TRICARE Dental Program
Monthly Premiums
Monthly premium rates are based on the sponsor's military status (active duty, Selected Reserve or Individual Ready Reserve [IRR]) and type of enrollment:
- Sponsor only
- Single enrollment (one family member; does not include sponsor)
- Family enrollment (more than one family member; does not include sponsor)
- Sponsor and family
The rates listed below are for May 1, 2012 - January 31, 2013. After that, premium rates will be adjusted annually every February.
| Active Duty Family Members |
|
| Selected Reserve, IRR (Mobilization Only) & Family Members |
|
| IRR (Non Mobilization) & Family Members |
|
The Single and Family rates do not include the sponsor
Cost Shares
You'll pay cost shares for covered dental services. Cost shares will vary depending on the sponsor's pay grade and your service area: CONUS or OCONUS.
|
Covered Services |
CONUS Service Area | OCONUS Service Area | |
|
Pay Grades |
Pay Grades |
Command-Sponsored Beneficiaries1 |
|
|
Diagnostic |
0% |
0% |
0% |
|
Preventive2 |
0% |
0% |
0% |
|
Sealants |
20% |
20% |
0% |
|
Consultation/ |
20% |
20% |
0% |
|
Post-Surgical Services |
20% |
20% |
0% |
|
Basic Restorative |
20% |
20% |
0% |
|
Endodontic |
30% |
40% |
0% |
|
Periodontic |
30% |
40% |
0% |
|
Oral Surgery |
30% |
40% |
0% |
|
General Anesthesia |
40% |
40% |
0% |
|
Intravenous Sedation |
50% |
50% |
0% |
|
Miscellaneous Services(occlusal guard, athletic mouth guard) |
50% |
50% |
0% |
|
Other Restorative |
50% |
50% |
50% |
|
Implant Services |
50% |
50% |
50% |
|
Prosthodontic |
50% |
50% |
50% |
|
Orthodontic3 |
50% |
50% |
50% |
- The cost shares for OCONUS command-sponsored beneficiaries do not apply to Selected Reserve and IRR family members and IRR (other than Special Mobilization Category) members. Beneficiaries in this category are subject to CONUS cost share arrangement as noted in the two middle columns.
- Space maintainers are fully covered for patients under age 19 when involving posterior teeth. They are covered at a 20% cost share for patients under age 19 when replacing anterior teeth only. Sealants are covered at 20% as noted above.
- Orthodontic treatment is available for enrolled family members:
- Children are covered up to age 21 or 23 (based on student status, learn more)
- Spouses are covered up to age 23
- National Guard/Reserve sponsors are covered up to age 23
Dental coverage is subject to specific limitations and exclusions. Please refer to the TRICARE Dental Program Benefit Booklet for a description of covered services, schedule of benefits payable, limitations and exclusions.
Plan Maximums
The TRICARE Dental Program limits how much can be paid per enrollee for dental services. Only the allowed fee (or the dentist's actual charge if lower) less your cost share is applied against the maximum. Services received from non-network providers do not apply toward your plan maximums.
Please view the TRICARE Dental Program Benefit Booklet for a complete list of services that do not apply to your plan maximums.
- $1,300 annual maximum per contract year, May 1 - April 30 for non-orthodontic services
- $1,750 lifetime maximum for orthodontic treatment (orthodontic diagnostic services are applied to the annual maximum)
- $1,200 accidental annual maximum for costs associated with dental care provided due to an accident (injury to teeth or supporting hard and soft tissues)
Last Modified:May 31, 2012
PrintContact
TRICARE Dental Program
MetLife
CONUS: 1-855-638-8371
OCONUS: 1-855-638-8372
TDD/TTY: 1-855-638-8373
https://mybenefits.metlife.com/tricare
