Q. Does the TRICARE Dental Program (TDP) offer
orthodontic coverage in the OCONUS service area?
A. Yes. The TDP offers orthodontic services for children up
to age 21 (or age 23 if enrolled full-time in a
college/university) and for active duty family
member spouses and National Guard and Reserve members
and their spouses under the age of 23. Coverage is effective
until the end of the month in which the member reaches the
applicable age limit, regardless if the treatment has
been completed.
National Guard and Reserve members are encouraged to consult
with their commanders before receiving orthodontic care
to ensure compliance with service policies as orthodontic
appliances could affect dental readiness. If advised to
remove the orthodontic appliances, the removal charges
are not covered by the TDP.
Q. Is OCONUS coverage different than coverage in the
CONUS service area?
A. No. Orthodontic coverage is the same in both service
areas, but how you access the care is different.
For details about covered orthodontic services and
limitations, see pages 59-63 in your
TRICARE Dental
Program Benefit Booklet.
Q. Where can I obtain orthodontic services in the OCONUS service area?
Non-Remote Locations
A. If you live in a non-remote location, you should first
determine the orthodontic availability at your military
overseas dental treatment facility (ODTF). If you need
to seek orthodontic care from a civilian provider
(Host Nation Provider), you are required to obtain
an initial
Non-Availability Referral Form (NARF) from
your ODTF or
TRICARE Area Office (TAO). Furthermore,
you must select an orthodontist from the
Host Nation Provider Directory. The Host Nation Provider Directory
provides you with a list of dentists that have been verified
by TMA as having met certain Government quality criteria.
To find a Host Nation Provider in your location, access
our Host Nation Provider Directory. First, select the Specialty
Option and then select Orthodontics. You may also contact your
TAO
for a copy of this directory.
The initial NARF authorizes you to seek care from a provider
on the Host Nation Provider Directory and is available from your
TAO or ODTF.
Once you receive the treatment plan from the orthodontist
(after the initial visit with the initial NARF), contact your
TAO
to have the treatment approved and the second, or final NARF issued.
The final NARF is required by United Concordia to process the
orthodontic claim for payment. Refer to your
TRICARE
Dental Program Benefit Booklet for more details of remote and non-remote
countries. The TRICARE Dental Program Benefit Booklet also provides
TAO contact information. All final NARFs must be issued by a TAO.
Remote Locations
A. You are required to have a Non-Availability Referral Form (NARF)
issued for all orthodontic services in the OCONUS service area since
you do not have access to a military ODTF. Furthermore, you must*
select an orthodontist from the
Host Nation Provider Directory. The
Host Nation Provider Directory provides you with a list of dentists
that have been verified by TMA as having met certain Government
quality criteria.
To find a Host Nation Orthodontist in your location, access our Host Nation
Provider Directory. First, select the Specialty Option and then select
Orthodontics. You may contact your TAO for a copy of this directory.
Once you receive the treatment plan from the orthodontist
(after the initial visit with the initial NARF), contact your TAO to
have the treatment approved and the second, or final NARF issued. The
final NARF is required by United Concordia to process the orthodontic
claim for payment. Refer to your
TRICARE
Dental Program Benefit Booklet
for more details of remote and non-remote countries. The TRICARE Dental
Program Benefit Booklet also provides TAO contact information. All final
NARFs must be issued by a TAO.
*In Canada, members may receive care from any
orthodontist; however, a NARF is still required.
Q. What will I pay out-of-pocket for orthodontic
care?
A. You must pay a 50 percent cost-share of the
TDP-allowed amount. There is a lifetime maximum
of $1,500 - this is the most that
United Concordia will pay for orthodontic services.
The Government will pay any difference between the
remaining 50 percent and the $1,500 lifetime maximum,
as well as any difference between the provider's charge
and United Concordia's allowance. After the lifetime maximum
is reached and the government has paid its portion, you
would be responsible for any additional orthodontic charges
or services. In OCONUS communities, you may be required to
pay up front and file a claim with United Concordia for
reimbursement. See a payment example on page 63 in your
TRICARE Dental Program Benefit Booklet.
Q. What do I need to do after receiving an initial
orthodontic evaluation?
A. Send the following information to United Concordia:
Initial NARF (for the initial orthodontic exam
and diagnostic services)
TDP OCONUS claim form
Provider's bill
Final NARF (The orthodontic treatment plan
must be submitted for payment with the final
NARF, showing approval of the treatment before
the treatment is started.)
Q. What if I move to the CONUS service area and I still
need orthodontic care?
A. No problem. You can transfer to a new orthodontist
when you move to the CONUS service area. Payments
are calculated based on the remaining orthodontic
maximum. Because OCONUS orthodontic treatment is
paid in one lump sum, your lifetime maximum may
be exhausted before the orthodontic treatment is
completed. If so, you are responsible for the full
amount for orthodontic services received after
the maximum is met.
Q. What if I still have questions?
A. You can call the TDP OCONUS customer service
department 24 hours a day, Monday through Friday
toll-free at 1-888-418-0466. You can
also e-mail your questions to
oconus@ucci.com.
