Your costs for the TRICARE Dental Program (TDP) coverage will vary when accessing
dental care in the OCONUS service area.
Overseas member cost-shares are the same regardless of the sponsor’s pay grade, while
enrollee premiums vary depending upon the TDP enrollment plan and the military status of
the sponsor. The annual maximum and lifetime maximums for orthodontics
are the same in the OCONUS and CONUS service areas. However, the accumulation of charges
against the annual and lifetime orthodontic maximum is different.
Cost-Shares
Unlike cost-shares in the CONUS service area, cost-shares in the OCONUS service area are the same for all enrollees regardless of the sponsor's pay grade.
The chart below provides an overview of cost-shares in the OCONUS service area for types of services covered under the TDP. Please
note: There are some exceptions to these cost-share amounts. These exceptions are explained following the chart.
* Space maintainers are fully covered for patients under age 19 when involving posterior teeth. They are covered at a 20% cost-share for patients under age 19 when replacing anterior teeth only.
** Selected Reserve and IRR family members and IRR (other than Special Mobilization Category) members are responsible for the applicable cost-share portion regardless of where the treatment is received.
See CONUS
Cost-Share chart.
Overseas Cost-Share Exceptions
There are some exceptions to the cost-shares listed in the chart above:
The Government will pay enrolled active duty family member and Selected Reserve and IRR (Special Mobilization Category) member cost-shares for all services except orthodontic, implant services, prosthodontic and other restorative services.
The Government will not pay cost-shares for any services received in the CONUS service area, regardless of whether or not the enrollee is returning to the CONUS service area on a permanent or temporary basis.
Although OCONUS coverage is available for Selected Reserve and IRR family members and to IRR (other than Special Mobilization Category) members, the Government will not pay for any cost-shares for these populations. All cost-shares are the responsibility of the member.
Annual and Lifetime Maximums
The annual and lifetime maximums for the OCONUS service area are the same as for the CONUS service area for orthodontics and other dental services.
Maximum
Description
Annual Maximum
$1,200 per enrollee per contract year (Feb. 1–Jan. 31 each year) for non-orthodontic services*
Lifetime Maximum
$1,500 per enrollee for orthodontic treatment
If an enrollee receives orthodontic services (other than orthodontic diagnostic services), payments for these services will not exceed $1,500 during the member’s eligibility lifetime. Orthodontic diagnostic services will be applied to the $1,200 annual maximum.
* Payments for certain diagnostic and preventive services
are not applied against the annual maximum. Please refer
to the
TRICARE Dental Program Benefit Booklet for specific
procedures.
In the OCONUS service area, the Government will pay for any costs in excess of United Concordia’s fee allowance up to the billed charge for all enrollees except Selected Reserve and IRR family members and IRR (other than Special Mobilization Category) members.
