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Frequently Asked Questions
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. Enrollees in the basic TRDP are not entitled to the same benefits and do not pay the same premiums as enrollees in the enhanced TRDP. Both the basic program benefits booklet and enhanced program benefits booklet are available online for detailed benefits information. 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. You may also verify whether you are enrolled in the basic or enhanced TRDP by checking the online Consumer Toolkit®. In addition to your 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. 2. Do my premiums increase during my enrollment in the TRDP? If so, when and how much? Yes. Monthly premiums under the TRDP are scheduled to increase slightly on May 1 of each contract year. Current and subsequent premium rates vary and are based on the region in which you maintain your primary residence as well as your enrollment option (single, two-person or family enrollment). Although premiums rates for both the basic and enhanced programs are scheduled to increase each May 1, enrollees in the basic program do not pay the same premiums as enrollees in the enhanced program. Enrollees can find the current premium rates for the enhanced TRDP on this web site. If you are enrolled in the basic TRDP, please call (888) 838-8737 to find out your current premium rates. Note that Department of Defense-directed implementation of further program enhancements could result in the contractual establishment of premium rate changes from those for the current contract year. Also, your monthly premium rate may change if you move or change your enrollment option. 3. How do I enroll dependents once I have enrolled in the TRDP? It is easy to enroll eligible dependents under your TRDP coverage at any time during your enrollment period. When you call or write us to enroll dependents, be prepared with the following required information:
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, and the dependent(s) must also satisfy the 12-month waiting period for major services, 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. Even though the basic TRDP is closed to new enrollments after August 31, 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 4. How do I disenroll dependents from my TRDP coverage ? You may disenroll dependents from your TRDP coverage at any time during your enrollment period, in much the same way as you would enroll them (see above). Remember that an enrolled dependent (spouse or child) must satisfy a 12-month commitment prior to disenrolling unless the request to disenroll the dependent is made specifically for any of the reasons listed below. When you call or write us to disenroll dependents, be prepared with the following required information:
The deletion of dependent(s) from your TRDP coverage will be effective 30 days after your initial request. 5. 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 $50.00 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. The deductible and maximum amounts restart each year on May 1. You can check the online Consumer Toolkit to find out how much of your annual deductible and maximum you have used year-to-date. 6. 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 network dentist or a Delta Dental Premier ® dentist is that he or she will complete and submit all the claims paperwork for you. Some non-network dentists may provide this service as well, or they may give you a standard dental claim form to complete yourself. As a service to you, Delta Dental has provided a claim form on this web site that can be printed out, completed and submitted as needed. If you need help in completing this 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 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 (or 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 current contract for the TRDP began on May 1, 2003, a contract year runs from May 1 through April 30. Your TRDP premiums, deductible and annual maximums begin, end and start anew on May 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 specific to your submitted claims for dental services allowed under the TRDP. 8. Are implants and composite fillings covered benefits under the TRDP? Not at this time. Neither implants nor composite (tooth-colored) fillings on posterior (back) teeth were included in the original basic benefit design of the TRDP. However, a silver-filling (amalgam) allowance for posterior composites was one of the first benefits to be added to the program design when the TRDP was enhanced in October 2000. 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 have additional benefits like an allowance for posterior composites. 9. 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.
10. How do I upgrade my basic coverage to the enhanced program? Upgrading your basic coverage is easy. All the information you need to know about upgrading your coverage to the enhanced program is available on this web site. When you are ready to upgrade, you have three options:
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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