Dental Implants—Make an Informed Decision

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.

Refer to your TRICARE Dental Program Benefit Booklet for more information regarding dental implant services.