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 command-sponsored
enrollees regardless of the sponsor's pay grade.
Non-command-sponsored enrollees have benefits paid at the
CONUS
rate.
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 (Aug. 1,
2011 - April 30, 2012) 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 command-sponsored enrollees except Selected Reserve and IRR family members and IRR
(other than Special Mobilization Category) members.
