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TRICARE-FAMILY MEMBER DENTAL PLAN (FMDP)
FACT SHEET



TOPIC 1: ELIGIBILITY

DISCUSSION: Example of Eligibility for the TRICARE-FMDP. In 1986 Congress established the Dependent Dental Plan (DDP) for the spouse, children, and eligible family members of active duty sponsors in the Seven Uniformed Services: Army, Air Force, Coast Guard, Marine Corps, Navy, National Oceanic and Atmospheric Administration, and Public Health Services.

Example of Non-Eligibility for the TRICARE-FMDP applies to the following: Active duty sponsors; Former military sponsors and family members; Former military sponsors who separated under special separation or transition assistance; Retired sponsors; Former spouses, Parents, Air Force or Contract Employees, and family members who are not TRICARE (formerly CHAMPUS) eligible.

POINT OF CONTACT: HEALTH BENEFITS ADVISOR and MPF CUSTOMER SERVICE ELEMENT

TOPIC 2: ENROLLMENT

DISCUSSION: TRICARE-FMDP enrollment participation is voluntary. Sponsors must be on active duty orders for more than 30 consecutive days and must remain on active duty for at least 24 months. If on extended active duty in the Air National Guard or Air Force Reserve, then the period must be at least 24 continuous months without a break in service.

EXCEPTION: OCONUS Returnees (sponsors and family members), going PCS outside the Service Plan Area, who are returning from an overseas duty station may enroll if the sponsor plans to remain on active duty for at least 12 months. OCONUS Returnees are encouraged to enroll in the TRICARE-FMDP prior to departing the overseas area, or within 30 days of signing in at new duty station

Sponsors family members will not be automatically enrolled in the TRICARE-FMDP at the Military Treatment Facility (MTF) or by the MPF Customer Service Element. Sponsors must apply for enrollment using DD Form 2494, TRICARE-Active Duty FMDP Enrollment Election, or DD Form 2494-1, Supplemental TRICARE-Active Duty FMDP Enrollment Election, and meet DEERS eligibility and enrollment requirements. Note: Join Service Members (JSM) must decide which sponsor will enroll in the TRICARE-FMDP for dental premium deductions. Enrolled family member(s) must be listed under the sponsor's DEERS record with TRICARE medical coverage (formerly CHAMPUS) to receive dental benefits and coverages.

TRICARE-FMDP enrollment is not restricted to Service Plan Area: Family members are not required to live in the TRICARE-FMDP service plan area to enroll, and sponsors may enroll at any time regardless of location providing eligibility enrollment requirements are met within the TRICARE-FMDP and DEERS. Family members can only use the TRICARE-FMDP in the following Service Plan Areas: Fifty United States, District of Columbia, Canada, Guam, Puerto Rico, U.S. Virgin Islands, the OCONUS area as "remote" or "non-remote" by contacting the Overseas Dental Treatment Facility (ODTF) lead agent. Additional assistance can be obtained from the Health Benefits Advisor (HBA) and the MPF customer serivce.

Extended TRICARE-FMDP Enrollment For Family Members Whose Sponsor Died While On Active Duty, Including Imminent Death. The following eligibility requirements for continued TRICARE-FMDP enrollment apply: Family members must have been enrolled in the TRICARE-FMDP at the time of sponsor's death; or during Imminent Death. Sponsor's death must have occurred while on active duty on or after 1 Oct 93. Family members must remain eligible for TRICARE (formerly CHAMPUS) during the period of extended enrollment. Eligibility for TRICARE-FMDP benefits remain in place until the last day of the 12th month following the death of the sponsor. Lastly, the Secretary of Defense has waived the requirement for family members to pay their fair share of monthly TRICARE-FMDP premiums at no cost.

POINT OF CONTACT: MPF CUSTOMER SERVICE ELEMENT

TOPIC 3: COVERAGE

DISCUSSION: The TRICARE-FMDP provides broad dental coverage for family members: Some dental services are covered at 100 percent, while other services are covered at 80, 60, and 50 etc. Some benefits are limited or not covered at all, with cost shares, maximums, limitations, and exclusions, similar to typical civilian group dental plans.

NOTE: Details of coverage 'cost-shares, maximums, limitations, requirements, exclusions, and family members eligibility are fully described in the dental contractor's Dental Benefit Book handout.

Example of TRICARE-FMDP Coverage. Sponsor signs DD Form 2494 or 2494-1 and submits enrollment application to the MPF Customer Service Element for processing: Form is completed and signed January 1, TRICARE-FMDP coverage will begin the following month, February 1; Form is completed and signed January 31, TRICARE-FMDP coverage will begin the following month February 1.

Example of TRICARE-FMDP Non-Coverage. Sponsor signs DD Form 2494 or 2494-1 and submits enrollment application to the MPF Customer Service Element for processing: Form is completed and signed in January, TRICARE-FMDP coverage will not begin in the same enrollment month; Form is completed and signed in January, TRICARE-FMDP coverage will not begin retroactive to previous month, December.

NOTE: TRICARE-FMDP dental deductions from a sponsor's pay must be made in advance of coverage, and family members must be DEERS enrolled with TRICARE (formerly CHAMPUS) eligibility.

Sponsors and family members may contact the DEERS Support Office (DSO) Beneficiary Telephone Center for TRICARE-FMDP coverage verification prior to receiving dental services at: 1-800-334-4162, CA; 1-800-627-5602, AK and HI only; and 1-800-538-9552, for all other states.

POINT OF CONTACT: HEALTH BENEFITS ADVISOR and MPF CUSTOMER
SERVICE

TOPIC 4: PREMIUM COST

DISCUSSION: The Office of the Assistant Secretary of Defense for Health Affairs (OASD HA) establishes the TRICARE-FMDP premiums. The legislation which established the dental plan, directed that premium costs be shared by the Government and the military sponsor. The Government share is 60 percent while sponsors are responsible for the remaining 40 percent.

The TRICARE-FMDP is a "prepaid" program - dental premium deductions from a sponsor's pay must be made in advance of coverage. There are two types of TRICARE-FMDP premiums, single or family. Single premium enrollment is for one family member only; Family premium is for two or more family members. Note: There are enrollment conditions: A sponsor cannot selectively enroll some family members and not enroll other DEERS and TRICARE (formerly CHAMPUS) eligible family members. All DEERS and TRICARE (formerly CHAMPUS) eligible family members must be enrolled or none at all, if they reside in the same household, and at least one family member is four years of age or older.

POINT OF CONTACT: FINANCE SERVICE OFFICE and MPF CUSTOMER
SERVICE ELEMENT

TOPIC 5: DENTAL CONTRACTOR

DISCUSSION: The current dental contractor for the TRICARE-FMDP is United Concordia Companies, Inc., (UCCI), formerly a subsidiary of Pennsylvania Blue Shield, located at Camp Hill, PA. Sponsor's and family members are encouraged to call or write to UCCI regarding questions concerning their TRICARE-FMDP benefits or claims submission. For more information about your dental plan, please call or write:

Toll-free telephone numbers:
1-800-866-8499
1-800-891-1854 (TDD)
8 AM - 8 PM EST
Monday - Friday




Write to:
United Concordia Companies, Inc.
FMDP Customer Service
P.O. Box 898218
Camp Hill, PA 17089-8218

For Claim Submission:
United Concordia Companies, Inc.
FMDP Claim Processing
P.O. Box 898220
Camp Hill, PA 17089-8220

POINT OF CONTACT: HEALTH BENEFITS ADVISOR

TOPIC 6: NETWORK DENTAL PROVIDERS

DISCUSSION: TRICARE-FMDP enrolled family members may receive dental care from any licensed/authorized dentist of their choice; however, a United Concordia participating dentist may save the sponsor time, paperwork, and money. Also family members can plan ahead for dental treatment costs and coverage by getting a non-binding pretreatment estimate (predetermination) for dental services.

POINT OF CONTACT: HEALTH BENEFITS ADVISOR

TOPIC 7: CLAIMS

DISCUSSION: United Concordia participating dentists initially file claims for the sponsor at no charge and accept payment (for dental services rendered) directly from the dental contractor, United Concordia Companies, Inc. Once a claim is processed, the family member will receive a Dental Explanation of Benefits (DEOB) explaining how the claim was processed - paid or denied payment. Questions concerning payments should be addressed to the servicing dentist or United Concordia's Customer Service Department.

POINT OF CONTACT: HEALTH BENEFITS ADVISOR and MPF CUSTOMER
SERVICE ELEMENT

TOPIC 8: OTHER DENTAL INSURANCE

DISCUSSION: Sponsor and family members may have other dental insurance. In this case, United Concordia will coordinate benefits between the two dental plans. Sponsors having questions concerning other dental coverage should read the Dental Benefits Booklet, or contact United Concordia's Customer Service Department.

NOTE: Other dental insurance purchased or obtained through private employment after initial TRICARE-FMDP enrollment is not grounds for early disenrollment or change in dental premium costs under the 24 month participation requirement. Refer to you Benefits Booklet for details regarding coordination of benefits between the two dental plans.

POINT OF CONTACT: HEALTH BENEFIT ADVISOR

TOPIC 9: RELOCATING (PCS, SEPARATION, & RETIREMENT)

DISCUSSION: Sponsors and family members who are relocating to stateside or overseas Permanent Change of Station (PCS), should verify their TRICARE-FMDP enrollment election and premium deductions for correct coverage's prior to moving. Upon arriving in the overseas area with family members, sponsors may disenroll from the TRICARE-FMDP if they desire. Disenrollment from the TRICARE-FMDP is not automatic upon PCS: assignment notification, travel, or reporting in to new duty station. Sponsor's must voluntarily disenroll at the MPF Customer Service Element by completing and signing DD Form 2494 to stop dental premium deductions and to terminate coverage's.

Example of voluntary TRICARE-FMDP Termination. Sponsor signs DD Form 2494 at the MPF Customer Service Element, disenrolling from the TRICARE-FMDP June 1, coverage will end June 30.

Example of voluntary TRICARE-FMDP Termination without coverage. Sponsor signs DD Form 2494 at the MPF Customer Service Element, disenrolling from the TRICARE-FMDP June 30, coverage is not in effect July 1.

Sponsors who are presently enrolled and have projected separation or retirement dates, TRICARE-FMDP disenrollment is automatic, with premium deductions stopping at the Defense Finance and Accounting Service, Denver (DFAS-DE). Sponsors End of Month Leave and Earning Statement (LES) will reflect dental deduction termination upon projected separation or retirement event date. There is no TRICARE-FMDP coverage for family members after the separation or retirement event date. Sponsors who have their separation or retirement dates adjusted, (i.e., administrative discharge, medical review board, a change of military status from enlisted to commission, or transfer from the Air National Guard and Reserve Component) must reenroll at the MPF Customer Service Element if TRICARE-FMDP coverage is to continue.

POINT OF CONTACT: MPF CUSTOMER SERVICE ELEMENT

TOPIC 10: MILITARY TREATMENT FACILITY (MTF) HEALTH BENEFITS ADVISOR (HBA)

DISCUSSION: The MTF HBA establishes a close working relationship with the MPF Customer Service Element, primarily answering active duty sponsors and family members with TRICARE-FMDP questions regarding eligibility, coverage, claims processing to the dental contractor, and maintaining a listing of network dental providers.

POINT OF CONTACT: BASE MTF HBA

TOPIC 11: MILITARY PERSONNEL FLIGHT (MPF) CUSTOMER SERVICE ELEMENT

DISCUSSION: The MPF Customer Service Element is responsible for TRICARE-FMDP enrollment, election coverage changes, disenrollment, error resolution, and may assist in resolving claims processing issues with the MTF HBA, DEERS, and Air Force Personnel Data System (PDS).

POINT OF CONTACT: BASE MPF CUSTOMER SERVICE ELEMENT

TOPIC 12: FINANCE SERVICE OFFICE (FSO)

DISCUSSION: The Finance Service Office (FSO) provides the MPF Customer Service Element assistance with the sponsor's Master Military Pay Account (MMPA) dental deduction "DC" record and copies of End of Month Leave and Earning Statements (LESs). These finance transactions are the result FMDP premium deduction events occurring at the Defense Finance and Accounting Service (DFAS-DE) and family members DEERS Identification (ID) card benefits at the Defense Manpower Data Center/DEERS Support Office (DMDC/DSO).

POINT OF CONTACT: BASE FSO

TOPIC 13: QUICK REFERENCE CHECK-LIST

DISCUSSION: Sponsors and their family members should perform the following tasks periodically, to ensure that their TRICARE-FMDP eligibility and enrollment coverage's are correct and up-to-date:

A. Validate DEERS and TRICARE (formerly CHAMPUS) eligibility and enrollment of family members, including End of Entitlement (EEN) for those family members issued an identification (ID) cards. If a family member was not issued an ID card, EEN validation in DEERS is still required at the Military Personnel Flight (MPF) customer service, since this event will affect medical and dental benefits, and privileges.


B. Verify monthly for correct TRICARE-FMDP dental premium deductions as reflected on the End of Month Leave and Earning Statement (LES). This is one source that indicates whether TRICARE-FMDP coverage is in effect, or coverage has changed from single to family and vice versa upon sponsor's election actions or family member's DEERS eligibility and enrollment requirements. See your local Finance Service Office (FSO) and Military Personnel Flight (MPF) Customer Service Element for premium transactions and DEERS eligibility and enrollment.


C. Read your Dental Benefit Booklet and know your family member's TRICARE-FMDP entitlements and benefits before proceeding with treatment from the dentist. For additional information, contact your servicing military Medical Treatment Facility (MTF) Health Benefits Advisor (HBA) or United Concordia Companies, Inc., (UCCI).


D. Contact your servicing (MPF) Customer Service Element when encountering TRICARE-FMDP problems regarding enrollment, election coverage changes, and disenrollment. Note: Contact your dental provider regarding enrollment/coverage, or denial payment(s) from the dental contractor. Your personal involvement with the dental contractor, MPF Personnel, Finance, or the DEERS Support Office will aid in the resolution process. Don't assume that the FMDP "system" will automatically correct, or resolve a problem error without your personal involvement.

Information Courtesy of U.S. Air Force

U.S. Military

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