box 69452
Harrisburg, PA 17106
Fax: 844-827-9926

*United Concordia representatives are available by phone from Sunday at 6 p.m. ET through Friday at 10 p.m.
ET, except holidays. Customer service representatives are available to assist you in English, German, Italian,
Japanese, Korean, and Spanish.

An Important Note About TRICARE Program Information

At the time of publication, this information is current. It’s important to remember that TRICARE policies and benefits are governed by public law and
federal regulations. Changes to TRICARE programs are continually made as public law and/or federal regulations are amended. Military hospital and
clinic guidelines and policies may be different than those outlined in this publication. For the most recent information, contact the TRICARE Dental
Program contractor. More information about TRICARE, including the Health Insurance Portability and Accountability Act Notice of Privacy Practices,
can be found online at www.tricare.mil.

As a TRICARE beneficiary, you have rights concerning your health care. To learn more about your rights and responsibilities in the Military Health
System, visit www.tricare.mil/rights.

TRICARE is managed by the Defense Health Agency. DHA and TRICARE are registered trademarks of the Department of Defense, Defense Health
Agency. All rights reserved.

Keep Your DEERS Information Up To Date!

It’s essential to keep information in the Defense Enrollment Eligibility Reporting System current for you and your family. Failure to update DEERS to
accurately reflect the sponsor’s or family member’s residential address or the ineligibility of a former dependent could be considered fraud and a basis
for administrative, disciplinary, or other appropriate action.
Welcome to the
TRICARE Dental
Program.

Your dental health can afect your overall health. Poor dental health is linked to heart
disease, respiratory infections, and diabetic complications. In children, poor dental health
can lead to early gum disease, infections, and low self-esteem. Your TRICARE Dental
Program benefts can help you maintain good dental health and prevent these types of
problems before they start. Besides regular dental checkups, the TDP also covers dental
procedures that can help fx existing problems.

The TDP is simple, cost-effective, and convenient. The TDP is a voluntary dental program.
Your TDP benefts, administered by United Concordia Companies, Inc., the TDP contractor, are
designed to help you achieve better dental health.

The TDP supports your dental health around the world. You can get dental care in the CONUS
(continental United States) and OCONUS (outside the continental United States) service areas.
The TDP CONUS service area includes the 50 United States, the District of Columbia, Puerto
Rico, Guam, and the U.S. Virgin Islands. The TDP OCONUS service area includes areas not in
the CONUS service area and covered services provided aboard a ship or vessel outside the
territorial waters of the CONUS service area.

You can use this handbook to fnd details about your TDP benefts, including enrollment,
eligibility, payment options, and cost-shares. You can also contact United Concordia at
844-653-4061 (CONUS), 844-653-4060 (OCONUS toll-free), or +1-717-888-7400 (OCONUS
toll) with questions or to get more details on your benefts. To learn more about the TDP and to
fnd a dental provider, go to www.uccitdp.com.

3
Table of Contents

1. Eligibility and Enrollment ............................................................................................. 6

Who’s Eligible ................................................................................................................................................ 6
Who Isn’t Eligible ........................................................................................................................................... 7
Age-Related Eligibility Rules........................................................................................................................... 7
Checking and Updating Your Eligibility ............................................................................................................ 7
Types of Plans................................................................................................................................................ 8
How To Enroll ................................................................................................................................................. 9
Efective Date of Coverage ............................................................................................................................. 9
Paying Premiums To Enroll and Stay Enrolled ................................................................................................ 10
Life Events Afecting Changes to Enrollment ..................................................................................................11
Adding or Removing a Family Member ...........................................................................................................11
Ending Coverage.......................................................................................................................................... 12
TDP Survivor Beneft .................................................................................................................................... 15
Eligibility To Use Military Dental Clinics ......................................................................................................... 15

2. National Guard and Reserve Important Information ..................................................... 16

Dental Readiness Assessment for National Guard and Reserve..................................................................... 16
Sponsor’s Changing Status .......................................................................................................................... 16

3. Choosing a Dentist .................................................................................................... 18

Choosing CONUS Dentists ........................................................................................................................... 18
Choosing OCONUS Dentists......................................................................................................................... 19

4. Your Costs and Fees .................................................................................................. 20

Premiums.................................................................................................................................................... 20
Maximums .................................................................................................................................................. 21
What Will I Pay?........................................................................................................................................... 22

4
5. TRICARE Dental Program Benefits and Exclusions ....................................................... 24
General TDP Policies.................................................................................................................................... 24
Time Intervals for Covered Services.............................................................................................................. 24
Covered Services......................................................................................................................................... 25
Non-Covered Services ................................................................................................................................. 27

6. Orthodontic Services................................................................................................. 29
Who’s Eligible for Orthodontic Services ........................................................................................................ 29
Orthodontic Lifetime Maximum ................................................................................................................... 29
Orthodontic Treatment in the CONUS Service Area ....................................................................................... 29
OCONUS Orthodontic Treatment .................................................................................................................. 30
Transferring Orthodontists ........................................................................................................................... 32

7. TRICARE Dental Program Claim Filing......................................................................... 34

Predetermination Requests ......................................................................................................................... 34
CONUS Claims............................................................................................................................................. 34
OCONUS Claims .......................................................................................................................................... 35
Dental Explanation of Benefts ..................................................................................................................... 36
Other Dental Insurance—Coordinating Benefts With the TDP ........................................................................ 37

8. Traveling and Moving With the TRICARE Dental Program .............................................. 40

Traveling...................................................................................................................................................... 40
Moving .........................................................................................................................................................41

9. Appeals, Grievances, and Fraud and Abuse ................................................................. 42

TRICARE Dental Program Appeals Process ................................................................................................... 42
Appeal Levels .............................................................................................................................................. 43
Grievances .................................................................................................................................................. 45
Fraud and Abuse ......................................................................................................................................... 45

10. Glossary of Terms ...................................................................................................... 46

5
Eligibility and Enrollment
WHO’S ELIGIBLE
The TRICARE Dental Program provides coverage for members of the National Guard and Reserve and
their eligible family members, as well as active duty family members and their legal dependents. Active
duty service members, retirees, and retiree family members get benefits through other plans. You can
learn about other plans at www.tricare.mil/dental. You can also check the Defense Enrollment Eligibility
Reporting System website to confirm your eligibility for the TDP. If you’re eligible, you must enroll to have
TDP coverage. Keep DEERS up to date so you can get care faster.
Note: You can use the TDP worldwide. When you move from the CONUS or OCONUS service area, you can
keep your TDP coverage.

TDP Covers You If:

• You’re in the National Guard and Reserve and not on active duty. This includes members of the Individual Ready
Reserve and the Selected Reserve of the Ready Reserve.*

OR

• You’re the family member of a uniformed services sponsor. This means you’re:

■ A spouse

■ An unmarried dependent child, stepchild, or adopted child (either pre-adopted or fnalized), until at least age 21
(or age 23 if certain criteria are met).†

■ A court-ordered legal dependent

Note: Your sponsor must have at least 12 months of uniformed service commitment left for you to get TDP. Qualifying
sponsors serve in one of the following uniformed services:
U.S. Army U.S. Space Force
U.S. Marine Corps U.S. Coast Guard
U.S. Navy Commissioned Corps of the U.S. Public Health Service
U.S. Air Force Commissioned Corps of the National Oceanic and Atmospheric Administration

* If you’re in the Selected Reserve of the Ready Reserve or the Individual Ready Reserve, you can enroll in the TDP when you
aren’t on active duty for more than 30 days. If you’re called to active duty, you get dental coverage under the Active Duty Dental
Program. See the Active Duty Dental Program Brochure at www.tricare.mil/publications or visit www.tricare.mil/addp for more
information.

† See “Age-Related Eligibility Rules” later in this section for more information.

6
WHO ISN’T ELIGIBLE • When your personal information changes, such as:

The following groups aren’t eligible for the TDP: ■ Military career status

• Active duty service members, including those ■ Family status

SECTION 1
National Guard and Reserve members called to ■ Phone number
active duty for more than 30 days
Your TDP enrollment information must match what’s
• Retired service members and their families
in DEERS. If it isn’t the same, your enrollment may be
• Former spouses delayed or denied. You could also face more serious
consequences. If you don’t update your address when
• Parents and parents-in-law
you move or report when a former dependent is no

Eligibility and Enrollment

• Disabled veterans longer eligible, you can face administrative, disciplinary,
or other action.
• Foreign military personnel
• Service members in the Transitional Assistance Sponsors and family members over age 18 can update
Management Program following activation for a contact information and change addresses in DEERS.
contingency operation Only sponsors can add or delete family members. To add
or delete a family member, you’ll need to show supporting
documents, like a marriage certificate, divorce decree,
AGE-RELATED ELIGIBILITY RULES or birth certificate. Bring the documents to a uniformed
Eligible unmarried children are covered by the TDP until services ID office.
the last day of the month in which they turn age 23 if:
Use the table below to find details about all the ways you
• They’re a student enrolled full-time at an approved can update DEERS:
institution of higher learning. In addition, they must
get at least 50% of their financial support from their
sponsor. If the student ends their education before Figure 1.1 Your Options for Updating DEERS
turning age 23, coverage ends at the end of the month
in which their education ends. https://milconnect.dmdc.osd.mil

• They have a disabling illness or injury that occurred: Online

■ Before their 21st birthday, or
800-538-9552
■ Between ages 21 and 23 while attending an approved 866-363-2883 (TDD/TTY)
institution of higher learning full-time. Phone
Additionally, they must get at least 50% of their
financial support from their sponsor during their 800-336-4416
schooling.
Fax

CHECKING AND UPDATING YOUR Defense Manpower Data Center

ELIGIBILITY Support Offce
400 Gigling Rd.
United Concordia, the TDP contractor, uses DEERS to Mail
Seaside, CA 93955
verify your eligibility. Always keep DEERS up to date
for each family member. You should update DEERS in To add a family member or update
the following situations: contact information, go to a
• When you have a life event, including: Uniformed Services ID card offce.
Find an offce near you at
■ Moving to a new address In Person https://idco.dmdc.osd.mil/idco.
■ Marriage Be sure to call ahead for hours
and instructions.
■ Divorce
■ Adoption

7
TYPES OF PLANS • You can choose to enroll your child before they reach
age 1, but they’ll be automatically enrolled at age 1.
TDP offers single and family plans for active duty family If you already have a family plan, your child will be
members and National Guard and Reserve members and automatically enrolled at no additional charge upon
their eligible family members. turning age 1. If you don’t have a family plan, the
child will be added at age 1 and the single plan will be
changed to a family plan.
Single Plan
• You can choose not to enroll family members who are
Single plans are for one eligible beneficiary. This may living in a separate location, such as family members
include: who are attending college away from home or with a
• One active duty family member, custodial parent/former spouse. You have the option
to enroll only the family members living in one
• One National Guard or Reserve sponsor, or location, or you can enroll family members in multiple
• One National Guard or Reserve family member locations. If you only want to enroll family members
(separate from the sponsor) in one location, the sponsor needs to contact United
Concordia. If you want to enroll your family members
National Guard and Reserve sponsors must enroll in their in all locations, the sponsor can enroll them using the
own single plan; then their family members can enroll in Beneficiary Web Enrollment portal on milConnect.
an additional plan to fit their needs. It could be another
single plan if there’s only one eligible family member. • In cases where a family member of an active duty
Family plans apply when there’s more than one eligible service member or active duty National Guard and
family member. Reserve member requires a hospital or special treatment
environment (due to a medical or mental health
Note: There will be one bill with a separate section for condition) for dental care otherwise covered by the
each plan. TDP, the family member may be excluded from TDP
enrollment. However, they may continue to receive
care from a military hospital or clinic. The sponsor
Family Plan must provide documentation, such as a signed letter or
Family plans are available for two or more eligible family memorandum from the provider or administrator, to
members. Family plans can’t include a National Guard or the TDP contractor attesting to this requirement for a
Reserve sponsor. Sponsors can only enroll in a separate hospital or special treatment environment. The sponsor
single plan. must provide the documentation with the request for
disenrollment, prior to receipt of the services.
If one family member enrolls in the TDP, all other eligible
family members must also enroll in the family plan. Enrollment Notes:
However, exceptions apply in the following situations:
• Because two sponsors can’t enroll the same family
• You can choose not to enroll in the TDP if you’re a member(s), one beneficiary can’t be enrolled under
National Guard and Reserve sponsor. You have the two TDP plans.
option to enroll your family members but not yourself.
If you and your eligible family members all enroll, • If the sponsor and spouse are both active duty, they
you’ll get one bill with two separate sections: one for can’t enroll each other as a family member. You can
your single plan and one for your family members. only enroll a National Guard or Reserve sponsor who
hasn’t activated for more than 30 days as a family
member under the other sponsor.

8
HOW TO ENROLL Note: It’s important that you keep your DEERS
information current. Your enrollment might be denied
if any information is missing from the TRICARE
There Are Three Easy Ways To Enroll

SECTION 1
Dental Program Enrollment/Change Authorization
You can enroll in the TDP online, by mail, or by phone. Form or if the information doesn’t match DEERS.
See the options for enrollment below: If this happens, your premium payment will be
refunded. You’ll then need to fill out a new TRICARE
Dental Program Enrollment/Change Authorization
Online: Form and pay the initial premium again. Once your
Step 1: Go to the milConnect website at enrollment is processed, you’ll begin coverage on the
https://milconnect.dmdc.osd.mil. next available effective date. The DMDC will confirm

Eligibility and Enrollment

Step 2: Log in with your Common Access Card, your enrollment with either an email or postcard.
DFAS (myPay) Account, or a DS Logon account. This notification will include instructions to access
milConnect for detailed information, such as welcome
Step 3: Click the “Manage Health Benefts” tab.
information and your TDP enrollment card. The TDP
This will open Benefciary Web Enrollment.
won’t pay for any dental care until you’re properly
Step 4: Click the “Dental” dashboard tab. enrolled.

By mail:
EFFECTIVE DATE OF COVERAGE
Step 1: Download the TRICARE Dental Program
Enrollment/Change Authorization Form from United Concordia compares the information in your
the milConnect website. request for enrollment with the information in DEERS
to make sure you’re eligible for the TDP, so keep DEERS
Step 2: Mail the completed form with your frst
updated. Your enrollment request is complete when
monthly premium payment by check, money
United Concordia confirms your eligibility in DEERS,
order, or credit card to United Concordia at:
gets your premium payment, and checks that your
United Concordia TRICARE Dental Program
application is complete.
P.O. Box 645547
Pittsburgh, PA 15264 Check your TDP enrollment card to see when your
dental coverage starts. You won’t be covered for any
By phone: dental care you get before the date written on your TDP
ID card.
CONUS: 844-653-4061
OCONUS*: 844-653-4060 (toll-free) If United Concordia can’t confirm your eligibility in
+1-717-888-7400 (toll) DEERS, it will reject your application. United Concordia
will ask you to contact the uniformed service personnel
TDD/TTY: 711 office. Once United Concordia resolves the issue, you’ll
receive eligibility confirmation.
*Must have AT&T access code to use
toll-free option. Visit “Contact Us” at
www.uccitdp.com to learn more.

9
Your effective date of coverage or termination depends PAYING PREMIUMS TO ENROLL AND
on the date United Concordia receives your request, STAY ENROLLED
not on the date you postmark it. If United Concordia
receives your enrollment/termination: Enrollment in the TDP begins on the effective
date written on your TDP enrollment card. You’re
• On or before the 20th of the month: Your responsible for any dental care you get before the date
enrollment or termination will take place on the written on your TDP enrollment card. Once enrolled,
first day of the next month. For example, if United you’re committed to 12 months of coverage and have to
Concordia processes your request between May 21 pay monthly dental premiums until your coverage ends.
and June 20, the enrollment or termination will start You’ll pay premiums one month in advance of dental
on July 1. care coverage (for example, premiums collected in June
• After the 20th of the month: Your enrollment or apply to July coverage). After you’ve been enrolled for
termination will begin on the first day of the second 12 continuous months, you can continue on a month-
month. For example, if United Concordia processes to-month basis. Or, you may qualify for an exception to
your request between June 21 and July 20, the end your enrollment early. See Figure 1.2 for examples.
enrollment or termination will start on Aug. 1.
Initial payment: Make the payment for your first month
of coverage online, by phone, or by mail. You can pay
Getting Your TDP Enrollment Card by credit card online. If you pay by mail, you can pay
by credit card, check, or money order. However, online
You can find your enrollment card on your milConnect enrollment is the fastest and easiest way for most people
account at https://milconnect.dmdc.osd.mil. (You’ll to enroll.
get an email or postcard indicating that you have
eCorrespondence.) To find your enrollment card: Ongoing payments:

• Step 1: Log on to milConnect. • ADSM-sponsored enrollment: If you’re enrolled

in the TDP through an active duty service member
• Step 2: Select “View My Healthcare Coverage.”
sponsor, you must use payroll allotment to pay your
• Step 3: Click the “Dental Coverage” tab. premiums.

• Step 4: Find your enrollment card under the “Related • National Guard and Reserve sponsor: National Guard
Links” section. and Reserve sponsors can pay their premiums by credit
card, electronic funds transfer, or payroll allotment.
You don’t need to show your TDP enrollment card to get
dental care, but it will help the dental office complete • National Guard and Reserve-sponsored enrollment:
proper TDP billing. If you’ve deleted your enrollment If you’re enrolled in the TDP through a National
card in your milConnect account, go to milConnect to Guard and Reserve sponsor, you can pay your
ask for a new one. premiums by credit card or electronic funds transfer.

Note: Online enrollment is the fastest and easiest way

to enroll for most people. If you sign up by mail, the
sponsor has to send the TRICARE Dental Program
Enrollment/Change Authorization Form to United
Concordia. Someone with power of attorney to enter
into contracts can complete and sign the form if the
sponsor isn’t available. Send a copy of the power of
attorney when you enroll. See the contact information
on the back cover of this handbook if you have questions
about power of attorney.

10
LIFE EVENTS AFFECTING CHANGES TO ENROLLMENT
The same life changes that need to be reflected in DEERS will also affect your TDP coverage.

SECTION 1
ADDING OR REMOVING A FAMILY MEMBER
Throughout your enrollment, you may need to add a family member to your TDP plan due to:
• Marriage
• Birth

Eligibility and Enrollment

• Adoption, including pre-adoptive and finalized adoptions reflected in DEERS
• Stepchild or court-ordered ward newly eligible for TDP
• Child added before turning age 1

You may need to remove a family member from How To Add or Remove a Family Member
your TDP plan due to: or Cancel Enrollment
• Death You can add a family member, remove a family
• Divorce (there’s no former spouse coverage for member, or end your TDP enrollment from the
this program) TDP online, by telephone, or by mail. See the front
inside cover for contact information.
• Retirement
Note: For most people, it’s easiest to make changes
• Loss of child’s eligibility when he or she marries or
online. To submit changes by mail, visit the
turns 21 or 23 if certain conditions apply related to
United Concordia website at www.uccitdp.com
school enrollment and financial support. See the
and download the TRICARE Dental Program
“Age-Related Eligibility Rules” section for details.
Enrollment/Change Authorization Form. Print,
complete, and mail the form to United Concordia.
You can also get an enrollment/change form at your
local military dental clinic or OCONUS TRICARE
Service Center.

Someone with a power of attorney on file with the TDP contractor can add or remove a family member or end
TDP enrollment if the sponsor isn’t available. Use the contact details on the back cover of this handbook to put a
power of attorney on file with United Concordia.

Automatic Enrollment of Children at Age 1

If you have a plan with the TDP, your child will be automatically enrolled on the first day of the month following
their first birthday. If you had a single plan before your child turned 1, your premium will change from the single
plan rate to the family plan rate.

11
ENDING COVERAGE

Once enrolled in the TDP, you’re committed to 12 months of coverage, unless you qualify for an exception (See Figure
1.2). If you want to end your TDP enrollment after 12 months, send a termination request to United Concordia. United
Concordia will terminate your service according to the date United Concordia receives your request, not on the day you
postmark it. See the “Effective Date of Coverage” section for more information.

Reasons You’re Allowed to End Enrollment Before You Finish the Initial 12-Month
Enrollment Period
When you enroll in the TDP, you make a 12-month commitment. However, some circumstances support ending the
commitment before that time is completed. Those scenarios are listed in Figure 1.2 below.

Figure 1.2 Ending Enrollment Before Finishing the Initial 12-Month Enrollment Period

SCENARIO DESCRIPTION

TDP family member loses A sponsor or family member could lose TDP eligibility because of death, divorce,
eligibility marriage, age limit of a child, or end of eligibility. See Figure 1.3 for details.

Sponsor and family move to the You can end TDP enrollment within 90 calendar days of moving to the OCONUS
OCONUS service area service area, unless you wish to keep TDP coverage for family members. Check
that the local military dental clinic can take care of your needs before you end
enrollment. Write the date you moved on the termination request when you ask
to end enrollment.

Active duty service member gets ADSMs who transfer to a duty station where space-available dental care is
permanent change of station available at the local military dental clinic can end any of their family members’
orders enrollments within 90 calendar days. Write the date of the transfer on the
termination request when you ask to end enrollment.

National Guard or Reserve Family members who enrolled within 30 days of the sponsor’s activation lose
sponsor deactivates TDP coverage when the sponsor deactivates.

National Guard or Reserve The sponsor’s TDP coverage ends.

member is transferred to Standby
Reserve or Retired Reserve

12
Reasons Your TDP Enrollment Could End or Change
If you don’t pay your premium(s), United Concordia will cancel your enrollment. Additionally, a 12-month “lock out”
goes into efect. Tis means that you can’t enroll for 12 months afer the last time you paid the premium. However,

SECTION 1
your TDP enrollment could change for other reasons, and you may or may not need to take action to keep your TDP
coverage. See the list of scenarios in Figure 1.3 below.

Figure 1.3 Enrollment Change/Termination of Enrollment Scenario

SCENARIO WHAT DO I NEED TO DO TO KEEP HOW WILL MY TDP ENROLLMENT

TDP COVERAGE? CHANGE?

Eligibility and Enrollment

Two active duty service The remaining active duty service member Coverage ends at 11:59 p.m. ET on the last day
members are married reenrolls the family, listing themselves as the of the month in which the parent who is listed as
with TDP-enrolled sponsor. the sponsor leaves active duty. For example, if the
children. The parent sponsor’s status changes on April 15, the last day
listed as the sponsor Reenroll within 30 days to make sure you get of coverage is April 30.
leaves active duty continuous coverage and to continue the original
service. 12-month commitment period. However, if the sponsor’s status changes on the
first day of the month, the last day of coverage is
An active duty service The sponsor enrolls in the TDP and/or reenrolls the last day of the previous month. For example, if
member transfers family members. The family will now be enrolled the sponsor’s status changes on April 1, the last
from active duty to under the sponsor’s new status. day of coverage is March 31.
the Selected Reserve
of the Ready Reserve Reenroll within 30 days to make sure you get
or Individual Ready continuous coverage and to continue the original
Reserve (special 12-month commitment period.
mobilization category).

A sponsor transfers to The sponsor reenrolls themselves and/or family

another service branch. members in the TDP. Reenroll within 30 days to
make sure you get continuous coverage and to
continue the original 12 month “lock in” period.

A National Guard You don’t need to do anything. TDP

or Reserve member automatically reenrolls your family members
(non-contingency in the TDP as Selected Reserve/IRR (special
related) transfers to mobilization category) family members.
the Selected Reserve
of the Ready Reserve Note: Your premium rates will follow the rules
or Individual Ready for Selected Reserve/IRR sponsors and/or
Reserve (special family members.
mobilization category).

13
Figure 1.3 Enrollment Change/Termination of Enrollment Scenario (Continued)

SCENARIO WHAT DO I NEED TO DO TO KEEP HOW WILL MY TDP ENROLLMENT

TDP COVERAGE? CHANGE?

A Selected Reserve Sponsor: You no longer have the TDP. The TDP Sponsor: You aren’t eligible for the TDP while you’re
of the Ready Reserve will automatically restore your coverage the an active duty service member. You’ll receive dental
or Individual Ready day after you deactivate. Once you deactivate, care at your military dental clinic or through the
Reserve sponsor or you’ll be responsible for finishing any months Active Duty Dental Program.
family have been remaining in the initial 12-month commitment
enrolled in the TDP for period from when you last had coverage by the Family Members: Coverage ends at 11:59 p.m.
more than 30 days, TDP. ET on the last day of the month the sponsor leaves
the sponsor is called active duty. For example, if the sponsor’s status
to active duty for more Family Members: You don’t need to do changes on April 15, the last day of coverage is
than 30 days, and the anything. The TDP automatically reenrolls you as April 30.
sponsor has enrolled an active duty family member. Your coverage will
themselves and family count toward the same 12-month commitment However, if the sponsor’s changes status on the
in the TDP more than period. first day of the month, the last day of coverage is
30 days before the the last day of the previous month. For example, if
start of the active duty Note: The TDP will automatically lower your the sponsor’s status changes on April 1, the last
orders. premiums when you become an active duty day of coverage is March 31.
family member. Your premiums will automatically
go back up when your sponsor deactivates. Coverage continues at the lower active duty family
member premium rate.

End-of-Eligibility Scenarios
In some scenarios, your TDP coverage ends because you’re no longer eligible. Figure 1.4 lists situations in which you aren’t
eligible for the TDP and outlines when your coverage ends.

Figure 1.4 End-of-Eligibility Scenarios

SCENARIO WHEN TDP COVERAGE ENDS

The sponsor retires or separates from You’re covered until the last day of the month in which the sponsor retires
active duty service. or separates. However, if the sponsor retires or separates on the first
day of the month, the last day of coverage is the last day of the previous
month. For example, if the sponsor retires or separates on April 1, the last
day of coverage is March 31.

Note: Retired sponsors and family members can sign up for the Federal
Employees Dental and Vision Insurance Program. Go to www.benefeds.
gov for more on FEDVIP.

An unmarried child turns 21 (or 23 if The child’s eligibility ends at 11:59 p.m. ET on the last day of the month in
certain conditions relating to their which they reach the age limit or school enrollment ends.
school enrollment and financial
support apply. See the “Age-Related
Eligibility Rules” section for details).

14
Figure 1.4 End-of-Eligibility Scenarios (Continued)

SCENARIO WHEN TDP COVERAGE ENDS

SECTION 1
The sponsor and their spouse divorce. The spouse’s eligibility ends at 11:59 p.m. ET on the last day of the month
the divorce is final.

TDP SURVIVOR BENEFIT • Incapacitated children for whichever is longest:

Eligibility and Enrollment

Surviving spouses and children are eligible for the TDP ■ Three years from sponsor’s date of death (not to
Survivor Benefit when a sponsor dies. Spouses are eligible exceed 21 years of age)
for three years beginning on the date of the sponsor’s ■ The date the child turns 21
death. Children are eligible until age 21, or until they
turn age 23 if certain conditions related to their school ■ The date the child turns 23, if certain conditions
enrollment and financial support apply. See the “Age- related to their school enrollment and financial
Related Eligibility Rules” section for more information. support apply (see “Age-Related Eligibility Rules”
for details).
You can use the TDP Survivor Benefit even if you or your
family member(s) weren’t enrolled in the TDP at the time Family members are still responsible for any applicable
of the sponsor’s death. You can also use the TDP Survivor cost-shares associated with the TDP Survivor Benefit.
Benefit if your sponsor was in the Selected Reserve of the
Ready Reserve and IRR (special mobilization category). Surviving spouses are eligible for the FEDVIP once
In this case, you can use the TDP Survivor Benefit even if the three-year TDP Survivor Benefit period ends.
the sponsor wasn’t on active duty orders or enrolled in the Surviving family members who didn’t qualify for the
TDP at the time of death. TDP Survivor Benefit may qualify for FEDVIP. Go
to www.benefeds.gov for more information about
Note: If you had the TDP at the time of your sponsor’s FEDVIP.
death, you don’t need to do anything to keep your dental
coverage. TRICARE automatically reenrolls eligible
surviving family members in the TDP Survivor Benefit. ELIGIBILITY TO USE DENTAL TREATMENT
TRICARE will notify you when it cancels your TDP FACILITIES
coverage and reenrolls you in the TDP Survivor Benefit.
According to federal statutes and regulations, family
If the death of a sponsor in an active duty, National members aren’t allowed to be covered for any care they
Guard, or Reserve status occurs, and the family wasn’t get at a military dental clinic in the CONUS service
enrolled in the TDP, DEERS will automatically notify area. However, family members can use military dental
the surviving family members of their eligibility for clinics in emergencies, for certain pediatric specialty
enrollment in the TDP and provide guidance to contact cases, and to get dental care related to care they get in a
United Concordia for enrollment if desired. military hospital or clinic. In the OCONUS service area,
The government pays 100% of the TDP Survivor Benefit you can get care at an overseas military dental clinic if
premium for the: operational requirements and the military dental clinic
resources allow. Contact your overseas military dental
• Surviving spouse for up to three years from the clinic to find out about your options for dental care in
sponsor’s date of death the OCONUS service area.
• Surviving children until age 21, or 23 if certain
conditions related to their school enrollment and
financial support apply (see the “Age-Related
Eligibility Rules” section for details).

15
National Guard and Reserve
Important Information
DENTAL READINESS ASSESSMENT FOR National Guard and Reserve
NATIONAL GUARD AND RESERVE
Members of the National Guard and Reserve are
sponsors go on and of active duty
required to have a dental exam once per year. In
addition, the Department of Defense requires you to
multiple times during their careers.
turn in a Department of Defense Active Duty/Reserve
Forces Dental Examination form (DD Form 2813) once
Figure 2.1 on the next page shows
each year to your service branch. DD Form 2813 is how TDP coverage changes when a
meant to help you document your dental health. United
Concordia network dentists will fill out the form at no sponsor’s status changes.
cost to you.
a contingency operation, National Guard or Reserve
Each year make sure you:
members become eligible for active duty dental benefits,
1. Contact your service branch representatives to find including the Active Duty Dental Program. For more
out service-specific requirements for DD Form 2813. information, visit www.tricare.mil/addp.
2. Schedule your dental exam. You can enroll in the TDP even if your family doesn’t
3. Download DD Form 2813 at www.tricare.mil/forms, enroll. Whether or not your family member(s) enroll,
and bring the form to your dentist to fill out. you’ll never be a part of a family plan. This means your
monthly premium will always be separate from your
4. Get at least one dental exam. family member(s).
5. Give the result to your service branch.

National Guard and Reserve Family Member

A SPONSOR’S CHANGING STATUS Coverage
Many National Guard and Reserve sponsors go If you’re a National Guard and Reserve family member,
on and off active duty multiple times during their you can enroll in the TDP at any time, even if your sponsor
careers. The TRICARE Dental Program offers doesn’t. You get continuous coverage when your sponsor
continuous coverage to National Guard and Reserve changes between active or inactive status. If you were
sponsors. Read this section to learn more about TDP enrolled in the TDP before your sponsor was called to
coverage for the sponsor and their family member(s) active duty, your coverage will continue automatically.
during these transitions. However, if you weren’t enrolled in the TDP when your
sponsor was called to active duty, continuous coverage may
not be automatic when your sponsor goes on or off active
National Guard and Reserve Sponsor Coverage duty. See Figure 2.1 on the next page for details.
If you’re a National Guard and Reserve sponsor, you You’ll have different premiums while your sponsor is
remain eligible for the TDP while on active duty for 30 on and off active duty. Premiums are lower when your
days or fewer. If you’re enrolled in the TDP before being sponsor is on active duty because they’re active duty service
called to active duty, you’re automatically enrolled in the members.
TDP during the periods when you’re eligible. The TDP
also automatically ends your enrollment when you aren’t The following flowchart shows how TDP coverage changes
eligible. Once called or ordered to active service for more when a National Guard or Reserve sponsor’s status
than 30 days for a preplanned mission or in support of changes.

16
Figure 2.1 National Guard and Reserve Activation/Deactivation Coverage Status

Sponsor

ENROLLMENT STATUS ACTIVATED DEACTIVATED

Enrolled The sponsor is disenrolled from the The sponsor is reenrolled in the TDP
In an individual TDP plan before TDP. Active duty benefts apply. automatically. They must fnish what’s
activation left of the 12-month minimum
enrollment period.

Not enrolled The sponsor isn’t eligible for TDP The sponsor is eligible for enrollment
Not in an individual TDP plan before enrollment. Active duty benefts apply. in TDP. They must fnish what’s left of
activation the 12-month minimum enrollment
period.

SECTION 2
Family Members

ENROLLMENT STATUS SPONSOR ACTIVATED SPONSOR DEACTIVATED

Enrolled Family members’ coverage continues Family members’ coverage continues

In an individual or family TDP plan at reduced premium rate. at the applicable National Guard and

National Guard and Reserve Important Information

(which is separate from the sponsor) Reserve premium rate. The family
before the sponsor was activated member(s) must fnish what’s left of
the 12-month minimum enrollment
period.

Not Enrolled Family members pay the reduced Family members’ coverage is
Not in TDP plan before the sponsor premium rate. The government pays automatically cancelled when the
was activated, within 30 days of 60% and the benefciary pays 40%. sponsor deactivates. The sponsor
sponsor activation The timing of enrollment affects the must contact United Concordia if
lock-in requirement, not premium family members want to reenroll.
rates.

Not Enrolled Family members pay the reduced Family members’ coverage continues
Not in TDP plan before the sponsor premium rate. The government pays uninterrupted at the applicable
was activated, more than 30 days 60% and the benefciary pays 40%. National Guard and Reserve premium
after sponsor activation This also applies to family members rate, which is a 100% non-
whose sponsors aren’t activated for a government shared premium rate.
specifc contingency operation. The family member must fnish what’s
The timing of enrollment affects the left of the 12-month minimum
lock-in requirement, not premium enrollment period.
rates.

17
Choosing a Dentist
CHOOSING CONUS DENTISTS Go to www.uccitdp.com to find a network dentist. If
you’re using a dentist you’ve seen before, make sure to
You can go to any licensed and authorized dentist you check that they’re still in United Concordia’s network.
choose in the CONUS service area, but staying in-
network saves you money and paperwork.
Predetermination of Payment
Network Dentists Before you get care that you or your dentist estimate
might include expensive procedures, ask your dentist to
The United Concordia network dentists have agreed to submit a payment review, known as a predetermination
use the TRICARE Dental Program rules and costs for of payment, to United Concordia. This way, you’ll know
care. approximately what your care is going to cost before you
get it. See “Predetermination Requests” in the TRICARE
If you use a United Concordia network dentist:
Dental Program Claim Filing section of this handbook to
• The amount you pay is based on United Concordia’s learn how to submit a predetermination.
negotiated fee for covered services. The negotiated
fee is usually lower than the normal rate in your local
area. Using United Concordia’s network dentists Commitment to Timely Appointments in the
saves you money. CONUS Service Area
• You won’t have to pay more than the applicable cost- United Concordia is committed to helping you find
share for covered services. However, you may have to a timely general dentistry appointment within a
pay more than the cost-share if you’ve reached your reasonable driving distance of your home. A timely
maximum or if limitations or exclusions apply. appointment in CONUS is an appointment that you’re
able to schedule within 21 days of your call to the
• You don’t have to pay the dentist for the full cost of
dentist’s office. In most CONUS locations, there will
care and wait for reimbursement. United Concordia
be at least one TDP network general dentist within
network dentists work directly with United
the established mileage parameters of your home, and
Concordia to get United Concordia’s part of the
you’ll be able to schedule a timely appointment.
payment.*
• You don’t have to fill out claims or give information If the first available appointment with a general dentist
to United Concordia to determine coverage and isn’t within 21 days and within the established mileage
payments. The United Concordia network dentists parameters of your home, contact United Concordia to
do this for you. get help. If United Concordia can’t schedule a timely
appointment, and the ZIP code in which the member
• Your dentist will fill out the Department of Defense
resides has been deemed non-compliant due to
Active Duty/Reserve Forces Dental Examination form
insufficient network dentist access, United Concordia
(DD Form 2813) for you, if you’re in the National
will pay the difference for you to see a non-network
Guard and Reserve, at no cost.
dentist. This way, your costs are about the same as
* If you choose not to sign an assignment of benefits statement on
the claim form when you see your dentist, the dentist may ask
what you would have paid to see a TDP network
you to pay United Concordia’s portion of the bill. In this case, dentist.
United Concordia will send the reimbursement to you instead
of to the dentist.

18
You can go to any licensed and authorized dentist you choose
in the CONUS service area, but staying in-network saves you money
and paperwork.
Non-Network Dentists CHOOSING OCONUS DENTISTS
Non-network dentists haven’t agreed to use the TDP In OCONUS locations, dentists may ask you to pay
rules and costs for care. If you use a non-network for covered services up front. If you use a TRICARE
dentist: OCONUS Preferred Dentist:
• You may have to pay the full fee for your care up • The most you should pay at the time of your visit is
front. the member cost-share portion, if any, of the covered
service (maximums, limitations, and exclusions
• Your out-of-pocket costs may be higher.
apply).
• You must pay the cost-share and the difference
between United Concordia’s allowance and whatever
• Your dentist will file claims for you.
the dentist bills. You may also have to submit claim Note: The mileage and timeliness rules don’t apply for
documents to United Concordia on your own. OCONUS appointments.
• You must sign an assignment of benefits statement
Go to www.uccitdp.com to see a list of TOPDs. You
on the claim form so that United Concordia can send
can get care from any licensed and authorized dentist.
payment to the dentist. Unlike United Concordia
However, you might find it easier to see a TOPD,
network dentists, non-network dentists don’t have
particularly since they’ll file claims for you.
to take payment directly from United Concordia.
If you don’t sign the form, or the non-network

SECTION 3
For all procedures, it’s a good practice to discuss the
dentist doesn’t take payment directly from United services you’ll be getting and the anticipated cost with
Concordia, United Concordia will send the payment your dentist. Be sure to ask your dentist to submit
directly to you. Then you’ll have to coordinate a payment review, known as a predetermination of
sending United Concordia’s part of the payment payment, to United Concordia before you get treatment
along to the dentist. that may be expensive. See “Predetermination Requests”
If your dentist is interested in joining the United in the TRICARE Dental Program Claim Filing section to

Choosing a Dentist
Concordia network, have them call United Concordia learn how to submit a predetermination.
customer service at 844-653-4061 or go to
Note: Before you get orthodontic care in the OCONUS
www.uccitdp.com.
service area, you have to submit a Non-Availability and
Referral Form (NARF). See “OCONUS Orthodontic
Treatment” in the Orthodontic Services section of this
handbook for more information on this form and steps to
getting orthodontic care in the OCONUS service area.

19
Your Costs and Fees
PREMIUMS Ongoing payments: Your options for making ongoing
premium payments depend on your type of enrollment.
A premium is the amount you have to pay each month See Figure 4.1 below to learn your payment options.
to get dental coverage through the TRICARE Dental
Program. The amount of the premium you pay is based
on your sponsor’s status. To figure out your premium: Paying Your Premiums Using Payroll Allotment
1. Go to www.tricare.mil/costs to find your premium If you’re a sponsor with a uniformed service payroll
cost. Keep in mind that premiums change each year. account, the government will take your premium directly
2. See Figure 4.1 below to find your share of the from your account. If there isn’t enough money in your
premium payment. account to pay the premium, United Concordia will bill
you directly. Once direct billing begins, sponsors may
not return to payment by allotment. Sponsors without
Making Your Payments enough money in their uniformed service payroll account
have the following payment options:
Initial payment: You can make the payment for your
first month of coverage online, by phone, or by mail • Initial payment: You can pay by credit card, debit
using direct billing. To pay online with a credit or debit card, check, or money order. To pay by credit or debit
card, go to https://milconnect.dmdc.osd.mil or call card, go to https://milconnect.dmdc.osd.mil or call
844-653-4061. You also have the option to mail a check, 844-653-4061.
a money order, or your credit or debit card information.
However, online enrollment is fastest and easiest for
most people.

Figure 4.1 TDP Beneficiary Premium Amounts and Choices for Making Payments
Premium Shares (Effective March 1, 2025)

IF YOU’RE … YOU PAY …

• A family member of an active duty service member or a Selected Reserve 30% of the premium.
family member on orders for more than 30 days (pay grades E-4 and below) The government pays the
remaining 70% for you.
• A Selected Reserve of the Ready Reserve sponsor (pay grades E-4 and below)

• A family member of an active duty service member or a Selected Reserve 40% of the premium.
family member on orders for more than 30 days (pay grades E-5 and above) The government pays the
remaining 60% for you.
• A Selected Reserve of the Ready Reserve sponsor (pay grades E-5 and above)

• A family member of an active duty National Guard or Reserve sponsor

• An Individual Ready Reserve (special mobilization category) sponsor

• An IRR (non-special mobilization category) sponsor 100% of the premium

• A Selected Reserve family member not on orders

• An IRR family member

• An eligible survivor 0% of the premium.

The government pays
100% for you.

20
Your Choices for Making Payments

TYPE OF ENROLLMENT PAYMENT OPTION

SECTION 4
ADSM-sponsored Must use payroll allotment to pay your premiums

National Guard and Reserve If the sponsor has a military payroll account, payroll allotment will be attempted
sponsor frst. If payroll allotment isn’t consistently available, or doesn’t have suffcient
funds, you may use credit card, debit card, or electronic funds transfer

National Guard and Reserve- May use credit card or electronic funds transfer

Your Costs and Fees

sponsored

• Initial payment: You can pay by credit card, debit customer service for details about services that don’t
card, check, or money order. To pay by credit or debit count toward the annual maximum, as well as questions
card, go to https://milconnect.dmdc.osd.mil or call about TDP benefits and exclusions.
844-653-4061.
• Ongoing payments: You can pay by credit card, debit Lifetime Maximum Benefit for Orthodontic
card, or electronic funds transfer. You can set up
Treatment
or change your ongoing payment method. You can
make payments online by signing in to My Account The orthodontic lifetime maximum is $1,750 per
at www.uccitdp.com. eligible beneficiary during their lifetime. Orthodontic
diagnostic services will be applied to the TDP’s annual
maximum.
MAXIMUMS
A maximum is the most the TDP will pay for a
beneficiary’s care within a certain amount of time. TDP United Concordia’s allowable
maximums are per beneficiary. Unused maximums don’t charge—Cost-shares = Charges
carry over to the next plan year. The TDP has three types applied toward the maximum
of maximums: benefit
Whichever
• Annual maximum benefit: the most TDP will pay
is lower:
for the beneficiary’s dental care per plan year. OR

• Lifetime maximum benefit for orthodontic Dentist’s actual charge—Cost-

treatment: the most the TDP will pay for shares + Charges applied
orthodontic care during the beneficiary’s lifetime. towards the maximum benefit

• Accidental annual maximum benefit: the most the

TDP will pay for any dental care a beneficiary gets
because of an accident per plan year.
Accidental Annual Maximum Benefit
The accidental annual maximum is $1,200 per
Annual Maximum Benefit beneficiary per plan year. The accidental annual
The annual maximum is $1,500 per beneficiary and maximum benefit goes toward any dental care you get
applies to non-orthodontic dental services. because of an accident.

Some diagnostic and preventive services don’t count For the purpose of the accidental annual maximum
toward your annual maximum. See the TRICARE benefit, the TDP defines an accident as an injury you
Dental Program Benefits and Exclusions section of get to your teeth and/or to the hard and soft tissues
this handbook for more information. To view services that support the teeth. Blunt force situated or occurring
that don’t count toward your annual maximum, go to outside the mouth must be the cause of the injury, not
www.uccitdp.com. You can contact United Concordia chewing or biting actions.

21
Maximums in the OCONUS Service Area WHAT WILL I PAY?
The TDP maximums are the same whether you’re in the In addition to making your premium payments, you
OCONUS or the CONUS service area. also have to pay cost-shares for dental care. A cost-
share is the portion of the allowable charge that you,
In the OCONUS service area, the government pays
the beneficiary, have to pay for the dental care services
the difference between United Concordia’s allowed fee
you get. United Concordia pays the remainder of the
and the billed charge. This doesn’t apply to Selected
allowable charge.
Reserve family members, Individual Ready Reserve
(IRR) family members, IRR (other than special Note: You can often reduce your out-of-pocket costs by
mobilization category) members, or those who aren’t seeing a United Concordia network dentist.
active duty command-sponsored. However, the
government won’t pay for any part of the maximum
that United Concordia has already paid, or for any What Percentage Will I Pay as a Cost-Share?
other costs once you’ve met the maximum.
The type of dental service you’re getting and the
For covered dental services, charges that count toward the sponsor’s pay grade affect the percentage of the cost-
maximum are calculated as follows: share you and United Concordia each pay. For details,
see Figure 4.2 on the next page.
The allowable charge is the amount United Concordia
will pay the dentist for a certain service. In the United
Concordia network, the allowable fee is a negotiated fee, Additional Considerations on Cost-Shares
a standard charge that’s already been agreed on by the
The following policies also apply to Figure 4.2 on the
dentist and by the TDP. The allowable charge is the same
next page:
for non-network dentists, but you may be responsible for
paying the difference between the allowable charge and • Anyone eligible for the TDP can get care in the
the dentist’s bill if you see a non-network dentist. CONUS and OCONUS service areas. However,
you only pay the OCONUS cost-shares if you’re an
OCONUS areas have a separate allowable charge. OCONUS command-sponsored beneficiary. If you
The cost-share is the portion of the allowable charge that aren’t command-sponsored, you’ll pay your cost-
you, the beneficiary, have to pay. The amount you pay share by pay grade.
never counts toward the maximum. Only the amount
that TDP pays to you or your dentist counts toward the • If you’re a command-sponsored beneficiary who gets
maximum. There are some limitations and exclusions. care in the CONUS service area, you pay cost-shares
See the TRICARE Dental Program Benefits and Exclusions based on the percentage for your pay-grade. This
section of this handbook for details. is the case even if you’re only temporarily in the
CONUS service area.
• If you aren’t a command-sponsored beneficiary,
Selected Reserve or IRR family member or IRR
(other than special mobilization category) member
who got dental care in the OCONUS service area,
you pay CONUS cost-shares based on the percentage
for your pay grade. You also pay any difference
between the dentist’s actual charge and United
Concordia’s allowed fee.

22
Figure 4.2 Benefciary Cost-Shares Summary Chart

COVERED SERVICES -
COST-SHARE FOR PAY COST-SHARE
- FOR COST-SHARE
- FOR
- – -
GRADES E-1–E-4 PAY GRADES E-5
- AND OCONUS COMMAND--

SECTION 4
ABOVE SPONSORED
BENEFICIARIES1

Diagnostic 0% 0% 0%

Preventive2 0% 0% 0%

Your Costs and Fees

Emergency services 0% 0% 0%

Sealants 0% 0% 0%

Basic restorative 20% 20% 0%

Endodontic 30% 40% 0%

Periodontic 30% 40% 0%

Oral surgery 30% 40% 0%

Miscellaneous services 50% 50% 0%

(occlusal guard, athletic
mouth guard)

Other restorative 50% 50% 50%

Implant services 50% 50% 50%

Prosthodontic 50% 50% 50%

Orthodontic 3 50% 50% 50%

1. If your sponsor is in the Selected Reserve of the Ready Reserve and Individual Ready Reserve, or if you’re in the IRR (other than
special mobilization category), cost-shares for command-sponsored beneficiaries don’t apply to you. Find your cost-shares using
the middle two columns above based on sponsor pay grade.
2. You’re fully covered for space maintainers on the back teeth through age 18. Sealants are fully covered for permanent molars
through age 18.
3. See “Who’s Eligible” in the Orthodontic Services section of this handbook for restrictions.

23
TRICARE Dental Program Benefts
and Exclusions
GENERAL TRICARE DENTAL PROGRAM POLICIES
• United Concordia will only pay your claims if your premium payments are current.
• United Concordia doesn’t cover certain services. See “Non-Covered Services,” or call United Concordia
customer service for more information.
• When you or your dentist files claims in the CONUS service area, you have to use the American Dental
Association Current Dental Terminology code and term for any care you get.
• The start or end date of certain types of treatment are important for insurance purposes, such as
crowns, inlays, onlays, buildups, posts and cores, and fixed prostheses. Contact United Concordia with
any questions about start and end dates or coverage for your treatment.

• Dentists can’t bill you for non-covered services unless you agree to receive and pay for the services
before treatment.

• The TDP doesn’t cover medical procedures. Medical and dental insurance programs are separate
programs.

• Claims must be submitted within 12 months of the date of service in order to be paid by the TDP.

• Some services are routinely performed with or as part of another service. These are considered integral.
Network dentists can’t bill you for integral services.

• Network dentists may not bill you to complete your claims.

TIME INTERVALS FOR COVERED SERVICES consecutive 12 months, 24 months, 36 months, or 5

years. You and your dentist don’t need to consider
The TDP covers a wide range of services. These include United Concordia’s plan year when scheduling the
diagnostic, endodontic, general, implant, orthodontic, frequency of these types of visits, including routine
periodontal, preventive, prosthodontic, and restorative care, recurring care, X-rays, oral exams, and more. Your
services, as well as oral surgery and sealants. consecutive 12-month calendar for recurring services is
individual to you. Go to www.uccitdp.com for specific
In some cases, you’re limited to a certain number of
guidance and benefit information.
services performed within set amounts of time: every

24
Every 12 months COVERED SERVICES
The following procedures are available during each This section provides information on covered services.
consecutive 12-month period at varying levels of For more information on covered services, including
frequency and coverage. Contact United Concordia for exclusions and limitations, visit www.uccitdp.com.
details on coverage amounts.
• 2 oral evaluations, or 3 if the third is from a different Diagnostic Services
dental office from the other two. This also applies to
children under age 1. The TDP covers a range of diagnostic services, such as
certain oral evaluations, periodontal evaluations, and
• 1 comprehensive gum evaluation X-ray films.
• 1 limited oral evaluation or 1 consultation
Most patients get routine oral evaluations. However, you
• 1 set of bitewing X-rays or 1 set of vertical bitewings can get a comprehensive evaluation, which is more detailed
• A second set of bitewing X-rays, if you’re relocating at and takes more time, if any of the following apply:

SECTION 5
least 40 miles from home for a permanent change of • You’re a new patient.
station and can show proof
• You haven’t had an oral evaluation in the past 36
• 2 routine teeth cleanings, or 3 routine teeth
months from the same office.
cleanings, when noted on the claim form that the
patient is pregnant or has a registered, covered • On an exception basis, such as in unusual circumstances
chronic medical condition or after your health has changed significantly
• 2 topical fluoride applications Note: TDP network dentists can’t charge you for X-rays

TRICARE Dental Program Benefits and Exclusions

• Up to 4 periodontal maintenance procedures or that aren’t covered or done for diagnostic purposes.
routine teeth cleanings, or mixture of the two
• Interim, complete, and partial dentures
Teledentistry Evaluations
Teledentistry is covered as a means of providing a dental
Every 24 months evaluation. It counts as one of your routine examination
Every 24 months, the TDP covers one full-mouth benefits under the TDP. The TDP’s routine examination
debridement to enable comprehensive evaluation and benefit allows for two routine examinations (plus
diagnosis, as needed. an additional routine examination if performed by
a different office) in a consecutive 12-month period.
You’re eligible to receive one teledentistry evaluation in a
Every 36 months consecutive 12-month period.

Every 36 months, the TDP covers:

• 1 full-mouth X-ray Endodontic Services
• 1 sealant per molar or 1 preventive resin restoration The TDP covers many endodontic services, such as certain
on the first and second permanent molars, through root canal procedures related to the pulp of the tooth, root
age 18 (tooth must be caries-free) canals, open and drain procedures, oral surgeries, root
amputation, and placements of final restoration.
• 1 reline/rebase
• 1 interim silver diamine fluoride
General Services
The TDP covers many general services, such as certain
Every Five Years
emergency treatment of pain, general anesthesia, IV
Every five years the TDP covers replacement of all teeth sedation, consultations, office visits, medications, care
and acrylic on a cast-metal framework, as needed. after surgery, mouth guards, and teeth bleaching after
certain endodontic procedures.

25
Implant Services Oral Surgery Services
The TDP covers certain implant services, such as certain The TDP covers many oral surgeries, such as certain
recementation, dental implants, and implant-supported surgical procedures related to the gums and jawbone,
prosthesis repair. erupted or partial tooth removal, biopsies, routine
postoperative care, and impacted third molar (wisdom
tooth) removal.
Integral Services
Many services are integral, which means they’re Orthodontic Services
included within other procedures. An integral service The TDP covers a variety of orthodontic services,
can’t be charged separately by your dentist when including diagnostic casts; certain limited, interceptive,
it’s done with another procedure. Some common and comprehensive treatments; and certain appliances
examples of integral services are listed below. For more and retention. You have a 50% cost-share for diagnostic
information, call United Concordia customer service. casts. Diagnostic costs count toward the annual
United Concordia customer service contact information maximum. See the “Orthodontic Services” section for
is listed on the back cover of this handbook. Integral more details.
services include, but aren’t limited to:
• Reevaluations, certain repairs, and restorations of the
same tooth Periodontal Services
• Recementations and adjustments to dentures The TDP covers many periodontal services related to
gum care, such as certain procedures involving gum
• X-rays taken to diagnose root canals and the root
tissue, crown lengthening, periodontal maintenance, root
canal treatment, pulpotomies done within 45 days of
planing, and grafts. Some procedures may require X-rays
a root canal, and root canal obstruction treatment
and periodontal charting, or in some cases, just X-rays.
• Diagnostic casts
• Gum evaluations in certain situations
Preventive Services
• Pulp vitality tests
The TDP covers certain preventive services such as teeth
• Space maintainer removal
cleanings, fluoride treatments, space maintainers, and
• The charge for a crown or onlay and all charges for space maintainer care.
work related to its placement
There is no cost-share for space maintainers if you’re
• Charges for related services, such as necessary wires
under 19. If you’re under 19, the TDP fully covers space
and splints, adjustments, and follow-up visits
maintainers for teeth in the back of your mouth only.
Other examples of integral services include certain routine
teeth cleanings and periodontal scaling, root planing,
periodontal maintenance, gingivectomy, gingivoplasty,
Prosthodontic Services
gingival flap procedure, mucogingival surgery or osseous The TDP covers some prosthodontic services, such
surgery, tissue conditioning procedures, posts and as certain procedures related to dentures, retainers,
restorative procedures, temporary fixed partial dentures, inlays, onlays, and crowns. For details, contact United
sealants and restorations, direct pulp caps and restorations, Concordia customer service.
gingival flap procedures, osseous surgeries, full mouth
debridement, diagnostic casts, surgical revision procedure,
and incision and drainage wires.

26
Restorative Services • Services you need because you didn’t follow your
dentist’s prescribed treatment plan, charges from any
The TDP covers many restorative services, such as
appointments you need to reschedule or don’t cancel
certain amalgam fillings, resin-based composite
on time, and certain procedures you need for reasons
fillings, crowns, onlays, pin retention procedures,
caused by your dentist
recementations, and veneers in some instances. You can
get coverage for restorative services needed because of • Cosmetic services or gold foil restorations
tooth decay, tooth fracture, attrition, erosion, abrasion, • Motor vehicle injuries, hospital costs, or adjunctive
or congenital or developmental defects, but not for services
cosmetic reasons. The type of restoration you get
• Charges for copies of charts
depends on the number of tooth surfaces involved.
• Nitrous oxide (with some exceptions) or oral sedation

Sealants • Taxes (state or territorial)

The TDP covers sealants and preventive resin in certain

• Certain surgeries, retreatments, specialized
procedures, implant procedures, diagnostic services,

SECTION 5
situations. You can get sealants on your permanent
inlays, onlays, procedures to the same area of the
molars if you’re under 19, your teeth don’t have any
mouth within certain time limits, dentures, and
decay or cavities and if certain surfaces of your teeth
repairs
haven’t had restoration work. You can only get sealants
on molars. Interim, silver diamine fluoride is covered • Adjunctive dental care (see “Adjunctive Services” on
through age 18. the next page for details)
• Repair for damaged space maintainers

TRICARE Dental Program Benefits and Exclusions

NON-COVERED SERVICES • Services related to diagnosis and treatment of
temporomandibular joint dysfunction (also known
There are some services the TDP doesn’t cover. Always as TMD or TMJ pain)
talk to your dentist before getting any major dental
procedures to make sure you understand whether • Plaque control programs, oral hygiene, and dietary
recommended procedures are covered, and in what instruction
amounts. The TDP doesn’t cover: • Services performed by a dentist who is your close
relative, including spouse, children, adopted and step-
• Anything not listed as covered
relatives, sisters and brothers, parents, and grandparents
• Services a dentist didn’t prescribe or directly supervise
• Services you receive from a dental facility maintained
(except in states where dental hygienists are allowed to
by your employer
practice without the supervision of a dentist)
• The same service on the same day by another dentist,
• Phone consultations
duplicate services
• Experimental services
Adjunctive Services
• Work-related accidents that your employer covers, The TDP doesn’t cover adjunctive dental care.
services covered through winnings in a lawsuit, Adjunctive dental care is dental care that’s one or more
services covered by the government, or payments you of the following:
wouldn’t be liable for making • Medically necessary to treat an otherwise covered
• Services you get outside (before or after) your medical (not dental) condition
effective dates of TDP coverage • An integral part of the treatment of the medical condition
• Services you don’t need for a medical reason and • Required in preparation for, or as a result of, dental trauma
aren’t recommended to you, services that aren’t up
to standard, or services that don’t meet acceptable
• Caused by medically necessary treatment of an
injury or disease
dental practices
TRICARE may cover these adjunctive dental services as
medical (not dental) services.

27
Documentation Required for Specific Services The existence of an alternative treatment doesn’t
necessarily mean it’s recommended. You and your
Some services are only covered if you submit supporting
dentist should decide which treatment is best for
materials to United Concordia, such as charts and X-rays.
you. If you choose the more expensive option, you
Generally, United Concordia network dentists will
must pay the difference between the dentist’s fee for
submit this information for you when they process your
the more expensive treatment and the cost of the
claims. However, if your claim reads “report required”
alternative treatment.
or “periodontal charting required,” you need to submit
supporting documents to United Concordia to be covered. Note: You can only use this option when United
Call United Concordia customer service for details. Concordia covers the service you’re getting. If you’re
getting a service that isn’t covered, United Concordia
Note: If you’re a command-sponsored beneficiary
won’t pay toward an alternative benefit.
who receives care in an OCONUS service area,
reports aren’t required unless specifically requested
by United Concordia. Dental Anesthesia Performed in a
Facility Setting
Alternative/Optional Methods of Treatment The TRICARE medical plan covers institutional and
Sometimes you can choose between several options to general anesthesia services for non-covered or non-
get treatment for your dental needs. When there are adjunctive dental treatment, as long as it’s medically
different choices for the same treatment, the TDP covers necessary and it’s either:
the cost of the least expensive professionally accepted • For patients with developmental, mental, or
treatment option. If you choose a more expensive physical disabilities
option, you may be able to get an allowance in the
amount of the cost of the least expensive procedure • For pediatric patients age 5 or younger
applied toward your care.
You need to get pre-authorization to get this service. For
To get the allowance, your treatment has to be a details on how to get pre-authorization, contact your
generally accepted dental practice, and has to be TRICARE regional contractor. Go to
a generally accepted alternative to the procedure www.tricare.mil/contactus for contact information. For
actually performed. more information, go to www.tricare.mil/dental.

28
Orthodontic Services
The TRICARE Dental Program covers orthodontic services. Read this section to learn who is eligible,
what’s covered, maximum coverage amounts, and how to get and pay for orthodontic care.

WHO’S ELIGIBLE ORTHODONTIC LIFETIME MAXIMUM

The TDP covers: United Concordia makes payments for orthodontic care
• National Guard and Reserve sponsors under age 23 until you reach your orthodontic lifetime maximum,
or OLM. See the Your Costs and Fees section of
• Spouses of active duty or National Guard and this handbook for information about your annual
Reserve sponsors, who are under age 23 maximum.
• Children under age 21, or under age 23 if meeting
conditions related to school enrollment
ORTHODONTIC TREATMENT IN THE CONUS
Keep the Defense Enrollment Eligibility Reporting SERVICE AREA
System updated. Your family member can get coverage
for orthodontic care if they show as eligible in DEERS.
See “Orthodontic Services” in the TRICARE Dental Orthodontic Cost-Share (CONUS)
Program Benefits and Exclusions section of this

SECTION 6
United Concordia pays 50% of the allowable charge of
handbook for more information. orthodontic care. You pay the other half, until reaching
your benefit maximum. Once you reach the lifetime
Note: If you’re a sponsor in the National Guard and
maximum, you pay the full cost of care.
Reserve, check with your unit commander before
getting orthodontic care to make sure it’s allowed. If you use a network dentist, your fee will be 50% of the
Otherwise, you may have to leave active duty or pay for TDP allowance. If you use a non-network dentist, your
the removal of your orthodontic appliance if it makes fee will be 50% of the allowance, plus the difference

Orthodontic Services
you ineligible for certain assignments. between the TDP allowance and the dentist’s billed
charge.
Your coverage lasts until the last day of the month
in which you reach your age limit. If you reach the
age limit for orthodontic care coverage during your Orthodontic Treatment Plan (CONUS)
treatment, the TDP contractor will reimburse you for
only the months that you were covered. You have to pay Work with your dentist to get a pretreatment
any costs for treatment received after you reached the (predetermination) estimate before starting your
age limit. orthodontic treatment. The pretreatment estimate lets
you and your dentist know what and how much United
Concordia covers and when you and United Concordia
will make payments.
WHAT’S COVERED?
Once your orthodontist submits an orthodontic
The TDP covers a wide variety of services, such treatment plan, you and your dentist will each get a
as casts, appliances (braces), and retainers. notice of the treatment plan payment schedule from

29
United Concordia. The treatment plan should state the OCONUS ORTHODONTIC TREATMENT
type and length of treatment and the total charge. If the
length of treatment is missing, United Concordia may
figure it out based on the reported charge. OCONUS Orthodontic Services
To get orthodontic services in the OCONUS service
area, you must have a Non-Availability and Referral
Orthodontic Payment Schedule (CONUS) Form (NARF). You can ask for this form from your
United Concordia makes payments for orthodontic TRICARE Area Office, overseas military dental clinic,
treatment that’s still in progress based on the amount of or designated OCONUS points of contact. You can get
time your dentist plans for your treatment to take, as care from any licensed and authorized orthodontist. Go
shown in the table below. to www.uccitdp.com to see a list of TRICARE OCONUS
Preferred Dentists.
Note: The member must be in the TDP during each
month that United Concordia makes a payment. United
Concordia’s total payments won’t exceed the OLM of OCONUS Orthodontic Cost-Share
$1,750. If you turn 21 (or 23 if certain conditions apply)
In the OCONUS service area, dentists may ask you to pay
during the course of orthodontic treatment, United
for covered services up front. If you use a TOPD, you should
Concordia’s payment will be calculated based on the
only have to pay the member cost-share portion of the cost
months of eligibility.
of the care.
United Concordia will mail you and your dentist a new
payment schedule any time changes to your treatment
plan affect the payment schedule. Your orthodontist
Command-Sponsored Family Members
should share any changes that happen during the course Your claims for orthodontic services are paid as follows:
of your treatment so that United Concordia can create
and send the new payment schedule.
• You pay a cost-share based on whichever is less: the
dentist’s actual charge or TRICARE’s allowed fee.
Note: You or your dentist should submit your claims right
after orthodontic treatment starts. Don’t wait to submit
• The TDP pays the other part of the appropriate
billed charges. The government reimburses United
claims until after the orthodontic treatment is finished.
Concordia for charges it pays over the allowed fee
(for command-sponsored members only).

THE TREATMENT IS EXPECTED TO UNITED CONCORDIA PAYS

TAKE …

Less than 6 months United Concordia makes one lump sum payment.

More than 6 months and United United Concordia makes one lump sum payment.
Concordia’s liability is less than $500

More than 6 months and United When braces are put on: United Concordia pays 25% of the payable
Concordia’s liability is $500 or more amount.

Monthly: United Concordia pays the remaining 75% of the payable

amount in equal, automatically calculated payments based on the
estimated length of treatment.

30
Learning by Example:
Payment Calculations
Sample Payment Calculation for Eligible Treatment (CONUS)
Here is an example of how your orthodontic payment might be calculated in the CONUS service area. The example
below is only meant to show you how payments are calculated; actual fees, duration of treatment, and payments
will vary.

Scenario: A network dentist (orthodontist) charges an allowed fee of $4,000. No previous orthodontic
lifetime maximum was used. The orthodontic payment would be calculated as shown below:

INSURANCE 1. $4,000 allowed fee x 50% cost-share = $2,000 insurance cost-share

PAYMENT =
2. $2,000 insurance cost share - $1,750 OLM = $250 balance chargeable to member. (The
$1,750
insurance payment is subject to a $1,750 OLM)

Note: The member has to pay the amount left unpaid by the TDP after applying the OLM. In
this example, this is calculated as: $2,000 insurance cost-share - $1,750 OLM = $250

MEMBER 1. $4,000 allowed fee x 50% cost-share = $2,000 member cost-share

OUT-OF-
2. $2,000 insurance cost-share - $1,750 OLM = $250
POCKET COST
(See the note to step 2 of the insurance payment calculation above)
= $2,250
3. $2,000 member cost-share + $250 = $2,250

SECTION 6
Sample Payment Calculation for Command-Sponsored Beneficiary (OCONUS)
Scenario: The total fee charged by a dentist (orthodontist) is $5,000 and the TDP allowed fee is $4,000:

Orthodontic Services
INSURANCE 1. $4,000 allowed fee x 50% = $2,000 insurance cost-share
PAYMENT =
Note: OCONUS, the government reimburses United Concordia for the portion of charges
$3,000*
that exceeds the OLM for command-sponsored members. In this example, this is
$2,000 - $1,750 = $250.

2. $5,000 dentist fee - $4,000 allowed fee = $1,000

Note: OCONUS, the government reimburses United Concordia for the portion of charges
that exceed the allowed fee for command-sponsored members. In this example, this is
$1,000.

3. $2,000 insurance cost-share + $1,000 = $3,000

BENEFICIARY $4,000 allowed fee x 50% = $2,000 member cost-share

OUT-OF-
POCKET COST
= $2,000

* OCONUS: United Concordia pays the dentist directly in one lump sum. The government later reimburses United
Concordia for the portion of the charges that exceed the allowed fee and the OLM for command-sponsored members.

31
Selected Reserve and Individual Ready Reserve Family Note: The lump sum payment for orthodontic care
Members in the OCONUS service area could use your entire
$1,750 OLM. If this is the case, you’ll have to pay out of
If you aren’t in a special mobilization category or not
pocket for additional care, including if you return to the
command-sponsored, you’ll pay CONUS cost-shares and
CONUS service area before the treatment is done.
have a $1,750 OLM. You also have to pay any fees that the
dentist or orthodontist charges above the TDP’s allowed fee. United Concordia pays the orthodontist directly for
services when you use a TOPD. You’ll only pay the
applicable cost-share when you use a TOPD.
Orthodontic Payment Schedule for Command-
Sponsored Beneficiary OCONUS
If you’re command-sponsored and get your orthodontic
TRANSFERRING ORTHODONTISTS
treatment in the OCONUS service area, United
Concordia will make your payment in one lump sum CONUS to CONUS
as long as the overseas orthodontist’s treatment plan is
approved. United Concordia’s payment also includes If you change orthodontists, your new orthodontist
any part of the claim that will be reimbursed by the will be the one to file claims. Your payments will
government (the government reimburses United depend on your OLM balance. You must notify United
Concordia for charges it pays over the allowed fee for Concordia if you stop getting orthodontic treatment, or
command-sponsored members only). You have to pay if your treatment finishes early. Contact information is
the amount of the claim that United Concordia doesn’t available on the front inside cover of this book.
cover. The amount you owe should at most be a 50%
cost-share of the allowed fee.
CONUS to OCONUS
Before you transfer to an orthodontist in the OCONUS
service area, you have to get a NARF from the TAO (or
designee). The TDP will make a lump sum payment
for your orthodontic care in the OCONUS service area
based on your OLM balance once the NARF and the
OCONUS treatment plan is issued.

OCONUS to CONUS
United Concordia usually pays for orthodontic care in the
OCONUS service area up front in one lump sum. If the
total payments met or exceeded the OLM, you won’t be
able to get coverage for claim payments by the TDP when
you move to an orthodontist in the CONUS service area. If
you reached your OLM, you’ll also have to pay to continue
care that wasn’t completed in the OCONUS service area.

32
Figure 6.1 OCONUS Referral Procedures for Orthodontic Services

Follow these steps to get orthodontic care:

Step 1: Get an initial Non-Availability and Referral Form (NARF).
1 You can get a NARF from your TRICARE Area Office, overseas military dental clinic, or OCONUS
point of contact. It should authorize you for an orthodontic exam and treatment plan that allows
you to get orthodontic care in the OCONUS service area.

Step 2: Find an OCONUS orthodontist.

2 Go to www.uccitdp.com for a list of TRICARE Overseas Preferred Dentists in your area.
You can go to any licensed and authorized dentist (orthodontist) you choose, but using
a TOPD saves you money and paperwork.

3 Step 3: Go to your initial exam.

Step 4: Send required documents to United Concordia and ask for a predetermination.
4 If you use a TOPD, the TOPD will send the required documents for you.

After your initial exam, send the following Ask United Concordia for a predetermination
documents to United Concordia: of payment:

• The NARF Fill out a claim submission and include a

SECTION 6
statement from the orthodontist that shows
• The claim form
the total cost of all the treatment you need.
• The provider’s bill for the initial exam United Concordia will review the request and
and treatment plan give you a summary of the covered costs.

Step 5: Make sure you have an approved NARF.

5 You need an approved NARF to get treatment. Use the guide below to figure out if you need to

Orthodontic Services
submit another NARF:

DO I NEED TO SUBMIT A SECOND NARF?

I (or my TOPD) submitted an approved My provider didn’t mention future treatment

NARF and the necessary information for with the exam/workup documents.
the rest of my treatment when I got the
predetermination of payment.

YES
NO
Submit a second NARF, the claim
submission document and the dentist’s bill
for the full orthodontic treatment to United
Concordia.

6 Step 6: Get treatment.

33
TRICARE Dental Program
Claim Filing
There’s a process for documenting and filing a claim for
every service used. This section describes that process Step 3: Once treatment is completed, return
for claim filing, whether in the CONUS or OCONUS the Dental Estimate of Benefit Notification to
service area, and provides more information on United Concordia
predetermination.
Write the date you got treatment on the form. You or
Note: Your premium payments have to be current for your dentist can do this.
the TRICARE Dental Program to pay your claims. If
your premium payments aren’t current, the TDP will Note: You can send the Dental Estimate of Benefit
delay or deny your claim. Notification to United Concordia as soon as you’ve
gotten any service listed on the form, even if there are
services listed on the form that you haven’t had.
PREDETERMINATION REQUESTS
Your predetermination of payment is good for six
A predetermination request is when you ask United months from the date listed on the Dental Estimate of
Concordia for a quote for the cost of dental care based Benefit Notification. After six months, you have to redo
on the terms of your insurance policy before you get the the predetermination request.
dental care.
Get a predetermination of payment before a procedure
that might be expensive. Talk with your dentist
CONUS CLAIMS
first if you’re unsure whether you should make a Go to www.uccitdp.com for United Concordia’s form
predetermination request. and instructions. You can also use any standard dental
claim form of the American Dental Association when
You and your dentist can use a predetermination of
you submit a claim to United Concordia in the CONUS
payment to find out:
service area.
• What your insurance will cover
• How much United Concordia will pay for a certain
Submitting Claims
dental service
You can go to any authorized or licensed dentist.
These steps explain the predetermination process: However, United Concordia TDP network dentists
handle paperwork and claims filing for you. If you don’t
see a United Concordia network dentist, you might have
Step 1: Submit a claim form to file your own claims.
You or your dentist can submit the claim. Write on
Submit a separate claim for each person who gets a
the claim form that you want to get a predetermination
service. Submit the sponsor’s Social Security Number or
of payment.
the individual’s Department of Defense Benefits Number
with any supporting documents you send to United
Step 2: Get the result Concordia.

United Concordia will contact you when your request

is ready. United Concordia will use a Dental Estimate Claim-Filing Deadline
of Benefit Notification to let you and your dentist know
You must submit claims to United Concordia within
the result of your request.
12 months after the date of service. Please submit
your claims to United Concordia as soon as possible,

34
especially for any claims related to orthodontic care. • Date(s) of service
Claims submitted more than 12 months after services
were performed will be denied. (TDP network dentists
• Provider name, address, and phone number
can’t bill you for services that are denied for this reason.) • Specific problem encountered

SECTION 7
• Procedure code(s) (If a procedure code isn’t on the
Claim Payments claim submission document, provide a complete
description of the service performed, including
The claims payment process is different if you see a applicable tooth number(s), where appropriate.)
network or a non-network dentist:
• Specific tooth/teeth treated for each service
• Network dentist: performed, where appropriate

TRICARE Dental Program Claim Filing

■ United Concordia makes its insurance payment • Total charges
directly to the dentist. Its payment doesn’t cover
your part of the cost-share. United Concordia also needs the following to process
your claim:
■ You pay your cost-share. Your cost-share bill will
usually come from the dentist’s office. • A completed claim form

• Non-network dentist: • If the service provided isn’t on the claim form, then
a copy of the dentist bill or statement of charges
■ United Concordia only pays the dentist directly
if you request it on the claim form. This is called • Non-Availability and Referral Form (NARF) for
an assignment of benefit. Otherwise, United orthodontic care
Concordia sends the payment to you, and then
you pay the dentist.
Claim-Filing Deadline
- If you don’t make an assignment of benefit on
the claim form, the non-network provider may You have to submit claims to United Concordia within
request payment from you up to the provider’s 12 months after the date of service. Submit your claims
billed charge, at the time of service. If you’re to United Concordia as soon as possible, especially for
eligible for any reimbursement, you’ll get it any claims related to orthodontic care. If the claim is
from United Concordia. submitted more than 12 months after the service was
performed, the claim will be denied.
■ You pay your cost-share and any part of the
dentist’s fee that goes over United Concordia’s
allowed charge. OCONUS Claim Payments
Note: You usually save money by seeing a network dentist. You may need to pay for your dental care up front in
the OCONUS service area, especially for orthodontic
work. You or your dentist will need to file a claim to get
OCONUS CLAIMS reimbursement.

The quickest and easiest way to get a claim form is Except for orthodontic care, United Concordia submits
online at www.uccitdp.com. If online access isn’t its payment to whoever submitted the claim: you or your
convenient for you, you can get a claim form from the dentist. In either case, United Concordia will give you a
nearest TRICARE Area Office, overseas military dental Dental Explanation of Benefits. United Concordia will
clinic, or from a designated OCONUS point of contact. send its payment to your dentist if you request it using
Contact United Concordia customer service if you need the applicable part of the claim form. Your dentist will
details about any of these options. get the payment if United Concordia can’t determine
who submitted the claim.

Submitting Claims You’ll get reimbursement from United Concordia in U.S.

Make sure the claim form provides United Concordia dollars. United Concordia submits its payments to your
with the following information: dentist in the OCONUS service area’s local currency,
when available from a recognized U.S. bank. United

35
Concordia uses the exchange rate in use the day you got Figure 7.1 Understanding the Dental
your care. Once United Concordia draws a payment in a Explanation of Benefts
foreign currency, it can’t be changed to U.S. dollars.
DATA FIELD DESCRIPTION

OCONUS POINT-OF-CONTACT PROGRAM Sponsor’s name Name of the uniformed service

member
If you have general questions or questions about claims
submission, contact United Concordia customer service. Beneficiary’s Department of Defense Benefts
identification Number
If you have questions about orthodontics in the
number
OCONUS service area or completing the NARF, contact
the TRICARE Area Office dental point of contact. Beneficiary name Name of the benefciary who got
the services—must match
what’s in DEERS
DENTAL EXPLANATION OF BENEFITS
Internal Control The unique number given to the
The DEOB is a document that explains what was covered
Number image of your claim in United
and in what amount for your dental services. The DEOB
Concordia’s database. Use this
breaks down the costs for the procedures, and helps you
number when you have
understand how much you have to pay in cost-shares, if
questions about the DEOB.
any. The amount you have to pay the dentist is written
on the DEOB. If you wrote on the claim submission Date processed Date United Concordia fnalized
document that you want United Concordia’s payment to the DEOB
go straight to your dentist, your dentist will also receive a
copy of the DEOB. Provider Name of dentist who provided
the service or treatment

Understanding Your DEOB Procedure Procedure code identifying the

description/ service performed (D + a four
The information described in Figure 7.1 will appear at Procedure code digit number). Includes tooth
the top of the DEOB. number/range, if applicable.

You can see your DEOB electronically at Service date Date you got treatment
www.uccitdp.com.
Provider’s charge Amount charged by the dentist
Note: The DEOB you get for treatment in the OCONUS
service area might have additional information you Allowance Maximum amount United
wouldn’t see on a DEOB for treatment in the CONUS Concordia will consider
service area. If you have any questions, contact United reimbursing for the service. It
Concordia customer service. includes adjustments for
limitations and exclusions.

Questions About the DEOB Amount paid Amount United Concordia will
pay for the treatment. It
Contact United Concordia customer service if you have includes adjustments for
any questions about the DEOB. When you call, have the cost-shares and maximums.
following information ready:
Amount not paid Amount not covered by the plan.
• Your name and date of birth
You may be held responsible for
• Patient’s dental benefit number or sponsor’s Social some of the amounts in the
Security number “amount not paid” column.

• Beneficiary/patient name Remarks Special messages or message

• Internal Control Number from the DEOB references explaining claim
payments

36
COORDINATING OTHER DENTAL • For some insurance companies, the “gender rule”
INSURANCE BENEFITS WITH THE TDP may determine the primary plan for your child’s
coverage instead. According to the gender rule, the
If you have other dental insurance, United Concordia male parent’s dental plan is always the primary plan.

SECTION 7
will work with your other insurance company to If your other insurance company uses this rule,
determine the coordination-of-benefits rules. These United Concordia will, too.
rules decide which plan is primary and which plan is
secondary when paying for care. • If you and your child’s other parent aren’t married
and both have dental plans, the insurance plan of the
The primary plan pays first; the secondary plan pays parent with custody is the primary plan. If the parent
second. You should always file claims with the primary with custody has remarried, the stepparent’s plan
plan first. After the primary plan has paid, you can file a

TRICARE Dental Program Claim Filing

will provide secondary coverage before the plan of
claim with the secondary plan. the parent without custody. If there is a court decree
declaring which parent is responsible for insurance
coverage, the decree takes precedence. You can send
When Is the TDP the Primary or Secondary any custody agreements to United Concordia through
Plan? the online form available at www.uccitdp.com
• The TDP is the primary plan when your spouse or
child doesn’t have their own dental plan. Submit
the claim first to United Concordia. If your spouse How Does the TDP Work as a Secondary Plan?
or child has a medical insurance plan that includes The primary plan pays benefits without regard to the
a dental benefit, submit the claim to that company secondary plan. If the TDP is your secondary plan, it
only after United Concordia has processed the claim will pay up to the usual allowable charge for any TDP-
and paid. covered services not paid for by your primary plan. See
the next page for examples of how this works.
• The TDP is the secondary plan when your spouse or
child has their own dental plan. Submit the claim first When the TDP is your secondary plan, it will never pay
to the other insurance company; submit it to United more than your dentist charges, or more than it would
Concordia only after the other insurance company have paid as the primary insurance plan. Together, your
has processed the claim and paid. When you submit primary and secondary coverage can never exceed the
a secondary claim to United Concordia, you need to dentist’s charge.
include a copy of the primary insurance plan’s DEOB.

The following situations are exceptions involving

children:
• If you and your spouse both have dental plans, the
“birthday rule” usually determines the primary plan
for your child’s coverage: the primary plan belongs
to the parent whose birthday falls earlier in the year.
For example, if the mother’s birthday is March 2 and
the father’s birthday is March 12, the mother’s dental
plan is primary.

37
Learning by Example:
Payment Calculations
Sample Payment Calculation: Other Dental Insurance, Coordinating Benefits With the TRICARE
Dental Program
Scenario A: You submit a claim for a $35 exam to your primary insurer and to the TRICARE Dental Program. In this
example, your primary insurer covers up to $28 for the exam and the TDP covers up to $30 for the exam.

1 $35 (claim) First, your primary insurance plan paid $28 when you submitted your
– $28 (insurance payment) claim for the $35 exam. This means your remaining balance after the
$7 (remaining balance) primary insurance payment is $7 for the exam.

2 $7 ≤ $30 (United Concordia allowable charge) Next, you submit a secondary claim to United Concordia as a TDP benefciary.
Your remaining balance of $7 is less than United Concordia’s allowable charge of
United Concordia pays $7, you pay
$30, so United Concordia will pay the remaining $7 charge. As a result, you have
nothing (remaining balance) no out-of-pocket costs.

Sample Payment Calculation: Other Dental Insurance, Coordinating Benefits With the TDP
Scenario B: You submit a claim for a $95 restoration to your primary insurer and to the TDP. In this example, your
primary insurer covers up to $80 for the restoration and you have to pay a 20% cost-share. The TDP covers up to
$70 for the restoration and you have to pay a 20% cost-share.

1 $80 (amount insurance covers of $95) First, your primary insurance plan paid $64 when you submitted a claim for
x 80% (insurance responsibility) a $95 restoration. This is because your primary insurance agrees to pay 80%
$64 (insurance payment) up to $80, or $64.

$80 (amount insurance covers)

x 20% (your responsibility)
$16 (your payment, 20% of claim)

You owe the remaining 20% on the first $80 of the bill, or $16. You also owe the
$95 (total claim) portion of the dentist’s charge of $95 that exceeds the allowable charge of $80,
– $80 (amount insurance covers) or $15. This means you owe $31 after your primary insurance payment.
$15 (your payment, remaining balance)

$16 (your payment, 20% of claim)

+ $15 (your payment, remaining balance)
$31 (your total remaining balance)

2
$70 (amount United Concordia covers of $95)
x 80% (United Concordia responsibility)
Next, you submit a secondary claim to United Concordia as a TDP
$56 (United Concordia max payment)
benefciary. When you submit a secondary claim to United Concordia,
United Concordia will pay the remaining $31, since $31 is less than the
$31 ≤ $56 (United Concordia max payment) TDP’s allowable charge for the procedure. As a result, you have no
out-of-pocket costs.
United Concordia pays $31, you pay
nothing (remaining balance)

38
 SECTION 7
Scenario C: You submit a claim for a $800 crown to your primary insurer and to the TDP. In this example, your
primary insurer covers up to $700 for the crown and you have to pay a 50% cost-share. The TDP covers up to
$650 for the crown and you have to pay a 50% cost-share.

1 $700 (amount insurance covers of $800) First, your primary insurance plan paid $350 when you submitted a claim
x 50% (insurance responsibility) for an $800 crown. This is because your primary insurance agrees to pay
$350 (insurance payment) 50% of the bill up to $700.

$700 (amount insurance covers)

x 50% (your responsibility)
$350 (your payment, 50% of claim)

You owe the remaining 50% on the first $700 of the bill, or $350. You also
$800 (total claim) owe the portion of the dentist’s charge of $800 that exceeds the allowable
– $350 (amount insurance covers) charge of $700, or $100. This means you owe $450 after your primary
$450 (your payment, remaining balance) insurance payment.

$350 (your payment, 50% of claim)

+ $100 (your payment, remaining balance)
$450 (your total remaining balance)

2
$650 (amount United Concordia covers of $800)
x 50% (United Concordia responsibility)
$325 (United Concordia max payment) Next, you submit a secondary claim to United Concordia as a TDP
benefciary. When you submit a secondary claim to United Concordia,
$450 ≥ $325 (United Concordia max payment) United Concordia will pay the remaining $325, since $450 is more than the
TDP’s allowable charge for the procedure. As a result, you must pay $125
United Concordia pays $325
out of pocket.

$450 (remaining balance) Note: Remember that the TDP, as a secondary plan, will never pay more
–$325 (United Concordia payment) than it would have as the primary plan. If the TDP plan had been primary in
$125 (your total out-of-pocket costs) this case, United Concordia would have paid 50% of the allowable $650
charge, which is $325. Since the remaining balance of $450 is greater than
$325, United Concordia will only cover $325 of your remaining $450 bill.
United Concordia pays $325, you
pay $125 (remaining balance)

39
Traveling and Moving With the
TRICARE Dental Program
If you’re a TRICARE Dental Program beneficiary, you’re covered worldwide, whether you’re traveling on leave
or moving to a new duty location.

TRAVELING
Use the chart below to find out about your TDP coverage when traveling worldwide:

Figure 8.1 TDP Coverage When Traveling Worldwide

I LIVE IN THE I’M TRAVELING TO THE I’M TRAVELING TO THE

CONUS SERVICE AREA OCONUS SERVICE AREA

CONUS Service Area You can visit any licensed, authorized dentist You’re covered in the OCONUS service area
for care. However, you’ll probably save time (areas not in the stateside service area,
and money by visiting a dentist in the TDP including a ship or vessel outside the
network. To find a TDP network dentist, go to territorial waters of the stateside service
www.uccitdp.com and click “Find a area). You’ll pay CONUS cost-shares, and
Dentist.” You can also call United Concordia United Concordia will handle your claims as
customer service for help. though you were visiting an out-of-network
dentist.
Note: The online directory is updated daily,
and you can search for a dentist by
specialty, last name, city, or ZIP code.

OCONUS Service Area You’re covered in the CONUS service area. You’re covered when you travel throughout
You’ll pay CONUS cost-shares and follow the OCONUS service area or move to a new
CONUS payment rules, regardless of OCONUS location. If you’re command-
command sponsorship status. sponsored, you’ll have reduced cost-shares
and claim payment rules.

40
MOVING After you’ve moved, go to www.uccitdp.com and
click on “Find a Dentist” to find a new TDP network
The TDP moves when you do. You don’t have to fill dentist near you. You can also call United Concordia
out new enrollment applications when you move customer service for help. Their contact information
because your coverage remains in place. Just be sure is on the back cover of this handbook.
to update your address in the Defense Enrollment
Eligibility Reporting System at https://milconnect. If you relocate within the OCONUS service area,
dmdc.osd.mil. The TDP doesn’t cover copying you can choose, within 90 calendar days of your
records for a sponsor’s permanent change of station. relocation, to terminate enrollment from the TDP.
You should get copies of your dental records before Go to www.tricare.mil/tdp for more information.
you move, so that you don’t have to pay for them at
your new location.

SECTION 8
Traveling and Moving With the TDP

41
Appeals, Grievances,
and Fraud and Abuse
If you have an issue that you haven’t been able to resolve by talking to United Concordia customer service
or by speaking to your dentist, you can file an appeal or grievance. Read this section to find out how to file
an appeal or grievance and how to report suspected fraud or abuse.

TRICARE DENTAL PROGRAM APPEALS PROCESS

You can submit an appeal if you don’t agree with a decision United Concordia made about your benefit. Your network
dentist or your representative may also be able to submit an appeal.

Can I Ask For An Appeal?

See Figure 9.1 to find out if you’re eligible to submit an appeal:

Figure 9.1 Who Can Make An Appeal

YOU CAN MAKE AN APPEAL IF YOU’RE YOU CAN’T MAKE AN APPEAL IF YOU’RE

• The patient who received the dental services • A dentist who has been disqualified or excluded from
being authorized
• A sponsor, parent, or guardian of a beneficiary who is
under age 18 or mentally incompetent • A network dentist or non-network dentist who doesn’t
have the beneficiary’s written permission to act as a
• The network dentist, non-network dentist, or other
representative*
person who has the beneficiary’s written permission to
act as a representative* • A beneficiary who received care or wants to get care
from a dentist who has been excluded, suspended, or
terminated as an authorized dentist

• A third party, such as an insurance company

* If you want to name a representative to make an appeal, you must fill out a copy of The Appointment of Individual to Act as Appeal
Representative Form. Go to the “Forms and Materials” section of www.uccitdp.com to submit the form online. You can also download
the form and submit it by mail.

42
What Can and Can’t Be Appealed? APPEAL LEVELS
To file an appeal, there must be a dollar amount you owe that There are three levels of appeal: reconsideration, formal
you want to reduce. There are two issues you can appeal: review, and hearing.
• The amount United Concordia has decided you owe.
To determine the maximum amount you can dispute
Level I: Reconsideration
in an appeal, remember to subtract your cost-share
from your bill. For example: Reconsideration is a formal request that you or your
representative makes to United Concordia. This request
Provider Charges You: $300 asks United Concordia to reevaluate your bill to be sure
that it’s correct.
Your Cost-Share Is: $75

Maximum Amount You Can Dispute $225 How to Request Reconsideration

in an Appeal Is:
1. You can only make a reconsideration request in
If you have any other dental insurance, you need to writing, not over the phone. Be sure to include:
subtract their payment from your bill, as well. ■ An appeals letter stating the reason for the request
For example: and the specific dollar amount you’re disputing
Provider Charges You: $300 ■ All supporting documentation (for example,
X-rays; dated periodontal charting; clinical
Your Cost-Share Is: $75 narratives; permanent change of station orders, if
applicable; progress notes; treatment records)
Your Other Dental Insurance Pays: $125
■ A copy of United Concordia’s initial determination
Maximum Amount You Can Dispute $100
2. Submit the reconsideration request online at

SECTION 9
in an Appeal Is:
www.uccitdp.com or mail it to United Concordia:
CONUS/OCONUS:
• Adverse decisions on predetermination requests (such United Concordia — TRICARE Dental Program
as a cost estimate from United Concordia you don’t P.O. Box 69450
agree with for dental work you haven’t received yet) Harrisburg, PA 17106

You can’t appeal the following issues: Fax:

Traveling and Moving With the TDP

• Disputes regarding requirement of law or regulation 717-635-4565 (CONUS)
844-827-9926 (OCONUS)
• The amount United Concordia decides is the
allowable charge for the service 3. Make sure that your request arrives on time. Find the
issue date (claim year and month) in the upper right
• Plan eligibility rules
corner of your Dental Explanation of Benefits. Your
• Dentists who have been excluded or suspended request has to be postmarked or received by United
by a government agency or state or local licensing Concordia within 90 calendar days of that date.
authority
4. Because you need to file within 90 days, don’t wait to
• Amounts exceeding your plan year or lifetime get copies of any supporting documentation that you
maximum don’t have readily at hand. Submit the request, and
explain in your appeals letter what else you plan to
• Services that are denied due to timely filing
submit and when you plan to submit it.
limitation
Note: You need to submit your reconsideration request
separately from any submission documents for other
dental claims. For example, if you’re filing a claim for
your daughter and disputing a claim for your son, you

43
can’t mail everything in one envelope. If you submit 3. Be sure your request arrives on time. Find the date
separate claims documents with your reconsideration on the letter United Concordia sent you about their
request, United Concordia will process the request as a reconsideration decision. Your request has to be
claim and deny it as a duplicate. postmarked within 60 days of that date.

Note: You can also find these instructions, along with 4. Because you need to file within 60 days, don’t wait
information about your right to appeal, on the DEOB to get copies of any additional information you don’t
that you received from United Concordia. have readily at hand. Submit the request, and explain
in your appeals letter what else you plan to submit
and when you plan to submit it.
What Happens During Reconsideration?
Note: You can also find these instructions, as well
United Concordia will review everything you or as information about your right to a formal review,
your representative submits. They may contact you, on the letter United Concordia sent you about their
your representative, or your dentist for additional reconsideration decision.
information. In some cases, they may refer your claim to
a United Concordia dentist consultant.
Level III: Hearing
Within 60 days of receiving your reconsideration
request, United Concordia should notify you and your If you disagree with the formal review decision from
dentist, in writing, of their decision. They will either DHA and owe $300 or more, you may request a hearing
cover the disputed cost, partially or in full, or confirm with DHA.
their original decision about what you owe.
1. You can only make your request for a hearing in
writing, not over the phone. Include the following:
Level II: Formal Review ■ An appeals letter stating the reason for the request
If you disagree with the United Concordia reconsideration and the specific dollar amount you’re disputing
decision and owe $50 or more, you can request a formal ■ Copies of the formal review decision from DHA
review from the Defense Health Agency.
■ Any other information not supplied with your
previous reconsideration and review requests.
How to Request a Formal Review 2. Mail your request to DHA at this address:
1. You can only make your request for a formal review
Defense Health Agency
in writing, not over the phone. Be sure to include the
Appeals, Hearings, and Claims
following:
Collection Division
■ An appeals letter stating the reason for the request 16401 E. Centretech Parkway
and the specific dollar amount you’re disputing Aurora, CO 80011

■ Copies of the letter and included information United 3. Be sure your request arrives on time. Find the date
Concordia sent about their reconsideration decision on the letter DHA sent you about their formal review
■ Any other information not supplied in your decision. Your request has to be postmarked within
original reconsideration request 60 days of that date.

2. Mail your request to the DHA at this address: 4. Because you must file within 60 days, don’t wait to
get copies of any additional information that you
Defense Health Agency don’t have readily at hand. Submit the request, and
Appeals, Hearings, and Claims explain in your appeals letter what information you
Collection Division plan to submit and when you plan to submit it.
16401 E. Centretech Parkway
Aurora, CO 80011

44
GRIEVANCES • Identity thefts—submitting claims for a non-eligible
individual as a covered beneficiary
United Concordia continuously monitors its network
dentists to be sure that they’re providing you with • Duplicate claims submissions
quality care and billing you correctly. If you have any • A dentist misrepresenting their credentials or
questions concerning the quality of your care, discuss concealing information about business practices
them first with your dentist. If you still have concerns that disqualifies him or her as an authorized TDP
after this conversation, get in touch with United provider
Concordia. Go to the “Forms and Materials” section at • Improper billing practices—submitting claims for
www.uccitdp.com to submit your concerns online, or unnecessary dental services
write to United Concordia at the following address:
• Routine waiver of beneficiary cost-share
United Concordia You can guard against fraud by always carefully
TDP Grievances reviewing your DEOB. Make sure that the information
1800 Center Street, 2AL4 on it is correct.
Camp Hill, PA 17089
• Check the date of service
Fax: 717-635-4560 • Check the type of services you received
You should include the following information: • Check that the payment issued was for the actual
services you received
• The sponsor’s name and Social Security number
or the patient’s Department of Defense Benefits
Number Reporting Fraud and Abuse
• The patient’s name and relationship to the sponsor If you suspect fraud, report it immediately to the Special
• The dentist’s name and address Investigations Unit by phone or mail.
•

SECTION 8
• An explanation of the concern Call the toll-free “Fraud Hotline” at 877-968-7455,
and choose option 2. The SIU maintains a 24-hour
United Concordia will investigate, resolve your concerns confidential voice mailbox for reporting suspected
as appropriate, and notify you of the results. fraud.

Neither the government, United Concordia, nor any of its • Submit written complaints directly to this address:
agents or representatives controls the quality of OCONUS United Concordia
dentists. If you have any complaints or concerns about Special Investigations Unit—TDP

Appeals, Grievances, and Fraud and Abuse

overseas dental service or quality of care, send them to 1800 Center Street
United Concordia at the address above. Suite 2B 220
Camp Hill, PA 17011
Fax: 877-603-6091
FRAUD AND ABUSE
Fraud and abuse can take many forms. Examples of
fraudulent and/or abusive practices include, but aren’t
limited to, the following:
• Submitting claims for services not performed
• Submitting claims for non-covered services disguised
as covered benefit services

45
Glossary of Terms
adjunctive dental care appeals/reconsiderations
Dental care that is one or more of the following: Procedures for you or your dentist to argue against
claims and coverage decisions you disagree with.
• Medically necessary to treat an otherwise covered
medical (not dental) condition
• An integral part of the treatment of the medical
assignment of benefits
condition A statement you can sign on your claim form that lets
• Required in preparation for, or as a result of, dental United Concordia send payment directly to the dentist.
trauma If you don’t sign the assignment of benefits provision,
United Concordia will send the payment to you, and
• Caused by medically necessary treatment of an you’ll then need to pay the dentist.
injury or disease
TRICARE may cover these adjunctive dental services as
medical (not dental) services.
authorized dentist
A licensed dentist or dental hygienist who provides services
within the scope of their license or registration and hasn’t
allowable charge/allowance/allowed fee been excluded, suspended, or sanctioned from providing
The maximum amount United Concordia will pay for a service under the TDP. Licensed dentists always have a
particular service you receive. The allowable charge for degree, either a DDS or DMD.
services from the TRICARE Dental Program nework
dentists is whichever is lower: the dentist’s normal
charge, or negotiated fee. The allowable charge is the
authorized provider
Any fully licensed provider—including dentists and
same for network and non-network dentists. You may
certified registered nurse anesthetists—approved to
be responsible for paying the difference between the
provide either dental care or covered anesthesia benefits
allowable charge and the dentist’s billed charges if
in their state. Dental hygienists practicing within the
you see a non-network dentist. TDP limitations and
scope of their licensure are also authorized providers,
exclusions may impact how much of the allowable
unless they have official restrictions on their status.
charge United Concordia covers.
Dentists currently sanctioned by U.S. Department of
Health and Human Services aren’t authorized providers
amalgam under the TDP network.
A mixture of metals (usually mercury, silver, tin, copper,
and sometimes other metallic elements) that your
dentist uses in direct dental restorations (fillings). Your
beneficiary (member)
A beneficiary is anyone who is eligible to enroll in the
dentist uses these mixtures because they work better for
TDP. Depending on your circumstances, you may be a
your teeth than any of the metals alone.
sponsor, a family member, or a survivor.

American Dental Association

The professional association of dentists (a non-federal
benefits
The dental services that the TDP authorizes and pays
entity). The ADA maintains the Current Dental
(partially or in full) for you to get.
Terminology Code, which is used when processing
dental claims and populating electronic health records.
CDT is one of the code sets outlined in federal privacy
bridge
regulations.
A false tooth that replaces a missing tooth or a row of
false teeth that replaces a row of missing teeth. Called a
prosthetic, a bridge fits between two of your teeth. The
bridge may be removable or fixed in place.

46
by-report procedures crown
Any procedure you can only get with a written explanation A porcelain, metal, or gold cover for a decayed,
of your need from your dentist. Your dentist may need to damaged, brittle, or discolored tooth.
include medical documentation with the report.

SECTION 10
Defense Enrollment Eligibility Reporting
claim System (DEERS)
The paperwork you or your dentist submits to United The Department of Defense website where you can find
Concordia to ask them to pay for a dental service you got. your healthcare eligibility information. Keep DEERS
updated with your personal information to ensure
accuracy.
claim form

Glossary of Terms
The document you use to request either payment or
a predetermination. If using it to submit a claim (a Defense Health Agency (DHA)
request for payment), be sure to write the date of service The government office responsible for overseeing the
(the date on which you got your dental care). If you TDP contract.
don’t write the date of service, United Concordia will
always assume that the claim submission document is a
predetermination request. dental estimate of benefits
See “predetermination.”

command-sponsored
A privilege granted by the uniformed service that allows Dental Explanation of Benefits (DEOB)
the service member’s family to accompany him or her. The notice United Concordia sends to you and your
dentist that explains the following:

CONUS Service Area • The type of service you got

The TDP service area that includes the 50 United States, • TDP’s allowable charge for the service
the District of Columbia, Guam, Puerto Rico, and the
U.S. Virgin Islands.
• The amount your dentist billed for the service
• The amount United Concordia will pay

composite restoration • The amount you may owe

Composite restoration (filling) refers to resin based
materials including but not limited to composites. May
include bonded composite, light-cured composite, etc.
denture
A removable set of artificial teeth. Partial dentures
Tooth preparation, acid etching, adhesives (including
replace only a section of teeth. Full dentures replace the
resin bonding agents), liners and bases, and curing
are included as part of the restoration. May be more entire upper or lower sections of teeth.
aesthetically pleasing, but generally don’t last as long as
amalgam restorations.
diagnostic services
Services your dentist offers to help determine what type
coordination of benefits of dental care you need. Examples include plaster or
The rules that say which insurance plan pays benefits stone models of teeth and X-rays.
first and which insurance plan pays benefits second, if
you’re covered by more than one plan.
eligibility
The federal rules that determine who can enroll in the TDP.
cost-share
Your share of payment for your dental care.

47
endodontic exclusion gingivectomy
The treatment of diseases of the dental pulp (nerve The excision, or removal, of gingiva. Gingiva are the soft
tissue) or injuries that affect the root tip or nerve of tissues covering the crowns of unerupted teeth (those that
the tooth (apex). The most common procedure in this are still hidden in your gums and haven’t yet come in) and
category is a root canal. surrounding the necks of those that have already erupted

enrollee implant
An enrollee is a beneficiary (member) enrolled in the TDP. A device an oral surgeon can place within or on your
upper or lower jawbone in order to make your mouth
ready for dental replacements.
exam
The evaluation your dentist performs to check the
condition of your mouth. An exam can be either an Individual Ready Reserve (IRR)
initial evaluation (comprehensive oral evaluation) or a Members of the Ready Reserve who aren’t in the
periodic one. Selected Reserve or Inactive National Guard. See “Other
than Special Mobilization Category” and “Special
Mobilization Category.”
exclusion
A service that the TDP doesn’t cover and that United
Concordia won’t pay for. inlay and onlay
Custom-made cast gold or porcelain alloy that your
dentist cements to a previously prepared cavity in your
Federal Employees Dental and Vision Insurance tooth. These are stronger and longer lasting alternatives
Program (FEDVIP) to an amalgam or composite filling.
Offered by the U.S. Office of Personnel Management,
FEDVIP offers a choice of premium-based dental plans
for retired service members and their family members, in-process orthodontic treatment
certain survivors, and Medal of Honor recipients and Any orthodontic treatment you began before you
their family members. Vision plans are available for enrolled in the TDP under United Concordia.
those enrolled in certain TRICARE health plans.

integral
filling A procedure that’s considered a necessary part of
Amalgam, metal, porcelain, or composite resin used to another billable procedure. When one dental procedure
restore lost tooth structure. Your dentist uses fillings to is considered integral to another, TDP won’t pay for
treat cavities. the integral procedure separately because it should be
included in the bill for the other service.

fluoride treatment
Application of fluoride (as a liquid, paste, foam, or lock-in period
tablet) to strengthen the tooth enamel. Your dentist uses The initial 12-month period during which you have to
fluoride treatment to prevent cavities. stay enrolled in the TDP.

general anesthesia lock-out period

IV drugs and inhaled gasses that put you into a The 12-month period during which you won’t be able
controlled state of unconsciousness, or “deep sleep.” to reenroll in the TDP if you lose coverage because you
Under general anesthesia, you don’t respond to pain and didn’t pay your monthly premium(s), or voluntarily
your reflexes don’t work. You also won’t know when disenrolled for other than an authorized reason, during
someone is speaking to you or touching you, and your the initial lock-in period. It begins the month following
doctor will need to help you keep breathing. the last month that you paid your premium(s).

48
maximum non-network dentist
The total dollar amount United Concordia will pay for A dentist who hasn’t signed a contract with United
all your dental services under the TDP, per beneficiary. Concordia to become a network dentist.
The annual maximum per plan year applies to non-

SECTION 10
orthodontic dental services. Orthodontic treatment has
a lifetime maximum. The accidental annual maximum occlusion
per plan year goes toward any dental care you get The relationship between the teeth in the upper and lower
because of an accident. arches at rest position. Your dentist often calls it your “bite.”

member (beneficiary) OCONUS Service Area

Glossary of Terms
The member (beneficiary) is any individual eligible to The TDP service area that includes areas not in the
enroll in the TDP. Depending on your circumstances, CONUS service area and covered services provided on a
you may be a sponsor, a family member, or a survivor. ship or vessel outside the territorial waters of the CONUS
service area, regardless of the dentist’s office address.

military dental clinic

A facility operated by the military that provides dental oral exam
care to eligible TRICARE beneficiaries. Also known as An initial evaluation or periodic check on the condition
military dental treatment facility. of your mouth.

military hospital or clinic oral surgery

A medical facility operated by the military that may Surgical services you may get to treat diseases, injuries,
provide you with inpatient and/or outpatient care. Military deformities, defects, and aesthetic aspects of the oral and
hospital and clinic capabilities vary from limited acute care maxillofacial regions (such as your mouth, jaws, and face).
clinics to teaching and tertiary care medical centers.

orthodontic services
National Guard and Reserve Services you may get to treat issues related to occlusion
Members of the Army National Guard, Army Reserve, (your “bite”) and speech.
Navy Reserve, Marine Corps Reserve, Air National Guard,
Air Force Reserve, and Coast Guard Reserve. (As a group,
they’re referred to as the “Reserve Component.”) osseous surgery
Surgery associated with periodontal (gum) disease.

network dentist
An authorized dentist who has signed a contract with other dental insurance
United Concordia. As part of this contract, he or she Additional dental coverage you may have through
accepts United Concordia’s allowable charge as full an employer, association, or private insurer. See
payment for any service covered by the TDP. Network “Coordination of Benefits.”
dentists agree to provide services to you at discounted
fees that are usually 10 to 35% lower than what other
dentists in their communities charge. Because of
Other than Special Mobilization Category
these lower charges, seeing a TDP network dentist can (Individual Ready Reserve)
increase the value of your benefit plan. A category that covers the majority of the individuals in
the Individual Ready Reserve. Usually these members
are trained and have previously served on active duty or
Non-Availability and Referral Form (NARF) in the Selected Reserve of the Ready Reserve. Members
An OCONUS form that you need to submit to your of this category also include some untrained individuals,
TRICARE Area Office, overseas uniformed services dental personnel participating in officer training programs,
clinic, or designated OCONUS point of contact before you and personnel awaiting initial active duty.
can start your orthodontic treatment.

49
periodontal services provider
Services you may get to treat diseases of the supporting Dentists legally able to practice dentistry, certain
and surrounding tissues of the teeth. certified dental hygienists authorized by law to provide
specified dental services, anesthesiologists, and certified
registered nurse anesthetists.
permanent change of station (PCS)
A move from one official duty station to another official
duty station. PCS can provide an exception to certain pulpotomy
limitations of the TDP. PCS doesn’t include relocation A procedure that removes damaged or infected pulp
to the home of record or place of selection under (the soft tissue inside the teeth) to preserve the healthy
separation or retirement orders. pulpal tissue that remains. Your dentist will usually then
restore the tooth with a crown or filling.

plan year
Your annual maximum applies to this 12-month period. Ready Reserve
Composed of the National Guard and Reserve,
organized in units or as individuals. The Ready Reserve
predetermination (dental estimate of benefits) consists of the Selected Reserve, the Individual Ready
The written estimate United Concordia provides when Reserve, and the Inactive National Guard.
you or your dentist asks how much United Concordia
will pay for a specific dental service you need, but have
not yet received. A predetermination is valid for six reconsideration
months from the date it’s issued. First level of the appeals process. If you or your dentist
disagrees with the amount United Concordia decides
you owe, you can request that United Concordia review
premium your bill to make sure that it’s correct. If you or your
The United Concordia charges in exchange for its dentist disagrees with a decision United Concordia
promise to pay for covered dental services. made about a predetermination authorization, you can
request that United Concordia reconsider its decision.

procedure code
A code your dentist and United Concordia use to resin
identify and define specific dental services. A type of dental restorative material not made from metal.

prophylaxis root canal

The cleaning and removal of plaque, stains, and calculus Procedure your dentist uses to save an abscessed (infected)
on the teeth. Also referred to as “prophy,” it’s a service tooth. He or she will clean out the tooth’s pulp, disinfect it,
you should ideally get from your dentist or dental and repair it with a permanent filling or crown.
hygienist every six months.

sealant
prosthetic A resinous material your dentist may put on the tops of the
Professional placement or maintenance of artificial teeth in the back of your mouth (usually the molars) to prevent
teeth, either fixed or removable. cavities. Dentists generally reserve sealants for children.

prosthodontic services Selected Reserve of the Ready Reserve

Professional placement or maintenance of artificial Members in the Selected Reserve designated as essential to
teeth, either fixed or removable. initial wartime missions who have priority over all other
Reserves. All Selected Reserve members are on active status.

50
space maintainer TRICARE Dental Program (TDP)
Fixed or removable appliance your dentist uses to Dental plan offered by the Department of Defense
preserve the space created in your mouth by the through the Defense Health Agency and administered
premature loss of a tooth. by United Concordia.

SECTION 10
Special Investigations Unit (SIU) TRICARE OCONUS Preferred Dentist (TOPD)
United Concordia’s fraud and abuse investigation TOPDs are OCONUS dentists who have signed an
department. agreement with United Concordia to participate in the
TDP. TOPDs will invoice United Concordia directly
for the TDP’s share of the bill and will provide English
Special Mobilization Category (Individual

Glossary of Terms
services and appropriate sterilization practices. TOPDs
Ready Reserve) are provided to you as a convenience, but you may
The category of members within the Individual choose to see any licensed and authorized dental
Ready Reserve who may be ordered to active duty provider you choose.
involuntarily. The service unit selects volunteer
members based on its needs and on the service
member’s grade and military skills. TRICARE Service Center
OCONUS service centers. They’re staffed by service
representatives who can explain the different TRICARE
sponsor options and help you choose the plan that suits you best.
The uniformed service member whose status determines
eligibility in the TDP.
uniformed services
The U.S. Army, U.S. Marine Corps, U.S. Navy,
student U.S. Air Force, U.S. Space Force, U.S. Coast Guard,
A beneficiary up to age 23 who’s enrolled in a full-time Commissioned Corps of the U.S. Public Health Service,
course of study at an approved institution of higher and the Commissioned Corps of the National Oceanic
learning, and for whom the sponsor provides over 50% and Atmospheric Administration.
of the financial support.

United Concordia Companies, Inc.

TRICARE Dental Program Enrollment/Change (United Concordia)
Authorization Form The administrator and underwriter of the TDP.
The form you use to enroll in the TDP, to add or remove
family members from a policy, to cancel a policy, and
to update your address and telephone number or those United Concordia Dentist Consultant
of your family members. Only the uniformed services Dentists that United Concordia employs to review claim
sponsor, or an individual to whom the sponsor has submissions, predetermination requests, and appeals.
assigned power of attorney, can submit this form.

X-rays
temporomandibular joint dysfunction (TMD) Radiation your dentists uses to photograph the bone
TMD is an acute or chronic inflammation of the tissue of the tooth above and below the gum line in
temporomandibular joint—the “hinges” between the order to evaluate the condition of your mouth.
lower jawbone and the bones of the skull.

TRICARE Area Office (TAO)

TAOs are located in certain overseas areas to assist you
if you live or are traveling overseas. A TAO completes
Non-Availability and Referral Forms for orthodontic
treatment in OCONUS areas and submits claims to
United Concordia for reimbursement for you.

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Directory of Resources
Online Enrollment and Billing Services
Visit www.tricare.mil/dental or Enrollment Forms
www.uccitdp.com
United Concordia
TRICARE Dental Program
CONUS P.O. Box 645547
Pittsburgh, PA 15264
Claim Submissions
United Concordia TRICARE Dental Program
CONUS: 844-653-4061 (toll-free)
P.O. Box 69451
OCONUS: 844-653-4060 (toll-free)
Harrisburg, PA 17106
United Concordia
Fax: 717-635-4565
711 (TDD/TTY)

Customer Service Billing Payments

844-653-4061 (toll-free) United Concordia Companies, Inc.
Sunday 6 p.m.–Friday 10 p.m. ET, P.O. Box 645534
except holidays Pittsburgh, PA 15264
United Concordia
711 (TDD/TTY)
Fraud and Abuse Issues
Inquiries
OCONUS
United Concordia
Claim Submissions Special Investigations Unit—TDP
United Concordia TRICARE Dental Program 1800 Center St.
P.O. Box 69452 Suite 2B 220
Harrisburg, PA 17106 Camp Hill, PA 17011
Fax: 844-827-9926 Fax: 877-603-6091

Customer Service Fraud Hotline

844-653-4060 (toll-free) 877-968-7455 (toll-free)
717-888-7400 (toll)
Representatives are available to assist you in English,
German, Italian, Japanese, Korean, and Spanish,
Other TRICARE-Related Listings
DMDC/DEERS Support Office
Sunday 6 p.m.–Friday 10 p.m. ET, except holidays
400 Gigling Rd.
United Concordia
Seaside, CA 93955-6771
711 (TDD/TTY)
Verify Eligibility: 800-538-9552

Quality of Care
Dental Provider Listings
Inquiries Visit www.uccitdp.com
United Concordia
HA422G070225WWDE

TDP Grievances
1800 Center St. 2AL4
Camp Hill, PA 17089
Fax: 717-635-4560

www.tricare.mil
Updated February 2025