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Frequently Asked Questions
1. How can we help educate retirees about the TRDP? There are many ways beneficiary liaisons can help Uniformed Services retirees learn about the TRDP. TRDP regional marketing representatives are available to give presentations on the TRDP at Transition Assistance Program classes, retiree appreciation days and other events. If a representative cannot be present, a short video that gives an overview of the Enhanced and Enhanced-Overseas TRDP is available for viewing at transition assistance classes. Your TRDP representative is able to supply you with enrollment materials to distribute to retirees. Have the TRDP web site address readily available for directing retirees to quick access to comprehensive program information. You can also call Customer Service toll-free at 888-838-8737 if you need further help. 2. Where can we get a supply of Benefits Booklets to hand out to retirees? They are always asking for them. New enrollees in the Enhanced TRDP are sent an Enhanced Program Benefits Booklet and personalized TRDP identification cards as soon as they enroll. Access to the complete Benefits Booklet is available online. Although large quantities of these Benefits Booklets are not available for distribution to retirees at the installations, you should always have one or two booklets available for reference in assisting retirees with questions about the TRDP. If you do not have a TRDP Benefits Booklet in your office, please contact your TRDP marketing representative for a copy. 3. Why are the premiums more for the Enhanced TRDP than for the TRICARE Dental Program? Many people who have dental health coverage are fortunate to have their past or present employer share some of the premium cost. However, the TRDP is a voluntary dental program that is sustained entirely by enrollee-paid premiums. The federal government does not subsidize premiums for the TRDP, so they may seem higher because they are entirely enrollee self-paid. 4. Why do premiums vary from area to area? TRDP premiums are based on the ZIP Code in which the primary enrollee resides and the enrollment option selected (single enrollment, two-person enrollment or family enrollment of three or more persons). There are currently five premium regions under the TRDP, and the premiums were determined relative to the cost of living in each of these five regions. Retirees can obtain their current Enhanced TRDP premium rate online or by calling Customer Service toll-free at 888-838-8737. Additionally, TRDP premium rates will change slightly on October 1 of each contract year. Enrollees in the Enhanced-Overseas Program pay premium rates equivalent to those for Enhanced Program enrollees in premium region C. 5. Please help us clarify for retirees what is meant by "COB" and how it works under the TRDP. "COB" is an abbreviation for coordination of benefits, which are rules that determine coverage and payment when the enrollee has other dental coverage in addition to the TRDP. It is to a TRDP enrollee's advantage to let the dentist know if he or she is covered by another dental plan, since most dental carriers such as Delta Dental cooperate with one another to allow the enrollee to make use of both programs—sometimes paying 100 percent of the dental bill. More information about coordination of benefits and how it works under the TRDP is available in the Benefits Booklet. 6. Under the TRDP, is Delta Dental the first or second payer in COB? In cases where an enrollee in the TRDP has other dental coverage, the following coordination of benefits rules are applied to determine which insurance pays first:
Claims under the TRDP should be filed first with the plan that pays first, since information about the first plan's payment is used by the other plan to determine its payment. For more information about coordination of benefits and how it works under the TRDP, refer to the Benefits Booklet. 7. Please explain how the orthodontic benefit under the TRDP works when orthodontic treatment had already begun under the TDP for active duty dependents. When an enrollee becomes eligible for orthodontic coverage under the TRDP after orthodontic treatment has already begun under the TDP (known as "in-process" treatment), the total amount payable under the TRDP is prorated according to the remaining portion of active treatment scheduled. Delta Dental will review the remaining balance of treatment and pay 50 percent of the TRDP allowable amount, up to the $1,500 lifetime orthodontic maximum. This means that even if the enrollee used any or all of the maximum benefit for orthodontics allowed under the TDP, he or she can still get up to the maximum benefit available under the TRDP for in-process orthodontic treatment. Certain circumstances may affect orthodontic payment under the TRDP. For more information on orthodontic benefits under the TRDP, refer to the Benefits Booklet. 8. What dentists can enrollees see under the TRDP? The TRDP is a combined fee-for-service/preferred provider plan. This means that TRDP enrollees have the ability to seek treatment from any licensed dentist who practices within the service area, regardless of whether or not he or she is a participating network dentist for the TRDP. Although there are some advantages to having treatment provided by a participating network dentist, the TRDP does not limit enrollees’ access to dental care by requiring that they seek treatment only from a dentist who belongs to a specific network. TRDP enrollees will save more on out-of-pocket expenses if they see a participating network dentist in one of over 100,000 locations nationwide. These network dentists have agreed to pre-negotiated fees and to submit all claims paperwork for enrollees. With a non-network dentist, reimbursement for TRDP covered services is not based upon a schedule of pre-negotiated fees. Seeing a non-network dentist can mean higher out-of-pocket costs, and enrollees may have to submit their own claims paperwork. TRDP enrollees also have the option of seeing a Delta Dental Premier® dentist for some of the same advantages as a participating TRDP network dentist. Although Delta Dental Premier® dentists do not participate in the networks that serve the TRDP, they will submit claims for enrollees, accept payment for TRDP services directly from Delta Dental, and abide by Delta Dental's quality-of-care standards. In addition, Delta Dental Premier® network dentists will not charge TRDP enrollees more than the fees they have agreed upon with Delta Dental; however, enrollees will still be responsible for applicable copayments and deductibles as well as any difference in the agreed-upon fees and the TRDP allowable fee for non-network dentists. Delta Dental does not maintain a dentist network overseas. However, Enhanced-Overseas TRDP enrollees, and Enhanced Program enrollees seeking emergency care overseas who need to locate a dentist can refer to the online Host Nation Provider List or call the 24-hour I-SOS referral number listed on this web site to find a dentist overseas. 9. In order to avoid a lapse in coverage, when should someone who is retiring from the Uniformed Services enroll in the TRDP? To avoid a lapse in coverage, those who are retiring from the Uniformed Services—including those who are retiring from active duty as well as members of the National Guard/Reserve who are transferring to Retired Reserve status—and who wish to enroll in the TRDP should do so in the month prior to their separation date. This will ensure their coverage under the TRDP begins as soon as their retirement from active duty or transfer to Retired Reserve status is effective. A person who enrolls after his or her retirement effective date will have a gap in coverage; for example, if the retirement is effective January 31 and the new retiree enrolls in the TRDP in February, coverage will begin March 1. If the enrollment is within 4 months after the effective date of the person’s retirement from active duty or transfer to Retired Reserve status, he or she is eligible to skip the initial 12-month waiting period and begin receiving many of the additional program benefits as soon as coverage becomes effective. 10. Where can retirees get a list of dentists who participate in the TRDP? A list of participating network dentist offices is readily available through our online dentist directory. Retirees may also call our toll-free automatic interactive voice response (IVR) line at 888-838-8737 to request a list of participating network dentists in their area. 11. Where can retirees get information on how much the TRDP will pay for a specific procedure? You may want to suggest that the enrollee use a free feature of the TRDP called predetermination before undertaking extensive dental treatment for such services as cast crowns, bridges and dentures. Although a predetermination is not required, it is a good way for the enrollee to find out in advance exactly what the TRDP will cover and how much the enrollee's out-of-pocket expenses will be. 12. Can retirees who live overseas get coverage under the TRDP?Yes, retirees who live overseas can now get comprehensive coverage worldwide under the new Enhanced-Overseas TRDP, Enrollees in the Enhanced Program are now eligible for coverage of emergency services when traveling overseas; however, they must have any other TRDP covered services provided by a licensed dentist within the TRDP service area (the 50 United States and the District of Columbia, Guam, Puerto Rico, the U.S. Virgin Islands, the Commonwealth of the Northern Mariana Islands, American Samoa and Canada) in order for the treatment to be reimbursed. 13. What advice should we give a TRDP enrollee who has a complaint about his or her dentist? We would encourage you to suggest that the enrollee first discuss and try to resolve the issue with his or her dentist. If this is unsuccessful, please ask the enrollee to put the nature of the complaint in writing, including what attempts were made to resolve it, and send it to us at: Delta Dental of California, Federal Services Grievance Department, PO Box 537015, Sacramento, California, 95853-7015. A Patient Grievance Form is available online for enrollees to view and print. The form may be faxed to Delta Dental at 916-858-0235. We will follow up with the dentist and attempt to resolve the issue. If the dentist is a participating network dentist and it is determined that the dentist is not complying with the terms of his or her participation agreement, then the issue may be referred to our Professional Services department for further action.
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