Retiree Delta Dental Insurance

NOTE Clarksville Dental Center is a premier provider for the retiree insurance. Our contract write-offs are basedon 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

This chart provides an overview of coverage under the Basic TRICARE Retiree Dental Program for patients who visit a participating network dentist.

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.

Download and view the Enhanced TRDP Benefits Booklet

To view the the Enhanced TRICARE Retiree Dental Program Benefits Booklet,
you need Adobe Acrobat Reader.

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