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Fact Sheets For

 

Medical and Dental Care for Reserve Component Members and Their Families

 

The TRICARE Dental Program

 

Office of Communications Communications and Customer Service TRICARE Management Activity

Skyline 5, Suite 810, 5111 Leesburg Pike Falls Church, VA  22041-3206

(703) 681-1775 www.tricare.osd.mil/factsheets/

TRICARE Management Activity

Fact Sheet

   

 

Effective Nov. 6, 2003, TRICARE eligibility was temporarily extended to 180 days under the Transitional Assistance Management Program (TAMP).

Updated March 8, 2004

Medical and Dental Care for Reserve Component Members and Their Families

 

Members of the Reserve Component who are called to active duty for more than 30 days are eligible for TRICARE, the same as any active duty service member. Families of these individuals also become eligible for TRICARE if the sponsor is called to active duty for more than 30 days. To ensure family members are eligible for TRICARE upon activation, sponsors should register their family members in the Defense Enrollment Eligibility Reporting System (DEERS).*


TRICARE for a Reserve Component Military Sponsor:

Members of the Reserve Component are entitled to medical care in any uniformed services military treatment facility (MTF) for any injury, illness or disease incurred or aggravated in the line of duty. When activated for more than 30 days, members of the Reserve Component become eligible for TRICARE Prime. All care should be sought from an MTF or TRICARE network provider. When the sponsor is no longer on active duty orders, TRICARE eligibility ends; however, line-of-duty care may be received in an MTF for injuries or illnesses incurred while the sponsor was on active duty.  Members ordered to active duty in support of a contingency operation and their family members may be eligible for transitional health care for 60 or 120 days, depending on their total active federal military service.  Under the temporary extension, these members and their families are eligible for health care for 180 days.


TRICARE for Families of Activated Members of the Reserve Component:

Family members of Reserve Component members become eligible for TRICARE Extra and TRICARE Standard on the first day of the military sponsor’s active duty if his or her orders are for more than 30 consecutive days or if the orders are for an indefinite period. They also become eligible for the TRICARE Pharmacy Program* and may have prescriptions filled at MTF pharmacies, through the TRICARE Mail Order Pharmacy or at retail pharmacies.

 

Eligible family members may enroll in TRICARE Prime if their sponsor is called to active duty for more than 30 days.  If eligibility criteria are met, eligible family members may enroll in TRICARE Prime Remote for Active Duty Family Members.  There are no enrollment fees or copayments for family members, but enrollment forms must be completed, and MTFs or TRICARE Prime network providers must be used. Many Reserve Component families may have continuing relationships with providers who are not in the TRICARE Prime network. In these cases, enrolling in TRICARE Prime may not be the best choice—instead, using TRICARE Standard can be the most flexible and economical option, even though beneficiaries must pay a share of the cost of health care.


 

TRICARE Dental Program (TDP)*:

Members of the Selected Reserve and Individual Ready Reserve and/or their eligible family members may enroll in the TDP. Reserve Component members who are ordered to active duty for more than 30 consecutive days are eligible for military dental care, the same as active duty service members, and are automatically disenrolled from the TDP if previously enrolled.  Reservists leaving active duty status (who were previously enrolled) are automatically reenrolled in the TDP.  However, coverage is not reflected in DEERS until the month following deactivation.  Reservists should ensure coverage is in effect by contacting the TDP Administrator, United Concordia Companies, Inc. (UCCI), at 1-800-866-8499.  If the reservist does not ensure coverage is in effect and obtains dental care prior to the date of coverage as shown in DEERS, United Concordia will automatically deny the claim.  Reservists receiving a claims denial for services rendered between the time they are deactivated and the time coverage takes effect should contact the United Concordia claims department and have their claim reprocessed.  The TDP requires a minimum 12-month enrollment period; however, that commitment is waived for families of reservists called to active duty for certain contingency operations, if they apply for the TDP within 30 days of entry on active duty.


Benefits Available During Demobilization:

Reserve Component members ordered to active duty for more than 30 days in support of a contingency operation (does not include full-time National Guard Duty) are entitled to transitional health care upon separation.  They are also entitled to dental care in military dental treatment facilities on a space-available basis with the same priority for care as active duty family members.   Family members are not eligible for transitional dental benefits, but they are eligible for dental benefits under the TDP. Members separated with fewer than six years of total active federal military service (as indicated on the DD 214) and eligible family members are eligible for 60 days of transitional health care. Members separated with six years or more of total active federal military service and their eligible family members are eligible for 120 days of transitional health care.

 

Reserve Component members are eligible for the Continued Health Care Benefit Program (CHCBP) when they lose military health benefits and their transitional health care benefit period has expired. They also may enroll their family members for this coverage. CHCBP provides benefits similar to TRICARE Standard for a specific time (up to 18 months for members and their family members). They must enroll within 60 days of the date that their transitional benefit period expires and pay quarterly premiums ($933 per individual, $1,966 per family). For more information about CHCBP, individuals may call toll free 1-800-444-5445, visit on-line at www.humana-military.com or write to Humana Military Healthcare Services, Attn: CHCBP, P.O. Box 740072, Louisville, KY 40201.


When a Reserve Component Sponsor Retires:

When Reserve Component members retire, they do not become eligible for TRICARE or space-available care in an MTF until they reach age 60 or are receiving retired pay. At that time, they and their family members may enroll in TRICARE Prime, or they may use TRICARE Extra or TRICARE Standard. Retired Reserve Component members also become eligible for TRICARE For Life when they become eligible for Medicare at age 65 and enroll in Medicare Part B. In addition, retired Reserve Component members, and their spouses and dependent children are eligible for the TRICARE Retiree Dental Program, regardless of the sponsor’s age and whether the sponsor is receiving retired pay.

 

For more information about medical care, dental care and other benefits for Reserve Component members and their eligible family members, interested parties may visit the TRICARE Web site at www.tricare.osd.mil/reserve/. More information about the TRICARE Dental Programs is available on the TRICARE Dental Program Web site at www.ucci.com/tdp/tdp.html and the TRICARE Retiree Dental Program Web site at www.ddpdelta.org.

 

 

*See also:
TRICARE Eligibility Fact Sheet
TRICARE: The Basics Fact Sheet
TRICARE Reserve Family Member Demonstration Project Fact Sheet
The Defense Enrollment Eligibility Reporting System Fact Sheet
TRICARE Pharmacy Program Fact Sheet
TRICARE Dental Program Fact Sheet

TRICARE Dental Program Survivor Benefit Fact Sheet

 

 

TRICARE Management Activity

Fact Sheet

   

 

Updated March 16, 2004

The TRICARE Dental Program

 

The TRICARE Dental Program (TDP) was implemented on Feb. 1, 2001. The TDP is a voluntary dental insurance program that is available to eligible Active Duty family members, Selected Reserve and Individual Ready Reserve (IRR) members, and their eligible family members. The TRICARE Retiree Dental Program is a separate program.*

Dental Coverage:

  • The TDP covers a wide range of diagnostic, preventive and restorative services—dental X-rays, examinations, cleanings, fluoride applications, sealants, fillings, root canals, crowns, etc.

  • Benefit package includes general anesthesia coverage when provided in connection with a covered benefit. Dentists or other professional providers must be licensed and approved to provide anesthesia in the state where the service is rendered.

  • Maximum annual benefit coverage is $1,200 for all routine dental care. The maximum lifetime orthodontic benefit coverage is $1,500.

  • Enlisted members in pay grades E-1 to E-4 have reduced cost-shares for certain procedures.

    

Eligibility:    Family members of all active-duty uniformed services members, Selected Reserve (SELRES) and Individual Ready Reserve (IRR) members and/or their families may enroll in the TRICARE Dental Program. Sponsors must have at least 12 months remaining of their service commitments at the time they or their families enroll. The 12-month enrollment commitment is waived for families of Reservists called to active duty for certain contingency operations if they apply for TDP within 30 days of entry on active duty. 

    

Eligibility is determined based on the service member’s military personnel information residing in the Defense Enrollment Eligibility Reporting System (DEERS). The uniformed services personnel office reports the information to DEERS.

    

Active duty personnel are not eligible for the TRICARE Dental Program. They receive dental care from military dental treatment facilities. Reservists who are ordered to active duty for a period of more than 30 consecutive days have the same benefits as active-duty service members.

 

* Additional information pertaining to reservists and their families can be found in the Medical and Dental Care for Reserve Component Members and their Families Fact Sheet

    

Former spouses, parents, parents-in-law, disabled veterans, foreign military personnel, and uniformed services retirees and their families are not eligible for the TRICARE Dental Program.

    

Enrollment:    Enrollment in the TDP is handled by United Concordia Companies, Inc. (UCCI), the TDP contract administrator. Enrollment/Change applications are available by calling UCCI at 1-888-622-2256. Online enrollment is available at www.ucci.com.

    

The enrollment application must be received by UCCI not later than the 20th day of the month for coverage to begin on the first day of the next month. UCCI is required to complete the enrollment process online real-time to the DEERS database. If UCCI receives the application after the 20th day of the month, coverage may not begin for two months. Incorrect eligibility information being provided to DEERS will cause applications to be denied. Enrollment options are available at www.ucci.com.

 

Once enrolled, members must stay in the TRICARE Dental Program for at least 12 months (with certain exceptions, such as loss of DEERS eligibility because of divorce, marriage of a child, etc.).  After 12 months, enrollment continues on a month-to-month basis.  The sponsor must contact UCCI to disenroll from the TDP.

 

The first month’s premium is due upon enrollment. The premium amount is shown on the enrollment form. After the first month, monthly premiums may be paid by payroll allotment, or, in some cases, may be billed directly to the member by UCCI.

 

Costs to the Beneficiary:

Beneficiary Category

Costs

 

Feb 1, 2004-Jan 31, 2005

Active duty family members and family members of Selected Reserve and Individual Ready Reserve (IRR) (Special Mobilization Category) sponsors on Active Duty orders for greater than 30 days

  • Single enrollment, $9.07

  • Family enrollment, $22.66

Selected Reserve or Individual Ready Reserve (IRR) (Special Mobilization Category) sponsor

  • Single enrollment, $9.07

Family members of Selected Reserve or IRR (Special Mobilization Category) sponsors not on orders for greater than 30 days

IRR (other than Special Mobilization Category) sponsors and their family members

  • Single enrollment, $22.68

  • Family enrollment, $56.66

For more information about the TDP, beneficiaries may access the benefit handbook online at www.ucci.com or by calling toll-free 1-800-866-8499, 24 hours a day. Members residing outside the continental U.S. (OCONUS) should call 1-888-418-0466 (toll-free). This number is available in the following countries: Australia, Bahrain, Belgium, Bolivia, Columbia, Egypt, Germany, Greece, Iceland, Italy, Japan, Netherlands, Norway, Panama, Portugal, Saudi Arabia, South Korea, Spain, Switzerland, Turkey and the United Kingdom. At all other locations, members should call 1-717-975-5017. Representatives are available to assist members in English, German and Italian 24 hours a day, Monday through Friday.

 

*See also: 

Medical and Dental Care for Reserve Component Members and Their Families Fact Sheet  
TRICARE Dental Program Survivor Benefit Fact Sheet

 

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