Frequently Asked Questions
Click on the topic below that most closely relates to your question to reveal the corresponding FAQ’s. As always, if you need additional information, please contact us.
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- Q. Does the TRICARE Dental Program (TDP) offer orthodontic coverage in the OCONUS service area?
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A. Yes. The TDP offers orthodontic services for children up to age 21 (or age 23 if enrolled full-time in a college/university) and for active duty family member spouses and National Guard and Reserve members and their spouses under the age of 23. Coverage is effective until the end of the month in which the member reaches the applicable age limit, regardless if the treatment has been completed.
National Guard and Reserve members are encouraged to consult with their commanders before receiving orthodontic care to ensure compliance with service policies as orthodontic appliances could affect dental readiness. If advised to remove the orthodontic appliances, the removal charges are not covered by the TDP.
- Q. Is OCONUS orthodontic coverage different than coverage in the CONUS service area?
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A. No. Orthodontic coverage is the same in both service areas, but how you access the care is different. For details about covered orthodontic services and limitations, see the TRICARE Dental Program Handbook.
- Q. Where can I obtain orthodontic services in the OCONUS service area?
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Before any orthodontic care, the TAO or designated OCONUS POCs must issue an initial NARF for an orthodontic examination and treatment plan authorizing the beneficiary to seek orthodontic care from an OCONUS orthodontist. Please reference the TOPD list that includes orthodontists for availability in your area. A listing of the TOPDs is maintained for your convenience and can be found online at www.uccitdp.com. However, you are free to seek care from any licensed and authorized dentist (orthodontist).
- Q. What will I pay out-of-pocket for orthodontic care?
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A. You must pay a 50 percent cost-share of the TDP-allowed amount. There is a lifetime maximum of $1,750 - this is the most that United Concordia will pay for orthodontic services. The Government will pay any difference between the remaining 50 percent and the $1,750 lifetime maximum, as well as any difference between the provider's charge and United Concordia's allowance. After the lifetime maximum is reached and the government has paid its portion, you would be responsible for any additional orthodontic charges or services. In OCONUS communities, you may be required to pay up front and file a claim with United Concordia for reimbursement. Sample payment example is below:
Example: The total fee charged by a dentist (orthodontist) is $5,000 and the United Concordia allowed fee is $4,000:
1. United Concordia will pay the dentist directly in one lump sum. That portion of the payment that relates to charges in excess of the allowed fee and orthodontia lifetime maximum is paid by United Concordia which, in turn, is reimbursed by the government.Result Calculation United Concordia payment = $3,000 $4,000 x 50% = $2,000 plus $1,000 (amount of dentist actual fee in excess of allowed fee) Beneficiary out-of-pocket cost = $2,000 $4,000 x 50% = $2,000 - Q. What do I need to do after receiving an initial orthodontic evaluation?
- A. Send the following information to United Concordia:
- Initial NARF (for the initial orthodontic exam and diagnostic services)
- TDP OCONUS claim form
- Provider's bill
- Final NARF (The orthodontic treatment plan must be submitted for payment with the final NARF, showing approval of the treatment before the treatment is started.)
- Q. What if I move to the CONUS service area and I still need orthodontic care?
- A. No problem. You can transfer to a new orthodontist when you move to the CONUS service area. Payments are calculated based on the remaining orthodontic maximum. Because OCONUS orthodontic treatment is paid in one lump sum, your lifetime maximum may be exhausted before the orthodontic treatment is completed. If so, you are responsible for the full amount for orthodontic services received after the maximum is met.
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Q. I’m at the dentist’s office and just learned I’m not enrolled in the TDP. Can I enroll and get treated today?
- A. Prospective TDP members should schedule their first covered dental appointment for a day when coverage is in effect, not the same day they enroll or pay their first premium. The start of the TDP’s coverage period depends on the start and end of the TDP billing cycle. If you enroll in the TDP by the 20th, for example, coverage would begin the first day of the following month. if you enroll after the 20th, your TDP coverage begins the first day of the second month.
- Q. What if I still have questions?
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A. You can call the TDP OCONUS customer service department 24 hours a day, Monday through Friday toll-free at 1- 844-653-4060 (access the AT&T toll-free dialing instructions here). You can also submit your question online.
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- Q. How do I determine if I am eligible for enrollment in the TRICARE Dental Program (TDP)?
- A. Family members of active duty members, Selected Reserve and Individual Ready Reserve sponsors and their families are eligible for the TDP. Before enrollment can be completed, United Concordia must confirm eligibility for coverage with DEERS (Defense Enrollment Eligibility Reporting System). It is extremely important that DEERS contains up-to-date information on each family member. If the information in DEERS does not match the information you provide during the enrollment process, enrollment in the TDP may be denied or delayed.
- Q. How can I update my eligibility, address and other information with DEERS?
- A. Sponsors or registered family members may make address and contact information changes, but only the sponsor can add or delete family members within DEERS or the Beneficiary Web Enrollment (BWE) Web site. (The BWE portal is accessible at www.tricare.mil/bwe). The addition or deletion of family members requires proper documentation such as a marriage certificate, divorce decree, and/or birth certificate that can be accomplished by the sponsor at an ID card facility or through a copy of a notarizedDEERS form that is provided to theDEERS office. You may update your DEERS information in one of the following ways:
- Online at https://myaccess.dmdc.osd.mil/identitymanagement/app/login. This method is a quick and easy way to update address and contact information.
- Visit a local personnel office that has a uniformed services ID card facility or a Real-time Personnel Identification System (RAPIDS) office. You can locate your nearest RAPIDS office via the RAPIDS Site Locator. Be sure to call ahead for hours of operation and other instructions.
- In Person by visiting a local personnel office that has a uniformed services identification (ID) card-issuing facility. To locate the nearest facility, visit www.dmdc.osd.mil/rsl. Please call ahead for hours of operation and for detailed instructions.
- Call the Defense Manpower Data Center Support Office at 1-800-538-9552. Hours of operation are Monday–Friday, 5:00 a.m.–5:00 p.m. (PT), except on federal holidays.
- Fax changes to DEERS at 1-800-336-4416. The sponsor’s Department of Defense Benefits Number and/or Social Security number must be included with the faxed documents.
- Mail changes to:
Defense Manpower Data Center Support Office
Attn: COA
400 Gigling Road
Seaside, California 93955-6771
- Q. Is an active duty service member eligible for the TRICARE Dental Program?
- A. Active duty service members are not eligible for the TDP. Active duty service members receive dental care through the Active Duty Dental Program (ADDP), which is also administered by United Concordia. For more information on the ADDP, visit addp-ucci.com.
- Q. Are retired military members eligible for the TRICARE Dental Program?
- A. Retirees are not eligible for the TDP. However, retirees may be eligible for the Federal Employee Dental and Vision Insurance Program (FEDVIP). For more information, you can visit our website at https://www.uccifedvip.com/fedvip/home/ or by visiting BENEFEDS' website at https://www.benefeds.com/.
- Q. Are children under 1 year old eligible for enrollment?
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A. Children under 1 year old may be voluntarily enrolled at any time. However, these children can be excluded from enrollment at the discretion of the sponsor if there is only one member of the family age 1 or older enrolled.
Note: Dentists' recommendations are for all children to have their first dental examination by age one.
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- Q. How long must I remain enrolled?
- A. By enrolling in the TRICARE Dental Program, the sponsor agrees to remain enrolled for a minimum of 12 months. After completion of the initial 12-month enrollment period, coverage will continue on a month-to-month basis.
- Q. Can I enroll only one of my family members?
- A. A sponsor must enroll all eligible family members that are at least one year old and reside at the same address. If an enrollment request is received for only one family member and DEERS (Defense Enrollment Eligibility Reporting System) indicates that other eligible family members live at the same address, the enrollment request will be rejected.
- Q. Why does the enrollment form ask if the sponsor intends to remain in the service for 12 months?
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A. The TRICARE Dental Program (TDP) requires that the sponsor and/or family members remain enrolled for a minimum of 12 months. Therefore, the sponsor must have at least 12 months remaining on his or her service commitment. If the sponsor does not have 12 months remaining on the current service commitment, enrollment can only be processed if the member indicates his or her intent to remain in the service after the end of the current service commitment. This 12-month period may be a combination of active duty and reserve status.
Note: If the sponsor's military status changes during the enrollment period, the premium rate will change accordingly.
- Q. I enrolled through milConnect. How do I know if it was successful?
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A. If you receive a confirmation page after you complete the online enrollment, your application has been successfully submitted to United Concordia. Please print the page and keep it for your records. Successfully submitting the enrollment form does not guarantee that you will be enrolled. If you include an e-mail address with your application, you will receive e-mail notification when the form approved or rejected. Enrollment is not immediate.
An identification card will be issued by the government that will confirm the effective date of coverage. Any dental treatment provided prior to the effective date of coverage will not be considered for payment by United Concordia. Please do not seek dental treatment without first confirming enrollment.
- Q. When does my coverage start?
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A. When United Concordia receives a request for enrollment, a query will be made to DEERS to confirm eligibility. If eligibility is confirmed, the appropriate initial premium payment is received and the form is completed, United Concordia will enroll you and/or your family members in the TDP. If the TDP Enrollment Form and the initial payment are received by the 20th of the month, coverage will be processed for the first day of the following month. If the TDP Enrollment Form and initial premium payment are received after the 20th of the month, coverage will be processed for the first day of the second month.
- Q. My policy is not yet in effect, but I need emergency dental treatment. Will United Concordia cover this visit?
- A. Services provided prior to the effective date of coverage cannot be covered by United Concordia. The sponsor will be responsible for full payment to the provider for any services provided prior to the effective date of coverage.
- Q. Will each family member receive a separate United Concordia Dental ID card?
- A. No. Our identification cards are issued in the contract holder’s name only. This card should be used by all dependents enrolled under the member’s contract which can be found on the back of your ID card.
- Q. I'm at the dentist's office and just learned I'm not enrolled in the TDP. Can I enroll and get treated today?
- A. Prospective TDP members should schedule their first covered dental appointment for a day when coverage is in effect, not the same day they enroll or pay their first premium. The start of the TDP’s coverage period depends on the start and end of the TDP billing cycle. If you enroll in the TDP by the 20th, for example, coverage would begin the first day of the following month. if you enroll after the 20th, your TDP coverage begins the first day of the second month.
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- Q. Is the National Guard/Reserve sponsor included in the family plan?
- A. The sponsor is not considered part of a family plan. The sponsor may be enrolled even if the family is not enrolled. The sponsor must choose to enroll himself or herself and will have a separate monthly premium and 12-month minimum enrollment commitment.
- Q. What happens if I enroll myself while on reserve status and I'm called to active duty?
- A. National Guard/Reserve sponsors are eligible to enroll in the TDP when they are not on active duty for more than 30 consecutive days. If a National Guard/Reserve sponsor enrolled in the TDP is called or ordered to active duty for more than 30 consecutive days, he or she will automatically be disenrolled from the program during the period of activation and automatically re-enrolled upon deactivation.
- Q. What happens if I enroll my family while on active orders and then I'm deactivated for non-contingency reasons?
- A. If a National Guard/Reserve sponsor enrolls the family member(s) while on active orders and is then deactivated, the family will remain enrolled in the TDP. The premiums will automatically change to the higher reservist rate. The sponsor then has the option to enroll. The sponsor must submit a completed enrollment form and initial premium payment in order to obtain coverage. The sponsor will be required to complete the minimum 12-month enrollment period.
- Q. I was activated for a contingency operation and enrolled my family in the TDP. How does my deactivation affect their enrollment?
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A. If a sponsor is activated in support of certain contingency operations and enrolls the family members within 30 days of the active duty start date, the family members will be automatically disenrolled from the TDP upon the sponsor's deactivation. The sponsor must contact United Concordia if he/she wishes to re-enroll in the TDP.
If a sponsor is activated in support of certain contingency operations and enrolls the family members more than 30 days after activation, the family members must complete the 12-month minimum TDP enrollment requirement.
- Q. I'm a National Guard & Reserve sponsor and am enrolled in the TRICARE Dental Program (TDP). I'm about to be activated. Do I need to disenroll from the TDP since I'll be eligible for active duty dental benefits?
- A. No, National Guard & Reserve sponsors who are enrolled in the TDP and who will be activated for 31 days or more are automatically disenrolled from the TDP. They will be automatically re-enrolled upon deactivation.
- Q. I'm about to deploy and have enrolled my family in TRICARE medical. Isn't dental included in the medical coverage?
- A. No, TRICARE medical and dental are two different programs. You must enroll in each separately.
- Q. What type of dental coverage is available for my family members once I'm activated?
- A. Family members of National Guard & Reserve sponsors are eligible for the TDP whether the sponsor is activated or not. The TDP provides a comprehensive dental benefit that is comparable to civilian dental insurance plans. View our Benefits Section
- Q. Can my family enroll themselves in the TDP?
- A. The sponsor must enroll family members unless he/she has signed a Power of Attorney (POA) allowing family members to enter into contracts. The POA must be provided with the enrollment form.
- Q. When is TDP dental coverage effective?
- A. If the enrollment form and first month's premium are received by the 20th of the month, coverage begins the first of the following month.
- Q. My family is already enrolled in the TDP. Are there any changes once I'm activated?
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A. Yes. If you are activated for 31 days or more, your family's monthly premiums will be reduced since the Department of Defense pays 60% of monthly premiums for active duty family members. National Guard & Reserve family members whose sponsors are activated for 31 days or more are considered active duty family members, and therefore receive the reduced premium rate.
Premiums for active duty family members are paid via military allotment from the sponsor's pay and will be reflected on the payroll.
Upon deactivation, your family will revert to the National Guard & Reserve family member premium rate (no government participation).
- Q. My family wasn't enrolled in the TDP prior to my activation. Are there any time limitations regarding enrollment?
- A. You can enroll your family at any time. There is, however, a 12-month commitment for your family to remain enrolled in the TDP. Premiums will be adjusted to the National Guard & Reserve family member rate (no government participation) upon deactivation. Note that if the sponsor enrolls the family within 30 days of activation in support of certain contingency operations, the family will be automatically disenrolled from the TDP upon deactivation and the 12-month commitment will be waived.
- Q. Where can I get more information on the TDP (enrollment, monthly premiums, cost-shares, benefits, POA, etc.)?
- Visit the TDP website (www.uccitdp.com) or call United Concordia's TDP Customer Service at 844-653-4061
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- Q. What happens if I enroll my family while I’m an active duty member and subsequently leave the active service?*
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A. If an active duty member leaves the active force and is considered a Selected Reservist or an Individual Ready Reservist, the family’s coverage will cancel at the end of the month during which the sponsor was deactivated. If the family re-enrolls within 31 days, a new 12-month enrollment commitment will not be incurred. The sponsor has the option to enroll once deactivated. To enroll, the sponsor must submit a completed enrollment form and initial premium payment in order to obtain coverage.
*Note: This information applies to active duty members who leave the active service, not Selected Reservists or Individual Ready Reservists who had been activated for any length of time.
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- Q. How do I cancel coverage after my 12-month contract ends?
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A. The sponsor may cancel TDP coverage at any time after the initial 12-month enrollment period has been met. Most beneficiaries will find going online to be the fastest and most convenient method. When submitting by mail, the TDP Enrollment Authorization document can be downloaded from the milConnect site, accessible at https://milconnect.dmdc.osd.mil/milconnect/. Please print, complete, and mail the TDP Enrollment Authorization document to United Concordia. Enrollment forms are also available by visiting the local uniformed services DTF or TRICARE Service Center (OCONUS).
If the sponsor is not available to cancel an enrollment, an individual with an appropriate POA can do so on their behalf. A copy of the valid POA must be on file with United Concordia. To put a POA on file with United Concordia, please complete an online POA submission form.
Important Note Regarding the Effective Date of Cancellation of Enrollments For most scenarios, if the cancellation of enrollment is completed by the 20th of the month, it will be effective the first day of the following month. If the cancellation of enrollment is received after the 20th of the month, the cancellation will be processed on the first day of the second month.
For example, if your cancellation of enrollment request is received by June 20, the cancellation will take effect on July 1. If your cancellation request is received on June 21 through July 20, the cancellation of enrollment will take effect on August 1. If the request is made by mail, it will be processed according to the date of receipt (not postmark). Please remember, you are responsible for all monthly premiums until coverage ends.
What are valid reasons for cancellation prior to the end of the 12-month enrollment period? Valid cancellation reasons are:- Loss of eligibility due to death, divorce, dependent child turning 21 (or 23 if enrolled full time at an accredited college and dependent on the sponsor for at least 50 percent of his or her financial support)
- Relocation to an OCONUS location, if a valid cancellation request is received within 90 days of relocation
- Transfer to a duty station where dental treatment is available, if a valid cancellation request is received within 90 days of relocation
- National Guard/Reserve Sponsor deactivation (sponsor activated more than 30 consecutive days).
- National Guard/Reserve member is transferred to standby or retired reserve.
For more information about disenrolling/canceling coverage, see the TRICARE Dental Program Benefit Booklet Eligibility and Enrollment Section.
- Q. I received a letter stating my coverage was cancelled. How do I reinstate my coverage?
- 1. If your coverage was cancelled prior to May 1, 2017, and you were locked out of the previous contract, you must wait until your 12-month lock-out is completed before re-enrolling in the TDP.
- 2.If your coverage was cancelled after May 1, 2017, United Concordia may allow your coverage to be reinstated if the sponsor contacts TDP customer service within six (6) months of the cancellation date and pays any missed premiums. To have your case reviewed, contact United Concordia by submitting your request through our online form or by calling 844-653-4061.
- Q. I am on active duty and PCSing to a different country with my family. Do I have to cancel my family's coverage?
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A. No, you do not have to cancel your coverage. Under the TDP, enrolled members are covered worldwide.
If you choose to cancel the coverage, you will be responsible for all treatment provided by civilian dentists in and outside of the United States. You will also be responsible for paying out of pocket for emergency services.
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- Q. How often can I go to the dentist for a routine cleaning/check-up?
- A. Two times within consecutive a 12-month period.
- Q. How do I know if a service is covered?
- A. You can access a full list of covered services by logging in to My Account or accessing the TDP benefit booklet. Always consult with your dentist on treatments and request a predetermination when you need to know whether or not a procedure is covered and how much you will be expected to pay for specific dental care. You can also call United Concordia's customer service representatives at 1-844-653-4061 24 hours/day Monday - Friday
- Q. What is an annual maximum?
- A. It's the maximum dollar amount a program will pay toward the cost of dental care incurred by an individual during a plan year. The annual program maximum per individual under the TDP is $1,500 per contract year. The TDP also provides a $1,200 annual maximum for dental accident services in addition to the $1,500 annual maximum.
- Q. What is a lifetime maximum?
- A. A lifetime maximum is the maximum amount of benefit you or your covered family member(s) can receive toward a specific service or group of services. The TDP has a $1,750 lifetime maximum for orthodontic services.
- Q. What is a Dental Explanation of Benefits (DEOB)?
- A. A DEOB is a Dental Explanation of Benefits statement sent to members each time a dental claim is processed by United Concordia. The DEOB displays the expenses submitted by the dentist and how the claim was processed. You can log in to My Account using your DS Logon to review your DEOBs and select to receive paperless DEOBs.
- Q. What is a predetermination?
- A. A predetermination (also referred to as a “Pre-D”) is a 'claim' that you submit before any services are actually rendered for a proposed treatment plan for covered services. It lets you and your dentist know what services will be covered, how much the plan will pay, how much you can expect to pay, and any alternate treatment options available for a proposed treatment plan. United Concordia recommends that you ask your dentist for a predetermination for all proposed dental treatments over $1,500. Just ask your dentist and he or she will submit information about the proposed treatment to us and we'll send you both a predetermination.
- Q. What is the dental accident benefit?
- A dental accident is an injury to sound natural teeth and supporting structures caused by a violent external force such as a fall or blow to the mouth. A separate annual maximum benefit of $1,200.00 is provided for each TDP enrollee for dental accident coverage. United Concordia will pay claims in accordance with the benefit limitations and cost shares for dental accident treatment defined as follows:
A. Covered services for the program, excluding orthodontics, are subject to all applicable general policies and exclusions, when provided for conditions caused directly by external and accidental means.
B. Dental accident benefits are limited to services provided to an eligible person within 180 days following the date of the accident, and do not include any services for conditions caused by an accident occurring before the enrollee’s eligibility date.
C. Once the $1,200 accident maximum is reached, benefits will be paid up to the annual $1,500 maximum, with applicable benefit limitations and cost share amounts - Q. Are implants a covered service?
- A. Implant services are covered for members age 14 and older. Implants are not covered when placed for a removable denture. Diagnostic information will be reviewed for payment consideration.
- Q. Are there any exceptions to the orthodontic age limitations?
- A. No, there are no exceptions to the specific age limitations for orthodontic coverage.
- Q. Are anesthesia services a covered benefit?
- A. Yes, under certain conditions. Anesthesia is covered if it is being provided with a definitive service that is also covered under the TRICARE Dental Program. Additionally, the anesthesia must be medically or dentally necessary for documented handicapped or uncontrollable patients or for justifiable medical or dental conditions. Your dentist should submit a report documenting why anesthesia was needed.
- Q. Are there any restrictions for impaction coverage?
- A. Yes, some services have age or frequency limitations. For patients under age 15 or over age 30, your dentist must submit a report to explain why the teeth needed to be removed. The claim will be reviewed by a United Concordia Dentist Advisor.
- Q. What kind of coverage do I have if I meet my contract year maximum?
- A. If a network dentist provided your service and you reach your contract year maximum, you will only be responsible to pay up to the allowable charge for the service.
- Q. Can I use my TRICARE medical benefits for my dental care?
- A. No. The TRICARE Dental Program (TDP) is separate and distinct from TRICARE’s medical plans. The TDP also requires a separate enrollment and monthly premium. You can learn about the different TRICARE health plans at Tricare.mil.
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- Q. What if I have other dental insurance?
- A. If you are a member of the TDP and have other dental insurance, United Concordia will coordinate benefits between the two plans. Depending on the situation, the TDP may act as primary or secondary payer.
- Q. How do I submit a claim to United Concordia when TDP is my secondary insurance carrier?
- A. In addition to completing the claim form, a copy of the primary carrier's Dental Explanation of Benefits (DEOB) determination must be included for TDP payment consideration as your secondary carrier.
- Q. Can I use my TRICARE medical benefits for my dental care?
- A. No. The TRICARE Dental Program (TDP) is separate and distinct from TRICARE’s medical plans. The TDP also requires a separate enrollment and monthly premium. You can learn about the different TRICARE health plans at Tricare.mil.
- Q. If I am no longer covered by two dental insurance carriers, do I need to notify United Concordia?
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A. Yes. The cancellation information should be submitted in writing from the patient or sponsor. The cancellation information should include the identification number, other carrier name, and the date of cancellation.
If a non-participating dentist provided the service and you've met your contract year maximum, you are responsible to pay the dentist's actual charge.
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- Q. How do I know if I Need to Submit a Claim to United Concordia?
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A. The processes for filing claims vary between the CONUS and OCONUS service areas.
CONUS
United Concordia will accept claims filed on any standard dental claim form of the American Dental Association (ADA) or on the TRICARE Dental Program (TDP) Claim form. A separate claim form must be submitted for each enrollee receiving services.
Note that TDP Network Dentists will handle all of the paperwork, including filing claims. United Concordia will reimburse your dentist directly for covered services, less the amount you paid for your cost-share.
However, if you seek treatment from a non-network dentist, you may be required to file your own claim. United Concordia will reimburse you for the claim, less the amount you paid for your cost-share. United Concordia will pay a nonparticipating dentist directly only if you designate on the claim form that the dentist is to receive the payment.
Additionally, any part of the dentist's fee exceeding United Concordia's allowance is your responsibility.
OCONUS
Many civilian overseas dental offices require their patients to pay for all dental services at the time they are rendered (see * below for exception). They also may require you to personally submit your claims to United Concordia for reimbursement of your out-of-pocket expenses (not including cost-shares). Your dental claims must be completed and submitted to United Concordia as soon as possible following the date of service, preferably within 60 days.
Any claim filed more than 12 months after the month in which the service was completed will be denied. To ensure your claim is properly processed and avoid any possible payment delay, these three items must be submitted to United Concordia:
- TDP OCONUS Claim Form The form can be obtained from the Forms & Materials section of this website. You can also request it from your TRICARE Area Office (TAO) or from any designated OCONUS Point of Contact (POC). Download a TDP OCONUS Claim Form.
- Dentist's Bill or Statement of Charges If the specific service(s) provided are repeated on the claim form, a separate office bill is not needed.
- Non-Availability Referral Form (NARF) A Non-Availability Referral Form (NARF) is required for orthodontic services.
You will be reimbursed in U.S. dollars unless you request payment in local currency. If you submit the claim and assign payment directly to the dentist, the claim will be paid to the dentist in foreign currency.
*TRICARE OCONUS Preferred Dentists (TOPDs) will only require you to pay any applicable cost-shares at the time dental services are rendered. The TOPD will submit your claims directly to and accept payment directly from United Concordia. - Q. I need to submit my own claim. What should I do?
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A. When submitting a claim to United Concordia, it is important that all of the appropriate information is provided. Failure to provide the necessary information will result in a claim payment being denied.
If you have to file your own claim(s), be sure to include the following information on your claim form:
- Date(s) of service
- Specific problem encountered
- Procedure Code(s)
- Specific tooth/teeth treated for each service performed
- Total charges
- A complete description of the service performed, including applicable tooth/ teeth numbers, if a procedure code is not provided
You'll also need to include a dentist's bill or statement of charges if the specific service(s) provided are not found on the claim form.
Claim forms should be submitted to United Concordia as soon as possible after the service, preferably within 60 days. Claims submitted more than 12 months after the month in which the service was provided will be denied. Prompt submission is especially important for claims involving an orthodontic treatment plan, because the banding date is used to determine timely filing.
- Q. My claim was rejected for missing information, yet that information was reported on the original claim. What do I do now?
- A. If the information was reported on the original claim, call TDP Customer Service (1-844-653-4061) and verify that all necessary information was received. If additional information is still needed, the TDP Customer Service Representative will advise you as to what information is still required. You should then resubmit the original claim with the additional information to the claims processing department. It is not necessary to attach the DEOB to the new claim.
- Q. Where do I send the claim?
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CONUS:
United Concordia
TDP Claims Processing
P.O. Box 69451
Harrisburg, PA 17106OCONUS:
United Concordia
TDP OCONUS Dental Unit
P.O. Box 69452
Harrisburg, PA 17106 - Q. Can my dentist bill me for services denied due to incomplete information?
- A. A network dentist cannot balance bill for claims rejected for incomplete treatment. However, non-network dentists can balance bill.
- Q. How do I prevent my claims from being denied?
- A. Submit the claim within one year and include all required information on the claim form.
- Q. Why are X-rays required?
- A. United Concordia requires that X-rays be submitted for certain services in order to review the services for necessity and quality.
- Q. My dentist submitted X-rays with the original claim, but the claim was rejected because of missing X-rays. What do I do now?
- A. The dentist's office will need to resubmit the claim with the X-rays and some additional information, e.g., additional X-rays, narrative, diagnosis, etc., based on the type of service reported. Contact your dentist's office to verify the status of the claim resubmission.
- Q. How can I get X-rays from my previous dentist, since payment can't be made for new X-rays?
- A. You have the right to request the X-rays or a copy of the X-rays taken by a dentist. Your dentist may charge a fee for copies.
- Q. I called recently and was unable to receive my child's or spouse's claims information. Why?
- A. If a member is age 18 or older, personal information can only be released to the member to whom the information pertains. Written authorization is required from the member before United Concordia can release information to others, such as the sponsor. For custodial parents, a court order must be received since they are not listed on the TDP contract.
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- Q. What is the monthly premium I have to pay each month?
- A. Premiums are based on the number of family members enrolled and if the uniformed services member is an active duty service member or a National Guard/Reserve member. Visit our Dental Costs page for more information.
- Q. What happens if I do not pay my monthly dental premiums?
- A. If the sponsor stops paying the dental premiums, the coverage will be cancelled. If the 12-month enrollment commitment was not fulfilled, the member(s) will be prohibited from re-enrolling in the TDP for 12 months. Non-payment of premiums may result in the account being sent to a collection agency.
- Q. Why did my premiums increase?
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A. Premiums are based on the number of family members enrolled and the sponsor’s military status (active duty service member or National Guard/Reserve member). If you recently added a family member, or if the sponsor was recently deactivated, your monthly premiums will increase.
NOTE: At the beginning of each TRICARE Dental Program (TDP) contract year (May 1 through April 30), a modest increase is applied to the premium rate.
- Q. My Payroll allotments/deductions stopped. Can this be restarted?
- A. There are many possible reasons that the allotment/deduction may have stopped. Please contact our office at 1-844-653-4061 to determine if you are still eligible for this payment option.
- Q. Can I pay my monthly dental premium payments automatically from a checking account or credit card?
- A. Yes, you can pay your premium automatically from your checking account or with a credit card. Through the electronic billing system (eBill), you can set up automatic monthly payments or schedule your payments each month. Log in through My Account and select “Pay My Bill” to establish your bill pay preferences. The instructions can also be found on the front of your monthly invoice.
- Q. Why does my invoice show two different accounts?
- A. If the sponsor and family are both enrolled, your invoice will show billing and payment information for each account. The invoice will, however, show one total amount due.
- Q. Are my payroll allotments/deductions pre-tax?
- A. Check with your local finance center to find out if your allotments/deductions are pre-tax.
- Q. I am expecting a refund for overpaid premiums. How long will this take?
- A. Refunds are generally processed and issued within 60 days of the cancellation of your coverage. If it has been 60 days since your original refund request, please contact our office at 844-653-4061.
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- Q. Can I visit any dentist?
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A. As a TDP enrollee, you may visit any dentist. However, inside the United States and its territories, you could experience reduced out-of-pocket costs by visiting a TDP network dentist.
There are several advantages to visiting a network dentist and finding a United Concordia TDP Network dentist is simple: just use our Find a Dentist online search tool.
- Q. How do I find a dentist in my area?
- A. Use our Find a Dentist feature to locate a network dentist in your area. You can search by last name, specialty, city, county or ZIP code. You can also call United Concordia's TDP Customer Service Department at 1-844-653-4061 and a dedicated customer service representative will find a network dentist for you.
- Q. What should I do if I can't find a network dentist or need help scheduling an appointment?
- A.Call our TDP customer service representatives for assistance.
CONUS Toll Free: 844-653-4061
OCONUS Toll Free: 844-653-4060 (view the AT&T access codes here)
- Q. If my dentist accepts TDP/United Concordia insurance, does that mean he is a TDP network provider?
- A. Not necessarily. A non-network provider may accept payments from United Concordia, but the provider does not agree to accept United Concordia's allowance as payment in full. The dentist will bill you for the difference between United Concordia's allowance and the dentist's total billed charge. Ensure the dentist is a TDP network dentist before visiting to avoid additional out-of-pocket expenses. Ask your dentist if he/she participates with United Concordia's DoD Programs network.
- Q. Why should I use a network provider?
- A. A network provider has signed a contractual agreement with United Concordia to follow TDP rules for providing care and accepting payments. A network dentist cannot bill you for the difference between United Concordia’s maximum allowable charge and his/her billed amount. Utilizing a network provider will save you out-of-pocket expenses as well as administrative hassle as the network provider will file a claim on your behalf.
- Q. If I am going to a group practice and one provider is in the TDP network, does that mean that all the dentists in that group are in the TDP network?
- A. Not necessarily. It is important to verify that the dentist of your choice is in the TDP network.
- Q. If my current dentist is not in the TDP Network, can I request that he/she become a United Concordia provider?
- Yes! We gladly accept nominations for new network provider. To nominate a dentist, simply complete and submit the Nominate Your Dentist form under Forms & Materials. Your current provider can also obtain an application to participate in the TDP Network by calling our toll-free customer service line at 1-844-653-4061 or by downloading the application.
- Q. Can members of the same family go to different dentists?
- A. Yes. Members of the same family can visit different dentists, even if one or more of them are not in the TDP Network. However, visiting a network dentist can save you money. Visit the Dental Costs page to see an example of your potential savings.
- Q. Will I need a referral from my dentist to visit a specialist?
- A. No. You do not need a referral from your dentist to visit a specialist. To find a TDP Network specialist, use Find a Dentist.
- Q. If I move, do I need to notify United Concordia of the name of my new dentist?
- A. No. The TRICARE Dental Program enables you to receive dental care from any licensed dentist. You do not need to contact United Concordia with the name of your new dentist prior to receiving treatment.
- Q. Is my dentist required to know what the TRICARE Dental Program covers?
- A. No. It is the member's responsibility to know their benefits and out-of-pocket expenses prior to authorizing or receiving treatment. A full list of covered benefits is available in My Account and your benefit booklet .
- Q. Do I need to take a claim form when I visit the dentist?
- A. If you visit a TDP Network dentist, you do not need to take a claim form, as our network dentists have agreed to file claims for you. However, it is a good idea to bring a Claim Form if you are visiting a non-network dentist.
- Q. What can a dentist bill me for?
- A. United Concordia TDP Network dentists accept our reimbursements, also known as maximum allowable charges (or MACs), as payment-in-full for covered services. United Concordia TDP Network dentists can charge you for applicable cost-share amounts, but they cannot balance bill you for the difference between their standard charges and the MACs. They can also bill you if you agree to receive an alternate treatment to a covered service or request a non-covered service (e.g., tooth bleaching). Non-network dentists can bill you for the difference between their standard charges and the MACs, which means you could save more by visiting a network dentist.
- Q. What if I have a question on a bill or service that I receive from my dentist?
- A. First, talk with your dentist. If you still have questions or concerns, call United Concordia's customer service representatives at 1-844-653-4061, 24 hours a day, Monday – Friday.
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- What is a Government Relations Liaison (GRL)?
- A GRL is a TDP benefits expert. Your GRL is responsible for promoting and educating eligible beneficiaries about TDP and supporting and assisting those enrolled in the TDP. Each GRL is responsible for a specific region of multiple states and/or territories.
- What does a GRL do?
- GRLs will come to your unit to provide TDP benefit briefings and exhibit displays to National Guard & Reserve units, family support groups and any military audience desiring TDP information. You don't have to wait for your unit to be activated or for deployment orders to arrange for a briefing. Request these informational events in advance by contacting your GRL.
- Why do I need to know my GRL?
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In addition to promoting and educating eligible beneficiaries about the TDP, one of the GRL's main responsibilities is to support and assist those participating in the TDP.
Most issues can be resolved quickly and thoroughly through our team of Customer Service Specialists at 1-844-653-4061 (CONUS) or 1-844-653-4060 (OCONUS). It is important that you first contact Customer Service prior to engaging a GRL. This will ensure prompt attention to your particular question or concern since the GRLs spend a majority of their time traveling to and from meetings, briefings, and conferences in support of TDP education and promotion. A GRL can, however, help with explaining how a claim was paid or why it was denied, error/problem resolution, TDP contract benefits and exclusions, locating participating dentists, how to enroll, and how to get the most out of your TDP benefit.
- How do I find my GRL?
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Each GRL is responsible for a region that includes multiple states and territories, including Guam and Puerto Rico. CONUS members can find a phone number for their GRL using the United Concordia Government Relations Liaison map.
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- Q. When can I request an appeal of a claim decision?
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A. If you or your participating dentist disagrees with United Concordia's benefit decision, the decision in question may be eligible for an appeal. During the appeals process, those involved in the initial determination have the opportunity to appeal adverse benefit decisions.
In order for a claim to be appealed, there must be an amount in dispute for which the patient has financial responsibility. The amount in dispute is calculated as the actual amount that would be payable under the TRICARE Dental Program (TDP) if the services in the dispute were determined to be payable, less any applicable cost-share or other dental insurance payment. You may also appeal adverse decisions on predetermination requests.
The following issues cannot be appealed:- Disputes regarding requirement of law or regulation
- The amount United Concordia determines to be the allowable charge
- Patient eligibility
- Dentists who have been excluded or suspended by a Government agency or state or local licensing authority
- Amounts exceeding the patient's contract year or lifetime maximum
- Services that are denied due to timely filing limitation
- Q. Who Can Request an Appeal?
- A. Parties to the initial determination can request an appeal, including:
- Participating dentists
- The patient who received the dental services
- Sponsors, parents or guardians of members younger than 18 years of age
- An individual or nonparticipating dentist who has been appointed (in writing) by the patient to act as the patient's representative in the appeal. Complete the Appointment of Individual to Act as Appeal Representative Form, which can also be found in the Forms & Materials section.
- Q. Who Cannot Request an Appeal?
- The following cannot request an appeal:
- Dentists who are disqualified or excluded from being authorized dentists
- Nonparticipating dentists (unless appointed in writing by an appealable party to act on his or her behalf)
- Members who have an interest in receiving care or who have received care from a dentist whose authorization has been excluded, suspended or terminated
- Sponsors, parents or guardians of family members 18 years of age and older are not parties to the initial determination. However, they may represent the family member if appointed - in writing- by that family member. Download the Appointment of Individual to Act as Appeal Representative Form, which can also be found in the Forms & Materials section.
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- Q. I have a concern about the quality of dental care I received. What can I do?
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A. United Concordia strives to ensure that members receive the highest quality care from our network dentists and that services are billed properly. United Concordia only pays benefits for dental services that meet acceptable standards of dental practice. In rare cases, a dentist may be removed from our listing of network dentists if United Concordia determines that he or she is not providing care within acceptable standards of dental practice.
If you have a question concerning the quality of care you received, you should first discuss the issue with the dentist that provided the service. If you still have concerns after talking to the dentist, you may submit them through our online grievance form available in the Forms & Materials section of this site.
United Concordia's trained staff will investigate the concern, resolve it as appropriate and notify you of the results.
