TRICARE DENTAL (08-2012), TRICARE DENTAL PROGRAM BENEFIT BOOKLET

Question 1

What is the TRICARE Dental Program(TDP) administered by?

Answer 1

MetLife

Question 2

How many geographical service areas is the TRICARE Dental Program (TDP) divided into?

Answer 2

2

Question 3

Which system is used to confirm TRICARE Dental Program (TDP) eligibility?

Answer 3

Defense Enrollment Eligibility Reporting System (DEERS)

Question 4

Family members of active duty service members (ADSMs) including unmarried children until reaching which age are eligible to enroll in TRICARE Dental Program (TDP) ?

Answer 4

21

Question 5

Family members of active duty service members (ADSMs) including unmarried children until reaching which age are eligible to enroll in TRICARE Dental Program (TDP) if enrolled in a full-time course of study at an approved institution of higher learning, and if the sponsor provides over 50 percent of the financial support?

Answer 5

23

Question 6

A family enrollment is defined as how many or more covered family members?

Answer 6

2

Question 7

Children under which age may be voluntarily enrolled at any time into the TRICARE Dental Program (TDP)?

Answer 7

4

Question 8

All beneficiaries must remain enrolled in the TRICARE Dental Program (TDP) for at least how many months?

Answer 8

12

Question 9

If an Active Duty Service Member (ADSM) transfers with TRICARE Dental Program (TDP) - enrolled family members to a duty station where space-available dental care is available at the local Dental Treatment Facility (DTF), the ADSM may choose to terminate enrollment for his or her family members from the TDP within how many calendar days of the transfer?

Answer 9

90

Question 10

If you fail to pay your TRICARE Dental Program (TDP) monthly premium(s), your TDP enrollment will be terminated. You will be prohibited from reenrolling in the program, or “locked out”, for how many months following the last month that premiums were paid?

Answer 10

12

Question 11

When a sponsor dies, the surviving spouse and children are eligible for the TRICARE Dental Program (TDP) Survivor Benefit. Spouses are eligible for how many years beginning on the date of the sponsor’s death?

Answer 11

3

Question 12

How often does the Department of Defense require all National Guard and Reserve members to undergo dental examinations?

Answer 12

Annually

Question 13

Which form will be used to assist TRICARE Dental Program (TDP) -enrolled National Guard and Reserve members in documenting dental health?

Answer 13

DD FORM 2813

Question 14

National Guard and Reserve sponsors are eligible to enroll in the TRICARE Dental Program (TDP) when they are not on active duty for more than how many consecutive days?

Answer 14

30

Question 15

Which type of dentist has signed a contractual agreement with MetLife to follow TRICARE Dental Program (TDP) rules for providing care and accepting payments?

Answer 15

Preffered Dentist Program (PDP)

Question 16

When using a Preferred Dentist Program (PDP) dentist, you should never pay more than the applicable cost-share for covered services subject to applicable maximums, limitations, and exclusions. MetLife recommends that you have your dentist submit a predetermination request when the cost is expected to be above which amount?

Answer 16

$300

Question 17

You will be able to seek care from a non-PDP dentist and MetLife will pay the claim for that particular procedure in a manner that limits your out-of-pocket costs to approximately what they would be from a Preferred Dentist Program (PDP) dentist if MetLife is unable to schedule an appointment within how many days?

Answer 17

21

Question 18

What is the annual maximum benefit per beneficiary, per plan year for non-orthodontic services?

Answer 18

$1,300

Question 19

What is the Orthodontic Lifetime Maximum (OLM) benefit per beneficiary for orthodontic treatment?

Answer 19

$1,750

Question 20

Claims submitted for payment more than how many months after the month in which a service is provided are not eligible for payment?

Answer 20

12

Question 21

How many oral evaluations (D0120, D0150, or D0180) are covered in a consecutive 12-month period?

Answer 21

3

Question 22

Comprehensive evaluations (D0150) are only eligible for new patients, on an exception basis, by report, for patients who have had a significant change in health conditions or other unusual circumstances, and for patients who have not had an oral evaluation within the previous how many months from the same office?

Answer 22

36

Question 23

How many comprehensive periodontal evaluations (DO180s) will be allowed per patient per consecutive 12-month period per office?

Answer 23

1

Question 24

Panoramic and full mouth X-rays are not routinely covered for patients under which age unless approved by MetLife ?

Answer 24

5

Question 25

How many routine prophylaxes are covered in a consecutive 12- month period?

Answer 25

2

Question 26

How many months from the date of finalization are TRICARE Dental Program (TDP) predeterminations valid for?

Answer 26

12

Question 27

If a patient or participating dentist disagrees with MetLife’s benefit decision may be eligible for an appeal. How many levels of appeal are there?

Answer 27

3

Question 28

Patients may request a formal review from TRICARE Management Activity (TMA) if they disagree with MetLife’s reconsideration and if the amount remaining in dispute is which amount or more?

Answer 28

$50

Question 29

A request for a formal review must be postmarked or received by the TRICARE Management Activity (TMA) within how many days from the date of the reconsideration determination?

Answer 29

60

Question 30

If a patient disagrees with the formal review decision from TRICARE Management Activity (TMA) and the amount in dispute is at least which amount or more, he or she may request a hearing with TMA?

Answer 30

$300

Question 31

What is an alloy that is typically composed of mercury,silver,tin, and copper along with other metallic elements added to improve physical and mechanical properties used in direct dental restorations?

Answer 31

Amalgam

Question 32

What is the professional association of dentist committed to the public’s oral health, ethics, science, and professional advancement; leading a unified profession through initiatives in advocacy, education, research, and the development of standards?

Answer 32

American Dental Association (ADA)

Question 33

Which system serves as a centralized Department of Defense data repository of personnel and health care benefits distributed to uniformed services members?

Answer 33

Defense Enrollment Eligibility Reporting System (DEERS)

Question 34

Endodontic Exclusions involve the treatment of diseases of the dental pulp (never tissue) or injuries that affect the root tip or nerve of the tooth (apex). What is the most common procedure that you will deal with?

Answer 34

Root canal

Question 35

What is the relationship between the teeth in the upper and lower arches at rest position?

Answer 35

Occlusion

Question 36

What is the ideal interval between prophylaxis treatment (prophys)?

Answer 36

Semi-annually

Question 37

What is MetLife’s fraud and abuse investigation department for reporting suspected fraud if a beneficiary believes a dentist or entity received insurance money through the submission of a false claim?

Answer 37

Special Investigations Unit (SIU)

Question 38

Which program provides dental care for uniformed services members who are entitled to retirement pay, members of the Retired Reserve under age 60, Congressional Medal of Honor recipients, un-remarried surviving spouses, and certain other eligible family members?

Answer 38

TRICARE Retiree Dental Program (TRDP)