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Retiree Delta Dental Insurance
*NOTE Clarksville Dental Center is
a premier provider
for the retiree insurance. Our contract write-offs are
based
on the premier delta dental fees not the Retiree fees.
There are two plans offered by the retiree insurance.
Basic Plan group #4600 (not offered to new subscribers)
The basic plan allows 1 cleaning a year for patients 14 and
older, 2 cleanings a year for age 13 and under. This plan
does not cover major services such as crowns and bridges.
It also does not cover resin (white) fillings on posterior
(back) teeth. Please see your plan booklet for complete
coverage.
Basic Benefits Booklet.
Enhanced plan is group #4601
Download and view the Enhanced TRDP Benefits Booklet
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This chart provides an overview of coverage
under the Basic TRICARE Retiree
Dental Program for patients who visit a
participating network dentist.
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Benefits available during
enrollment |
*Delta Dental Pays:
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Diagnostic services
(such as exams) |
100%
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Preventive services
(such as cleanings)
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100%
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| Basic Restorative
services (such as fillings) |
80%
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| Endodontics
(such as root canals) |
60%
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| Periodontics
(such as gum treatment) |
60%
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| Oral Surgery
(such as extractions) |
60%
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| Emergency
(such as treatment for minor
pain) |
80%
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Deductibles & Maximums |
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Annual Deductible
(per person, limit $150 per family, per benefit
year)
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$50
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| Annual
Maximum (per person, per
benefit year) |
$1000
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| Benefit Year:
May 1- April 30 |
*The percentage paid by Delta Dental is based
on the allowed amount for each procedure. Only participating
network dentists have agreed not to charge more than the TRDP
allowed amount. Your out-of-pocket costs may be higher if care
is received from a non-participating provider.
Covered benefits are subject to certain
limitations. For more information on all covered services and
detailed information on benefit levels, limitations, exclusions,
program policies and payments for non-participating providers,
please see the
Basic Benefits Booklet.
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Download and view the Enhanced TRDP Benefits Booklet
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To view the the Enhanced
TRICARE Retiree Dental Program Benefits Booklet,
you need
Adobe Acrobat Reader. |
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Request your
Appointment
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