ENLISTED ADVANCEMENT REVIEW COURSE e4-e7 TOPIC : TRICARE DENTAL PROGRAM FACILITATOR : HM1 (SW) Sudduth PHONE/E-MAIL : 532-9109 / valerie.sudduth@med.navy.mil

Who Is Eligible for the TDP? Family members of active duty, National Guard, and Reserve service members Includes spouses and unmarried children (including stepchildren, adopted children, and wards) under the age of 21. full-time students enrolled at an accredited college or university and they are more than 50-percent dependent on the sponsor for financial support.

Who Is Eligible for the TDP? National Guard and Reserve service members Members of the Individual Ready Reserve (IRR) and the Selected Reserve of the Ready Reserve may enroll in the TDP when they are not on active duty orders for a period of more than 30 consecutive days. Any National Guard or Reserve member who is called or ordered to active duty for a period of more than 30 consecutive days receives the same benefits as an ADSM and cannot be enrolled in the TDP.

Verification of Eligibility MetLife verifies member eligibility through DEERS. Only the sponsor can add family members to or delete them from DEERS

Individuals Who Are Not Eligible for TDP Coverage Active duty service members, including National Guard and Reserve members called or ordered to active duty for more than 30 consecutive days Retired service members and their families Former spouses Parents and parents-in-law Disabled veterans Foreign military personnel Service members in the Transitional Assistance Management Program (TAMP) following activation for a contingency operation

Enrollment Options Single Enrollment Family Enrollment

Enrollment Period All beneficiaries must remain enrolled in the TDP for at least 12 months, unless the termination of enrollment request qualifies as an exception After completing the 12-month minimum-enrollment period, enrollment may be continued on a month-to-month basis until an enrollment termination request is made by the sponsor.

Enrollment Sponsors who fail to pay premiums will be locked out for 12 months before they can request reenrollment. If there is an existing family plan in effect, children will be automatically enrolled on the first day of the month following the month in which they reach age 4.

Effective Date of Coverage When MetLife receives a request for enrollment, an inquiry will be made to DEERS to confirm eligibility. If eligibility is confirmed, the appropriate initial premium payment is received, and the request for enrollment contains all necessary information, MetLife will enroll you and/or your family members in the TDP.

Effective Date of Coverage cont. If initial payment is received by the 20th of the month, coverage will be processed for the first day of the month following the date of receipt. If the initial premium payment is received after the 20th of the month, coverage will be processed for the first day of the second month after receipt of the documents.

Effective Date of Coverage cont. For example: If the initial premium payment is received by May 20, coverage will be effective June 1. If the request for enrollment and initial premium payment are received May 21 through June 20, coverage will be effective July 1.

Enrolling MetLife provides you with three convenient options for adding or deleting family members: Online: www.tricare.mil/bwe Mail It Telephone

Disenrolling from the TDP You must remain enrolled in the TDP for a minimum of 12 months. You may choose to disenroll from the TDP once you meet your 12-month initial enrollment period or if you have a valid reason to disenroll.

TDP Survivor Benefit When a sponsor dies, the surviving spouse and children are eligible for the TDP Survivor Benefit. Spouses are eligible for three years beginning on the date of the sponsor’s death. Children remain eligible until age 21, or age 23 if enrolled in a full-time course of study at an approved institution of higher learning

TDP Survivor Benefit There is no requirement for surviving beneficiaries to have been enrolled in the TDP at the time of their sponsor’s death. The TDP Survivor Benefit also applies to family members of the Selected Reserve of the Ready Reserve and IRR (special mobilization category), regardless of whether the sponsor was on active duty orders or enrolled in the TDP at the time of his or her death.

Costs and Fees Premiums: ADFM, AD National Guard and Reserve : 60% Government/40% Member Cost Share Selected Reserve and IRR (Special Mobilization Category) Members IRR (other than Special Mobilization Category) Members 100 % Member Cost Share Eligible Survivors 100% Government

Annual Maximum Benefit There is a $1,300 annual maximum benefit per beneficiary, per plan year for non-orthodontic services. Each plan year begins May 1 and ends 17 April 30.

Lifetime Maximum Benefit for Orthodontic Treatment For orthodontic treatment, there is a $1,750 OLM benefit per beneficiary. Orthodontic diagnostic services will be applied to the $1,300 dental program annual maximum.

Claim-Filing All premium payments must be paid to date in order for claims to be processed for payment. If the premiums are not current, it will result in the delay or denial of claims. Claims submitted for payment more than 12 months after the month in which a service is provided are not eligible for payment.

General Policies Services must be necessary and meet accepted standards of dental practice. Medical procedures, as well as procedures covered as adjunctive dental care under TRICARE/Medical policy, are not covered under the TDP.

General Policies Services, including evaluations, that are routinely performed in conjunction with, or as part of, another service are considered integral. Participating dentists may not bill patients for denied services if they are considered integral to another service.

Questions