Even with regular care and visits to your dentist, dental emergencies
can occur - no one can plan for a toothache or injury
to his or her mouth. You'll be happy to know that if a
dental emergency does occur, the TRICARE Dental Program
provides coverage for the unexpected.
What is the TDP Dental Emergency Benefit?
The TDP provides a dental emergency benefit to relieve pain,
which is referred to as palliative emergency treatment.
Palliative emergency treatment is covered on a per-visit
basis, and there is no enrollee cost-share.
To be considered palliative emergency treatment, the problem
has to occur suddenly and unexpectedly and must require
immediate attention. The dentist must provide treatment to
ease your symptoms. Palliative emergency treatment is covered
when no definitive care is provided. When a definitive
procedure, such as a filling, is reported on the same day
as the emergency treatment, the emergency treatment will be
denied.
What Other Emergency Services are Covered?
If the only service provided is to evaluate your condition and
your dentist refers you to another dentist for treatment and/or
prescribes medication, then the service is considered a limited
oral evaluation. Like palliative emergency treatment, limited
oral evaluations are also a covered benefit under the TDP and
there is no cost-share.
In some emergency situations, your dentist may provide a
specific procedure to treat your problem, such as an extraction.
In these cases the actual procedure provided would be considered
for payment. Applicable cost-shares would apply.
The TDP also covers after-hours office visits if your dentist needs
to see you after his or her regularly scheduled office hours. A 20
percent cost-share applies to after-hours office visits.
Important Reminder
While some emergencies can't be avoided, please note that
if you are having a dental problem, you should see your dentist
as soon as it is identified. This can lessen the possibility
of it becoming a more extensive and/or costly situation.
Where Can I Find Information about Dental
Emergencies, Cost-shares and Other
TDP-Covered Benefits?
Your
TRICARE Dental Program Benefit Booklet
lists all covered procedures. Just call 1-800-866-8499
should you require any additional information regarding benefits,
cost-shares, emergency care or any other TDP questions you
may have.
