On May 1st, 2017, Tricare retirees and their families witnessed a significant shift in their dental coverage as it transitioned from Metlife to United Concordia. Since then, United Concordia has been at the forefront of managing dental coverage for Tricare Retirees, along with their families and active duty members.
In this blog, we will delve into the unique features and key aspects of Tricare Retiree and Family Dental Plans under United Concordia Dental.
Tricare Retiree Dental Program (TRDP) for Sponsor and Family:
Annual Maximum and Routine Dental Services:
- The annual maximum does not apply to routine dental services such as evaluations, cleaning, and X-rays except (D0140, D1351 and D9110).
- No annual deductibles are applicable.
Alternate Benefit for Resin Restorations:
- The alternate benefit may apply to resin restorations on posterior teeth with more than three surfaces.
- Specific codes like D2394 (Posterior Composite - 4 or more surfaces) might receive alternate benefits.
Fiscal Year Coverage:
- Eligibility and accumulations operate on a fiscal year basis, running from May 1st to April 30th, deviating from the traditional calendar year.
Claim Filing Limit:
- Claim filing is limited to 12 months from the date of service.
Guidelines for Scaling and Root Planning:
- Evidence of bone loss is required for scaling and root planning procedures.
Exclusions for Impacted 3rd Molars:
- Removal of impacted third molars under the age of 15 or over the age of 30 is not covered under the plan.
Electronic Claim Submission:
- Payer ID for electronic claim submission is "89070" and "CX002".
- Claims Mailing address is "PO Box 69451 Harrisburg, PA 17106-9451".
Orthodontic Services:
- The plan covers dependent, students, and spouses up to the age of 23 for orthodontic services.
Evaluation Limits:
- Evaluations are allowed up to three in a 12-month period, with a maximum of two performed by the same dentist consecutively.
Veneer Coverage:
- Veneers are covered only for six upper and six lower anterior teeth.
Coverage Variations Based on Pay Grades:
Coverage for endodontics, periodontics, and oral surgery varies based on the sponsor's pay grade.
- E5 and above: Coverage is at 60% insurance responsibility.
- E1 through E4: Coverage is at 70% for the specified services.
Anesthesia Coverage:
- General Anesthesia (D9222, D9223) is covered at 60%, irrespective of the pay grade.
- IV Sedation (D9243, D9239) is covered at 50%.
Understanding the intricacies of Tricare Retiree and Family Dental Plans under United Concordia is crucial for maximizing the benefits and ensuring comprehensive dental care for military retirees and their families.