TRICARE Dental

TRICARE TRICARE DentalDentalAn Overview of the Military An Overview of the Military

Health System’s Dental Health System’s Dental Insurance ContractsInsurance Contracts

Disclaimer: For information purpose only, presenter is not Disclaimer: For information purpose only, presenter is not subject matter expert. Slides provided by COL Martin/ CDR subject matter expert. Slides provided by COL Martin/ CDR

Mitton of TMAMitton of TMA

TRICARE Dental Program (TDP)TRICARE Dental Program (TDP) Children’s InitiativeChildren’s Initiative

TRICARE Retiree Dental Program TRICARE Retiree Dental Program (TRDP)(TRDP)

AgendaAgenda

TRICARE Dental TRICARE Dental ProgramProgram

Offered by the Department of Defense through the Offered by the Department of Defense through the

TRICARE Management Activity (TMA)TRICARE Management Activity (TMA) Contractor: United Concordia Companies, Inc. Contractor: United Concordia Companies, Inc.

((UCCI administers and underwrites the TDP for TMA)UCCI administers and underwrites the TDP for TMA)

Option year one of five: Began 1 Feb 06Option year one of five: Began 1 Feb 06

Provides worldwide dental coverage to family members Provides worldwide dental coverage to family members

of all active duty uniformed services personnel and of all active duty uniformed services personnel and

National Guard/Reserve members and /or their familiesNational Guard/Reserve members and /or their families

Website:Website: www.TRICAREdentalprogram.comwww.TRICAREdentalprogram.com


Premium Based ProgramPremium Based Program

Premiums shared between Premiums shared between enrollee (40%)enrollee (40%) and and Government (60%)Government (60%) Active Duty Family MembersActive Duty Family Members National Guard/Reserve MembersNational Guard/Reserve Members Guard/Reserve Family Members pay 100% of premiumGuard/Reserve Family Members pay 100% of premium

Cost sharesCost shares Lower for grades E-1 to E-4Lower for grades E-1 to E-4

Annual maximum $1,200Annual maximum $1,200

Lifetime orthodontic maximum $1,500Lifetime orthodontic maximum $1,500


Worldwide CoverageWorldwide Coverage

Uniform Benefit Uniform Benefit CONUS/OCONUSCONUS/OCONUS

Comprehensive BenefitComprehensive Benefit

Enhanced Benefits for New Enhanced Benefits for New ContractContract

TDP Contract ObjectivesTDP Contract Objectives

Increase overall TDP enrollment and Increase overall TDP enrollment and

increase utilization of diagnostic and increase utilization of diagnostic and

preventive servicespreventive services

Increase enrollment of National Guard and Increase enrollment of National Guard and

Reserve members in pay grades E-1 to E-4Reserve members in pay grades E-1 to E-4

TDP Benefit ChangesTDP Benefit ChangesEffective Feb 2006Effective Feb 2006

BENEFITBENEFIT CURRENT CONTACTCURRENT CONTACT 2006 2006 CONTRACTCONTRACT

BicuspidBicuspid CoveredCovered Not coveredNot covered SealantsSealants

Implants and Implants and Not covered Not covered Implants and Implants and related prosthetics related prosthetics ImplantImplant Prosthetic Prosthetic covered covered

Services Services

Full Mouth Full Mouth Not coveredNot covered Covered once per 24-month Covered once per 24-month DebridementDebridement period.period.

Frenectomy Frenectomy Not coveredNot covered Covered Covered

Annual maximumAnnual maximum $1200 $1200 $1200 $1200 Lifetime OrthoLifetime Ortho $1500 $1500 $1500 $1500

Dental ImplantsDental Implants Covered benefit as of 2/1/06Covered benefit as of 2/1/06

Covers both the Implant and the Crown placed on the ImplantCovers both the Implant and the Crown placed on the Implant

Subject to the $1200 annual maximum Subject to the $1200 annual maximum

OCONUS -- must submit NARF for Implant to be eligible.OCONUS -- must submit NARF for Implant to be eligible.

TDP Monthly TDP Monthly PremiumPremium

(Rates Effective 2/1/06 – (Rates Effective 2/1/06 – 1/31/07)1/31/07)

Shared PremiumShared Premium SingleSingle FamilyFamily Selected Reserve MemberSelected Reserve Member $10.51$10.51 IRR – Spec Mob CategoryIRR – Spec Mob Category $10.51$10.51 Active Duty Family or Family Active Duty Family or Family

of Reservist on Active of Reservist on Active Duty orders for more than 30 Duty orders for more than 30 daysdays

$10.51$10.51 $26.27$26.27

Full PremiumFull Premium IRR – Other than Special IRR – Other than Special

Mobilization CategoryMobilization Category$26.27$26.27

SELRES & IRR Family SELRES & IRR Family MembersMembers

$26.27$26.27 $65.68$65.68

National Guard/Reserve National Guard/Reserve

E1 – E4 Enrollment ProjectE1 – E4 Enrollment Project TDP contractual objective to increase enrollmentTDP contractual objective to increase enrollment Quality Improvement Program (QIP) projectQuality Improvement Program (QIP) project

Goal: increase enrollment by 70% in option year 1Goal: increase enrollment by 70% in option year 1 Demonstration Sites (San Diego, San Antonio, Demonstration Sites (San Diego, San Antonio,

Hampton Roads/VA Beach)Hampton Roads/VA Beach) Informational postcard w/ floss card to over 12,000 eligible Informational postcard w/ floss card to over 12,000 eligible

but not enrolledbut not enrolled Toll-free telephone numberToll-free telephone number Dental Benefit Advisor (DBA) briefings in conjunction w/ Dental Benefit Advisor (DBA) briefings in conjunction w/

mailingmailing Other initiatives include: print ads, posters for each Other initiatives include: print ads, posters for each

unit, DBA survey, Enrollment and Billing telephone unit, DBA survey, Enrollment and Billing telephone surveysurvey

TDP Contracts and Covered TDP Contracts and Covered LivesLives

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

1,800,000

Contracts 652,693 671,780 690,114 706,970 728,137

Covered Lives 1,602,158 1,658,318 1,707,679 1,747,653 1,779,469

CY2001 (OP1) CY2002 (OP2) CY2003 (OP3) CY2004 (OP4) CY2005 (OP5)

CY = contract year (option year); The TDP option year is Feb 1 to Jan 31

Enrollment of Active Duty Enrollment of Active Duty Family MembersFamily Members

40

50

60

70

80

90

100

% ADFM (Act only) 78.9 81.2

% ADFM (Grd/Res) 48.7 56.3

% Combined ADFM 73.1 76.8

CY2004 (OP4) CY2005 (OP5)

CY = contract year (option year); The TDP option year period is Feb 1 to Jan 31

CY2005 data is through Dec 2005.

Active Duty Family Members include Family Members of National Guard/Reserve members called to Active Duty for more that 30 days

TDP UtilizationTDP Utilization UtilizationUtilization

Utilization figures calculated using enrollees that Utilization figures calculated using enrollees that were enrolled for entire 12 months of calculated were enrolled for entire 12 months of calculated year.year.

TDP Utilization: 63.8%TDP Utilization: 63.8% Percentage of enrollees reaching $1200 Percentage of enrollees reaching $1200

maximummaximum Less than 1% of enrollees reach annual maximumLess than 1% of enrollees reach annual maximum

Percentage of children utilizing orthodontic Percentage of children utilizing orthodontic servicesservices 7.5% orthodontic utilization7.5% orthodontic utilization

TDP Provider Network TDP Provider Network GrowthGrowth

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

Individual Providers* 49,938 51,667 53,435 54,863 56,572 57,782

All Locations 63,964 65,856 67,876 72,434 74,441 75,893

1-Jan-2001 1-Jan-2002 1-Jan-2003 1-Jan-2004 1-Jan-2005 1-Jan-2006

*Includes specialists – currently, there are over 10,000 specialists in the TDP network.

PROVIDER NETWORKPROVIDER NETWORK

Network Access: Gen dentist, 35 driving Network Access: Gen dentist, 35 driving miles, 21 daysmiles, 21 days

RequiredRequired ActualActual01/31/0201/31/02 97.0% 97.0% 98.8% 98.8%01/31/0301/31/03 97.5% 97.5% 99.2% 99.2%01/31/0401/31/04 97.5% 97.5% 99.6% 99.6%01/31/0501/31/05 97.5% 99.2% 97.5% 99.2%

02/01/0602/01/06 99.0% 99.3% 99.0% 99.3%

Enrollee Enrollee Satisfaction Survey 2005Satisfaction Survey 2005

SeptembeSeptemberr

OctoberOctober NovembeNovemberr

Network AccessNetwork Access 90%90% 94%94% 92%92%

Claims ProcessingClaims Processing 95%95% 96%96% 96%96%

Customer ServiceCustomer Service 85%85% 89%89% 83%83%

Enrollment ProcessEnrollment Process 92%92% 90%90% 95%95%

Size & Quality of NetworkSize & Quality of Network 90%90% 91%91% 89%89%

Composite ScoreComposite Score% rating good, very good or % rating good, very good or excellentexcellent

90%90% 92%92% 91%91%

Children InitiativeChildren Initiative TMA requesting services assistance to TMA requesting services assistance to

encourage dental examinations for Service encourage dental examinations for Service member children by their member children by their first birthdayfirst birthday

Initiative backgroundInitiative background Many children suffering preventable dental Many children suffering preventable dental

disease including Early Childhood Caries (ECC)disease including Early Childhood Caries (ECC) Resultant disease culminates in costly procedures Resultant disease culminates in costly procedures

often under general anesthesiaoften under general anesthesia Much of the financial burden is not covered Much of the financial burden is not covered

by the dental insurance or TRICARE medical by the dental insurance or TRICARE medical benefits and are the responsibility of the benefits and are the responsibility of the Service member (60% of general anesthesia Service member (60% of general anesthesia is covered for TDP members)is covered for TDP members)

TMA Letter

Children Initiative Children Initiative (cont’d)(cont’d)

Automatic enrollment of children at Automatic enrollment of children at age 4age 4

Before age 4, enrollment must be Before age 4, enrollment must be requested through UCCIrequested through UCCI

No additional premium if already on No additional premium if already on family planfamily plan

Single enrollees, with spouse only, Single enrollees, with spouse only, early enrollment will increase early enrollment will increase premium to family levelpremium to family level

Children Initiative Children Initiative ObjectivesObjectives

Dental Providers educate Service Dental Providers educate Service members about importance of early members about importance of early childhood dental visits (TMA childhood dental visits (TMA recommends at year 1)recommends at year 1)

Dental Providers as ambassadors – Dental Providers as ambassadors – understanding the program, speaking understanding the program, speaking to patients with knowledge that TDP to patients with knowledge that TDP offers 100% coverage for all offers 100% coverage for all diagnostic and preventive services, diagnostic and preventive services, excluding sealantsexcluding sealants

www.tricaredentalprogram.com

TRICARE Retiree Dental TRICARE Retiree Dental ProgramProgram

Contractor: Delta Dental of CaliforniaContractor: Delta Dental of California

Option year three of five: Began May 05Option year three of five: Began May 05

HistoryHistory

1997 – Legislation for retiree dental program1997 – Legislation for retiree dental program

1998 – Basic Program Implemented1998 – Basic Program Implemented

2000 – Enhanced Program Implemented2000 – Enhanced Program Implemented

2003 – New Contract Implemented2003 – New Contract Implemented

2005 – Reached 900,000 Covered Lives2005 – Reached 900,000 Covered Lives

Website:Website: www.trdp.orgwww.trdp.org


CONUS CoverageCONUS Coverage

Premium Based Program with Premium Based Program with deductiblesdeductibles

Enrollees pay Enrollees pay 100% of the 100% of the premiumpremium

Annual growth in number of Annual growth in number of contractscontracts


PremiumsPremiums Three levelsThree levels Five regionsFive regions

BenefitsBenefits Comprehensive benefitComprehensive benefit 100/80/60/50 cost shares100/80/60/50 cost shares 12-month waiting period for crowns, prosthetics and 12-month waiting period for crowns, prosthetics and

orthodontics (waiver)orthodontics (waiver) Orthodontics for children and adults ($1,200 lifetime Orthodontics for children and adults ($1,200 lifetime

max)max) Accident coverageAccident coverage Deductible $50/$150Deductible $50/$150 Annual maximum $1,200Annual maximum $1,200

TRDP Contracts and TRDP Contracts and Covered LivesCovered Lives

0

200,000

400,000

600,000

800,000

1,000,000

Contracts 264,131 292,858 319,048 359,354 434,664

Covered Lives 578,857 634,965 684,716 763,975 925,874

CY2001 CY2002 CY2003 (OP1) CY2004 (OP2) CY2005 (OP3)

Current Contract Period(OP3 is through January 2006)

CY = contract year (option year); The TRDP option year is May 1 to Apr 30

TRDP Provider NetworkTRDP Provider Network

0

20,000

40,000

60,000

80,000

100,000

Dentist Locations 78,958 93,016 95,269

CY2003 (OP1) CY2004 (OP2) CY2005 (OP3)

Individual Providers: 61,695(OP3 is for December 2005)

CY = contract year (option year); The TRDP option year is May 1 to Apr 30


RetentionRetention

Year EnrolledYear Enrolled % Retained to Date% Retained to Date 19981998 68.8%68.8% 19991999 74.2%74.2% 20002000 77.3%77.3% 20012001 83.2%83.2% 20022002 84.8%84.8% 20032003 89.2%89.2% 20042004 94.3%94.3% 20052005 98.0%98.0%

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TRICARE Dental