The TRICARE Dental Program (TDP) now includes
coverage for dental implants. You should discuss with
your dentist whether an implant is right for you.
There are some things you need to consider in order
to make an informed decision regarding implants.
Cost is a Factor A single implant will most
likely use up all of your $1,200 annual maximum.
*Additionally, you are responsible for a 50
percent cost-share for these services. Furthermore,
implants involve not only the surgical placement of
the implant itself but are generally followed by a
crown or other prosthodontic device. This may
require two different dentists to perform these two
separate services.
* Although dental implants might use up
your $1,200 annual maximum, you may still be
able to obtain other dental services. That is
because diagnostic services (including some
X-rays) are not subject to the $1,200
annual maximum. You can still receive two exams
and two cleanings in a 12-month period at no
cost to you when provided by a participating
dentist.
Since you will have an out-of-pocket expense, it is
recommended that you submit a request for predetermination
when planning implant treatment. It is also wise to
submit a predetermination for both the implant placement
and the subsequent crown or other prosthodontic service.
(OCONUS procedures differ - see
the
OCONUS Requirements section) This process allows you
and your dentist to know prior to treatment if the treatment
will be covered by United Concordia, as well as the
anticipated payment amount.
To request a
predetermination, ask your dentist to submit a dental
claim form with the proposed treatment information.
Your dentist will submit the claim for predetermination
with the required X-rays. No dates of service
are needed when requesting a predetermination because the
services have not been performed.
Once processed, United Concordia will notify you and your
dentist through a Dental Predetermination Notification
and Request for Payment Form. A predetermination is
not a guarantee of payment, but it gives you an idea of
the cost involved based on the information submitted at
the time the determination was processed.
Limitations Apply
Members under age 14 are not eligible for implant services
unless submitted with X-rays and approved by a United
Concordia Dentist Advisor.
Implants are not covered when placed for a removable
denture.
Replacement of an implant is covered only if the
existing implant was placed at least five years
prior to the replacement and the implant has
failed.
Replacement of implant prosthetics is covered only
if the existing prosthetics were placed at least five
years prior to the replacement and satisfactory
evidence is presented that demonstrates they are not,
and cannot be made, serviceable.
Repair of an implant-supported prosthesis and repair
of an implant abutment are only payable upon report by a
United Concordia Dentist Advisor review. The report should
describe the problem and how it was repaired.
OCONUS Requirements Enrollees living overseas who
choose to have dental implants must obtain a
Non-Availability and Referral Form
(NARF) from an overseas dental treatment
facility (ODTF) or their TRICARE Area Office
(TAO) before having the work done off base. The
NARF, once required for all dental services not provided
by an ODTF, is now only needed for dental implants and
orthodontics.
"In the past, if you lived overseas you may have
received all of your dental care at the on-base
dental clinic," said Navy Cmdr. Robert
Mitton, deputy director of the TRICARE Management
Activity's (TMA) Dental Care Division.
"Now, if the base facility doesn't have
the dental resources or availability, they will give
you the NARF for off-base dental care."
You must use a provider identified on the host-nation
provider list for off-base implants (and
orthodontics) in both remote and non-remote
locations. "One of the reasons you must use an
identified host-nation provider is so that services
can be monitored for safety, quality and cost-effectiveness,"
Mitton said. The host-nation provider list is available
from the
TAO, U.S. Embassy
or Consulate office, or from other local representatives
of the U.S. Government.
