TRICARE recently implemented two important changes that enhance TRICARE's dental coverage and improve access to care. The first change improves coverage for general anesthesia and institutional costs, which are covered under the TRICARE medical benefit. The second change improves access to dental care for TRICARE Dental Program (TDP) members in overseas locations by simplifying the payment and claim submission processes.

General Anesthesia

Effective July 1, 2007, the TRICARE medical benefit began covering general anesthesia services and institutional costs for dental treatment provided to beneficiaries with developmental, mental or physical disabilities, and to children age 5 or under.

Established by the National Defense Authorization Act (NDAA) for Fiscal Year 2007, this change specifically affects TRICARE beneficiaries' dental coverage through the TRICARE medical benefit. Reimbursement for general anesthesia and institutional costs will be based on beneficiaries' selected TRICARE program option (e.g., TRICARE Prime, TRICARE Standard, TRICARE Extra, etc.). Members should contact their TRICARE regional contractor for prior authorization before seeking these services. Although general anesthesia is also a TDP-covered benefit, the member has a 40-percent cost-share and the TDP does not cover the institutional, or facility fee.

If you use your medical benefit for these services, it will not be counted against your TDP $1,200 annual maximum benefit. You should make an informed decision as to which coverage is best for you.

The maximum allowable benefit for CONUS/OCONUS is $1,200 per active duty family member per contract year.

"This change helps to enhance the benefits offered by the TRICARE program and enables beneficiaries with special needs to receive the dental care they need," said Dr. Gary Martin, an Air Force colonel, dentist and TRICARE Dental Care Division Director.

Dr. Martin encourages parents to use the preventive care benefits offered by the TDP. "To avoid costly and extensive dental procedures requiring general anesthesia, remember to take your children to the dentist when they get their first tooth. This will help prevent tooth decay."

Overseas Civilian Dental Care

The TDP recently added a new list of preferred dentists outside the Continental United States (OCONUS). The vast majority of these preferred dentists will be in non-remote locations. TDP members seeking dental care overseas will only have to pay the applicable cost-share, not the full payment, up front when they see a preferred dentist. Additionally, preferred dentists will submit claims on behalf of TDP members.

Until recently, many host nation providers required payment in full before dental treatment was provided. Members would then have to submit a claim for reimbursement.

Dr. Martin explained, "Members often delay needed dental treatment because they don't have the money up front. Adding preferred dentists to the program will help improve access to care for our TDP family members living overseas."

If you are a TDP member who is anticipating a move overseas, please do not disenroll from the TDP until you know whether there is an OCONUS military dental treatment facility available and what dental services can be provided. When you live overseas, the TDP provides coverage for approved dental care that is not available at the overseas dental treatment facility.