FAQs: Enhanced-Overseas Program >>
FAQs: Prospective Enrollees >>
FAQs: Premium Changes >>

Frequently Asked Questions

1. How do I know which program I am enrolled in? >>
2. How do I enroll dependents once I have enrolled in the TRDP? >>
3. How do I disenroll dependents from my TRDP coverage? >>
4. What is meant by a “deductible” and an “annual maximum amount”? >>
5. Does the TRDP require a special form for submitting claims? >>
6. My dentist does not participate in the TRDP network. Besides lower fees, what other advantages does seeing a dentist in the TRDP network provide over seeing a non-TRDP network dentist? >>
7. Can you explain the difference between a calendar year, a contract (benefit) year and a coverage year? >>
8. What important things do I need to know about upgrading
   my coverage? >>
9. How do I upgrade my coverage to the Enhanced Program? >>
10. Is there a way to find out how much the program will pay before I have treatment done? >>
11. Are implants and composite fillings covered benefits
    under the TRDP? >>
12. If I had a crown put on a tooth last year and I paid for it, would the Enhanced TRDP cover another one on the same tooth in a year or so, if I need it? >>
13. Is there any way I can review my benefits, check on the status of my processed claims, keep track of how much of my deductible and annual maximum I‘ve used, and even look at my premium payment history at my own convenience—without having to call Delta Dental to get this information? >>

1. How do I know which program I am enrolled in? One way to tell whether you are enrolled in the Basic or Enhanced Program is by your enrollment date. The Basic Program, which began in 1998, was closed to new enrollments effective September 1, 2000. Those who enrolled on or after September 1, 2000 are automatically enrolled in the Enhanced Program, which began on October 1, 2000. Enrollees who enrolled in the TRDP prior to September 1, 2000 can retain their enrollment in the Basic Program or can upgrade their coverage to the Enhanced Program at any time.

In October 2008, coverage under the TRDP became available worldwide, offering the comprehensive scope of benefits through the Enhanced-Overseas TRDP to enrollees living overseas.

Another way is to check your ID card for the group number of the program in which you are enrolled: Group 4600 designates that you are enrolled the Basic TRDP, and group 4601 designates your enrollment the Enhanced TRDP. If you are enrolled in the Enhanced-Overseas TRDP, your group number is 4602.

You may also verify whether you are enrolled in the Basic or Enhanced TRDP by checking the online Consumer Toolkit®. In addition to verifying your enrollment, the toolkit allows you to print an ID card, review your benefits, check claims status and find out how much of your annual deductible and maximum remains—as well as manage almost every aspect of your TRDP enrollment.

Enrollees in the Basic TRDP are not entitled to the same benefits and do not pay the same premiums as enrollees in the Enhanced or Enhanced-Overseas TRDP. Both the Basic Program Benefits Booklet and Enhanced Program Benefits Booklet are available online for detailed benefits information. A supplemental guide to the Enhanced Program that provides information specific to enrollees in the Enhanced-Overseas TRDP is also available.
 

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2. How do I enroll my dependents once I have enrolled in the TRDP?
 It’s easy to enroll an eligible spouse or dependent(s) under your TRDP coverage at any time during your enrollment period by using the “Manage Enrollment” feature on the Consumer Toolkit®. This feature allows you to add an eligible spouse and/or dependent(s) and even update your name, address and other contact information.

You can also enroll your eligible spouse and/or dependent(s) by telephone or by writing to Delta Dental. When you call or write us to enroll dependents, be prepared with the following required information:

• Primary enrollee’s name (first, last, middle initial) and identification number
• Dependent(s)' name(s) (first, last, middle initial)
• Gender of eligible dependent(s), i.e., male or female
• Relationship of dependent(s) to primary enrollee, i.e., spouse or child
• Dependent(s)' date(s) of birth.
• If dependent child is over age 21, indicate if full-time student
• If dependent child is over age 23, indicate if disabled.
  Note: If dependent child is over age 21 and not a full-time student, or over age 23 and not disabled, the dependent child is not eligible. Proof of full-time student status is required to enroll dependents over age 21.
• Payment information for premium differential, as appropriate, i.e., single-person to two-person enrollment; single-person to family (three or more persons) enrollment; or two-person to family enrollment.

Coverage for the eligible dependent(s) will be effective the first of the following month after the dependent(s) is added.

It is important to note that when a dependent(s) is added to an enrollee’s TRDP coverage, the primary enrollee's initial 12-month enrollment commitment in the Enhanced TRDP starts over again with the dependent(s)' coverage effective date. Although the 12-month enrollment commitment for the primary enrollee restarts when a dependent(s) is added to the coverage, the primary enrollee retains credit toward the 12-month waiting period for the number of months he or she has been enrolled in the TRDP. If the primary enrollee has already satisfied the 12-month waiting period for major services at the time he or she enrolls a dependent(s), the primary enrollee continues to be eligible for major services, and the newly added dependent(s) is also eligible for the same level of services.

Although the Basic TRDP has been closed to new enrollments since September 1, 2000, enrollees in the Basic Program can still add dependent(s) to their Basic Program coverage at any time during the period they remain enrolled in that program. The 12-month enrollment commitment for the primary enrollee starts over again with the dependent(s)' coverage effective date and must be satisfied by the primary enrollee before voluntary disenrollment can be considered.

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• Dependent(s)' name(s) (first, last, middle initial)
• Primary enrollee’s name (first, last, middle initial) and identification number
• Gender of eligible dependent(s), i.e., male or female
• Relationship of dependent(s) to primary enrollee, i.e., spouse or child
• Dependent(s)' date(s) of birth.
• Reason for disenrollment request: Loss of eligibility (dependent child over age 21 and no longer full-time student or over age 23 and no longer disabled), death (date of death required), divorce (date of divorce required), etc.

The deletion of dependent(s) from your TRDP coverage will be effective 30 days after your initial request.

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4. What is meant by a “deductible” and an “annual maximum amount”? A deductible is the dollar amount that a patient must pay toward certain covered services before the TRDP can determine payment of a claim for those services. The deductible amount under the TRDP is $50 per enrollee per contract year, with a $150 cap per family per contract year.

The annual maximum amount (also called the maximum allowable amount) is the total amount per enrollee per contract year that Delta Dental will pay toward the enrollee’s TRDP covered services. The annual maximum amount allowed by the Enhanced TRDP for most covered procedures is $1,200 per enrollee per contract year, and $1,000 per enrollee per contract year for those who remain in the Basic Program.

Your deductible and annual maximums do not apply to most preventive and diagnostic services, which are covered by the TRDP at 100% of the program’s allowed amount. Also, remember that because participating TRDP network dentists accept lower fees for the dental care they provide, services to which your annual maximum does apply typically cost less. This means that seeing a TRDP network dentist for your dental care allows you to stretch your maximum amount farther so that you have more money left over to use for additional services.

The deductible and maximum amounts restart each contract year on October 1. You can check the onlineConsumer Toolkit® to find out how much of your annual deductible and maximum you have used year-to-date.

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5. Does the TRDP require a special form for submitting claims?
No. The TRDP accepts any standard dental claim form and does not require dentists to use a special form to submit your claims. One advantage of seeking treatment from a TRDP participating network dentist is that he or she has agreed to complete and submit all your TRDP claims paperwork for you.
As a service to you, Delta Dental has provided a TRDP Claim Form on this website that can be printed out, completed and submitted if needed. You can also print a claim form from the Consumer Toolkit® as well as view the status of any of your processed claims. If you need help in completing the claim form, you can call our Customer Service staff toll-free at 888-838-8737 for assistance.

Claims for TRDP covered services should be submitted to:
Delta Dental of California
Federal Government Programs
TRICARE Retiree Dental Program
PO Box 537007
Sacramento, CA 95853-7007
United States of America

We have also provided a special Enhanced-Overseas TRDP Claim Form on this website and on the Consumer Toolkit® especially for use by enrollees in the Enhanced-Overseas Program as well as by Enhanced Program enrollees who have received emergency treatment while traveling overseas. For details on specific submission requirements and processing policies for overseas claims, please refer to the Enhanced-Overseas TRDP supplemental guide.

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6. What are the advantages of seeing a dentist in the TRDP network over seeing a non-TRDP network dentist? Participating TRDP network dentists have an agreement with Delta Dental to save enrollees money and can decrease enrollees’ copayments by an average of 22%, reduce the amount of paperwork, and provide quality dental care at the best value. Participating TRDP network dentists

• accept reduced fees for treating TRDP patients;
• submit all TRDP claims paperwork (including required documentation);
• abide by Delta Dental’s quality-of-care standards, which are among the industry’s highest;
• submit a predetermination of cost for more extensive treatment, upon request and free of charge;
• bill TRDP patients only for any applicable deductible and copayment at the time of service, with no other upfront charges;
• accept their lower, agreed-upon network fees as payment in full; and
• accept payment directly from Delta Dental.

Giving enrollees the option to choose a participating TRDP network dentist affords them the same level of coverage and the highest quality of dental care regardless of the network dentist’s agreement with Delta Dental to charge significantly reduced fees for treating TRDP patients.  If you would like your dentist to consider becoming a participating TRDP network dentist, please let us know, and we will be happy to send him or her an invitation to join the network.

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7. Can you explain the difference between a calendar year, a contract (benefit) year and a coverage year? A calendar year is the 12-month period that begins on January 1 and ends on December 31.
A contract year (also known as a benefit year) is the 12-month period that starts with the effective date of Delta Dental’s current contract with the Department of Defense to administer the TRDP. Since the latest contract for the TRDP began on October 1, 2008, a contract year now runs from October 1 through September 30. Your TRDP premiums, deductible and annual maximums begin, end and start anew on October 1 of each contract year.
A coverage year is the 12-month period that begins with your effective date of coverage (the first day of the month following acceptance of your TRDP enrollment application). Your coverage year is used to determine applicable processing and payment policies (such as frequency and time limitations) specific to your submitted claims for dental services allowed under the TRDP.

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8. What important things do I need to know about upgrading my coverage? There are several important things you should know when you make the decision to upgrade your Basic Program coverage to the Enhanced Program.

• You must satisfy the same 12-month waiting period as a new enrollee in the Enhanced Program before you are eligible to receive major services like crowns, bridges, dentures, dental implants and orthodontics.
• You have a 30-day grace period in which to change your mind and remain in the Basic Program instead. If, however, you or your dentist submits claims for Enhanced Program benefits during the 30-day grace period, you can no longer revert to your Basic Program enrollment. Your 12-month enrollment commitment in the Enhanced Program remains in effect beginning with your coverage effective date, and you may disenroll only after satisfying the 12-month enrollment period.
• Since a new 12-month commitment begins when you upgrade to the Enhanced TRDP, both your maximum and deductible are reset to zero. This means that even though you and each of your enrolled family members must each meet your $50 annual deductible (up to a family maximum of $150), you gain a full $1,200 maximum benefit allowance for the year for each enrollee as well when you upgrade your coverage from the Basic to the Enhanced Program. Seeing a TRDP network dentist helps stretch your $1,200 annual maximum even farther, so you can have more money left to get additional services,
• Enrollees in the Basic Program who do not choose to upgrade to the Enhanced Program may remain enrolled in the Basic TRDP for as long as they wish. However, because the primary enrollee (retiree or unremarried surviving spouse) "sponsors" the enrollment of his or her dependents in either of the TRDP groups (Basic or Enhanced), family members who are enrolled in the TRDP must be enrolled in the same group as their sponsor. This means that if you are an enrollee in the Basic Program, you cannot enroll your eligible family members in the Enhanced Program unless you upgrade your coverage to the Enhanced Program as well. If you are a Basic Program enrollee who decides to upgrade your coverage to the Enhanced Program and who has dependents who are also enrolled in the Basic Program, your dependent(s) who are still eligible for the program must also upgrade their coverage, or you may disenroll them at the time you upgrade.

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9. How do I upgrade my Basic Program coverage to the Enhanced Program? Upgrading your Basic Program coverage is easy. All the information you need to know about upgrading your coverage to the Enhanced Program is available on this website. When you are ready to upgrade, you have two options:

Download the upgrade acceptance form from this website and return it with your check, money order or credit card payment information to:

Delta Dental of California
Federal Government Programs
PO Box 537008
Sacramento, CA 95853-7008
United States of America

• Upgrade over the telephone with your Visa© or MasterCard©. Call Customer Service between 6 a.m. and 6 p.m. Pacific Time, Monday through Friday, toll-free at 888-838-8737.

You can upgrade your coverage to the Enhanced Program at any time, and your enrollment in the Enhanced Program will be effective the first of the month following receipt of your upgrade acceptance form.

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10. Is there a way to find out how much the program will pay before I have treatment done? Under the TRDP, you can ask your dentist to submit a predetermination, which is a non-binding estimate of how much Delta Dental would approve, allow and pay if you had the services performed. There is no cost to you for your dentist to submit a predetermination.

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11. Are dental implants and composite fillings covered benefits under the TRDP? Yes! As of October 1, 2008,coverage for dental implant services as well as one- and two-surface composite (tooth-colored) fillings on posterior (back) teeth were added to the scope of benefits  of the Enhanced TRDP. Additionally, a silver-filling (amalgam) allowance for three- and four-surface posterior composites --one of the first benefits to be added to the program design when the TRDP was enhanced in October 2000--is still a benefit today. Although Basic Program enrollees are not eligible for this benefit, those who remain enrolled in the Basic TRDP have the opportunity to upgrade their coverage at any time if they wish to become eligible for additional benefits like dental implants and posterior composites.

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12. If I had a crown put on a tooth last year and I paid for it, would the Enhanced TRDP cover another one on the same tooth in a year or so, if I need it? Under the Enhanced TRDP, coverage for crowns is subject to the 12-month waiting period. Once the 12-month waiting period has been satisfied, Delta Dental will make payment on a crown if it is due to fracture or decay of an existing tooth. We recommend that you discuss your treatment options with your dentist; he or she will assist you in deciding the best course of treatment for your particular situation.

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13.  Is there any way I can review my benefits, check on the status of my processed claims, keep track of how much of my deductible and annual maximum I‘ve used, and even look at my premium payment history at my own convenience—without having to call Delta Dental to get this information? Yes! The Consumer Toolkit® is a dynamic, self-service tool that allows you to do everything you’ve mentioned and more—all in one place! The online Consumer Toolkit is available to TRDP enrollees 24 hours a day, seven days a week, so you can get the information you need to manage almost every aspect of your TRDP enrollment, when you need it, at your convenience. To use the Consumer Toolkit, you’ll first need to register by creating a unique username and password. Once you’ve successfully registered and logged in, you’re on your way to taking charge of your benefit and account information.

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