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advancement instructions > TRICARE dental program > Flashcards

TRICARE dental program Flashcards

0
Q

What are the two TDP geographical service areas?

A

CONUS and OCONUS

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1
Q

The TRICARE dental program is administered by who?

A

MetLife

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2
Q

What areas are include in the TDP CONUS area?

A 
All 50 states
DC
Puerto Rico
Guam
U.S. virgin island
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3
Q

What does DEERS stand for?

A

Defense enrollment eligibility reporting systems

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4
Q

Unmarried children of active duty service members are eligible for the TDP until what age?

A

21

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5
Q

Unmarried children of active duty service members are eligible for the TDP between the ages of 21-23 if one of what two things occur?

A

Full time student and Sponser provides over 50% of the financial support

They have a disability illness or injury before they turned 21 or while the were a full time student between 21-23

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6
Q

Who can add or delete family members within DEERS?

A

Only the Sponser

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7
Q

The addition or deletion of family members require one of what four papers?

A

Marriage license
Divorce decree
Birth certificates
Death certificates

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8
Q

What are four ways a Sponser can update DEERS?

A

Website
In person at a local office
Call defense manpower
Fax

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9
Q

Are ADSM eligible for TDP?

A

No

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10
Q

Are retired service members and their families eligible for TDP?

A

No

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11
Q

Are former spouses eligible for TDP?

A

No

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12
Q

Are disabled vets eligible for TDP?

A

No

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13
Q

What are the two TDP plans?

A

Single

Family

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14
Q

Children under what age maybe volunteered to enroll in TDP but is not automatic?

A

4

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15
Q

If there is an existing family plan in effect, children will be automatically enrolled when?

A

First day of the month that they turn 4

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16
Q

What is the required method of payment for ongoing TDP coverage?

A

Payroll allotment

17
Q

If initial payment to metLife is submitted prior to what day, coverage will start the first day of the next month?

A

20th

18
Q

Sponsors who fail to pay premiums will be locked out for how long?

A

12 months

19
Q

If the Sponsor dies, the surviving spouse and children are eligible for TDP survivor benefits for how long?

A

3 years

Children same age rules apply

20
Q

If the spouse is not enrolled in the TDP at time of sponsors death are they eligible for TDP survivor benefits?

A

Yes they can enroll at any time

21
Q

The government will pay what percent of the premiums of the TDP survivors benefits?

A

100%

22
Q

What program are spouses of deceased Sponser eligible for after the three years of TDP survivors benefits?

A

TRICARE retiree dental program

23
Q

What is the form DD form 2813?

A

DOD active duty/reserve forces dental exam form

24
Q

Do reservist and national guard need to pay for their annual screening?

A

No

25
Q

MetLife recommends that your dentist submit a predetermination request when the cost is expected to be above what price?

A

$300

26
Q

What happens if you use a no -network dentist?

A

You have to pay the difference from what MetLife wont pay

Also they might not submit your claim on your behalf

27
Q

What is the premium share for family members of ADSM?

A

60% government

40% beneficiary

28
Q

If the Sponser has a military payroll account, and if sufficient funds are available the government will collect the sponsor’s share of the premium through what?

A

Uniformed service finance center

29
Q

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

A

$1,300

30
Q

What are the dates for the plan years?

A

1 may till 30 April

31
Q

What is the lifetime max benefits for orthodontic treatment per beneficiary?

A

$1,750

32
Q

In addition to the annual maximum, there is an accidental annual max. What is it?

A

$1,200

33
Q

How many routine prophylaxis visits are covered in a consecutive 12 month period?

A

2

Unless pregnancy then you must document it and you get a third visit

34
Q

Adult prophylaxis will be allowed on patients what age or older?

A

13

35
Q

How many topical fluoride applications are allowed in a 12 months period?

A

2

36
Q

Sealants are only covered on what teeth?

A

Permanent molars

37
Q

Who is eligible for orthodontic treatment?

A

Family members non-spouse with same age requirements as everything else

Spouses till age 23

38
Q

Claims submitted how many months after service will be denied?

A

12

39
Q

If a beneficiary receives treatment from. MetLife approved dentist who will MetLife pay?

A

The dentist. The dentist will then bill the pt for the difference

40
Q

If a beneficiary receives treatment from a non-MetLife dentist who will MetLife pay?

A

The beneficiary

41
Q

What are the three levels of appeal?

A

Reconsideration
Formal review
Hearing

advancement instructions (55 decks)

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