Explore your new dental coverage options now at tricare.benefeds.com. You can enroll during the Federal Benefits Open Season, which runs from Nov. 12 until midnight Eastern Standard Time Dec. 10, 2018.
If you are currently enrolled in the TRICARE Retiree Dental Plan (TRDP), administered by Delta Dental, you will not be enrolled in a FEDVIP plan automatically for 2019.
You must enroll during the Federal Benefits Open Season. If you do not enroll, you will not have dental coverage Jan. 1.
Also note: Due to each MOAA member's unique circumstances, MOAA benefits experts can only answer general questions about benefits. They cannot select a plan for members.
As you consider the plan that is best for you, here are some considerations:
- the location of your eligible family members,
- dental services you and your family might need,
- network type,
- option choice,
- cost sharing, and
- premium cost in your area.
Are you and your family members located in the same area?
For example, if you live in Washington, D.C., and your child attends school in California or overseas, you should choose a nationwide/international plan. However, a regional plan could prove to be a better choice, if you and your family all live within the same service area.
Depending on your family needs, some plans might be better choices than others.
For example, if your child needs braces (or is currently in the process of getting braces), consider a plan that does not have a waiting period for orthodontic services.
There are no waiting periods for crowns, implants, or other major services.
If you expect to need major services, such as crowns or implants, visit the FEDVIP TRICARE website to review the plan brochure, called a Statement of Benefits, to see your share of the payment for the service, called a copayment or coinsurance.
NOTE: Plan-specific exclusions or limitations, such as a missing tooth clause, might apply.
[RELATED: FEDVIP 2019 dental rates (PDF)]
FEDVIP plans include three network types:
- exclusive provider organizations (EPOs),
- health maintenance organizations (HMOs), and
- preferred provider organizations (PPOs).
Under EPOs, you can use any dental provider within the EPO network (general dentist or specialist) without a referral, but you cannot go outside the network for care. There are no out-of-network benefits in an EPO.
Under HMOs, you have access to a defined, contracted network of dental providers. However, you must receive services from your selected participating general dentist. If specialty services are necessary, a referral will be provided by your participating general dentist.
In FEDVIP HMO plans, an orthodontist can be selected from the network for orthodontia services without a referral.
Under PPOs, you can obtain care from any licensed dentist. If the dentist is a nonparticipating provider, benefits will be considered out-of-network. When you see a dentist who is outside of the network, you usually will have more out-of-pocket costs.
It is important to know if your dentist is part of your dental plan's network. Otherwise, you might spend more than expected for your dental services.
Under the PPO model, you might continue to see an out-of-network dentist by paying more out-of-pocket costs. Under the EPO and HMO models, you might be responsible for paying for all services you receive from an out-of-network dentist.
Some FEDVIP carriers provide a Standard option and a High option.
High option plans have higher monthly premium. Typically, High option plans have lower coinsurance costs, higher orthodontic lifetime limits, and higher annual maximums. Choosing a High option plan reduces the unexpected expenses but costs more each month.
Standard option plans have a lower monthly premium and a lower maximum benefit. Generally, the amount you pay for each service is greater. Choosing a Standard option plan reduces monthly premium expenses, but you could pay more for specific services.
FEDVIP carriers require some form of cost sharing by the enrollee, except for a majority of in-network preventive care services.
In EPO and HMO plans, you have fixed copayments for specific services. An HMO plan also will have an office visit copayment each time you see your dentist. For example, you might pay your dentist $10 for each office visit, in addition to a set dollar amount for a specific treatment.
Under PPO plans, you typically pay a percentage of the negotiated payment to the dentist, known as coinsurance. None of the FEDVIP PPO or EPO plans require an additional office visit copayment each time you see your dentist.
In the table provided, the range of copayments or the percentage of payment is noted for each type/class of service. You can refer to the statement of benefits for each plan at tricare.benefeds.com for more detailed information.
When you sign up for a FEDVIP dental plan, you will be responsible for paying a monthly premium.
In most cases, depending on your eligibility and available funds and/or allotments, FEDVIP will set up an allotment automatically with your pay provider to pay for your FEDVIP premiums, post-tax. FEDVIP premium rates vary by location. You can check monthly premium rates and make comparisons using the plan comparison tool available on the TRICARE FEDVIP website.
This article first appeared in the November issue of Military Officer, which includes a comparison chart of all plans. Military Officer is available to Premium and Life members.