TRICARE Dental Program P.O. Box 645547 Pittsburgh, PA. Specifically designed for—and exclusively offered to—Active Duty Family Members and National Guard & Reserve Members and their families. Comprehensive coverage wherever you go.
The purpose of this Data Protection Statement is to notify you of the practices that will govern the processing of your personal data and to obtain your explicit consent for the processing of your personal data consistent with it, in particular in accordance with the legal requirements of the European Union’s (“EU”) General Data Protection Regulation (“GDPR”):
- TRICARE Dental Program - Grievances 1800 Center Street 2AL4 Camp Hill, PA 17089 Fax: 717-260-7168. Enrollment Applications Enrollment/Change Form and Initial Payment. United Concordia TRICARE Dental Program P.O. Box 645547 Pittsburgh, PA. Recurring Payments. United Concordia TRICARE Dental Program P.O. Box 645534 Pittsburgh, PA 15264.
- December 31, 2018 marks the end of the TRICARE Retiree Dental Program (TRDP) as retirees will be required to enroll in a dental plan through the Federal Employees Dental and Vision Insurance.
- TRICARE Dental Costs. The TRICARE Dental Program is an affordable option for eligible beneficiaries. With Government-shared premiums and cost-shares, you get the most coverage for minimal out-of-pocket costs. Cost-shares vary depending upon the sponsor's pay grade. A breakdown of cost-shares and premiums is available in the sections below.
- To ensure efficient service, refills must be requested in advance by calling the refill number on the prescription bottle (757-953-2500 or 1-866-878-9321) or using Tricare Online Refills require 2 duty days to process (not to include Saturday, Sunday or Holidays).
The personal data collected may include your address, city, postal code, country, phone number, email address, IP address, as well as any other personal information you choose to provide (“Personal Data”). This information will be used for purposes of performing services to, or on behalf of, our enterprise customers and prospective customers as part of and in relation to matters regarding our provider, health plan, and subsidiary enterprise care delivery, administration and operations. We will retain the information in our system in accordance with applicable law and our Data Protection Policy:https://www.highmark.com/hmk2/gdpr.shtml
Your email address and phone number may be used to contact you. All reasonably appropriate measures will be taken to prevent disclosure of your Personal Data beyond the scope provided directly or indirectly herein or as may be reasonably inferred from the content contained in this notice or the website.
Your Personal Data will be disclosed to appropriate personnel for purposes of performing services to, or on behalf of, our enterprise customers and prospective customers as part of and in relation to matters regarding our provider, health plan, and subsidiary enterprise care delivery, administration and operations. Notwithstanding the above disclosures, we will disclose the Personal Data we collect from you under the following circumstances:
- (i) when required or permitted by law or government agencies,
- (ii) when required valid requests by law enforcement,
- (iii) for purposes relevant to corporate policies or litigation to the extent permitted under applicable law or when it is prescribed in GDPR or other applicable law.
We use third-party service providers to process Personal Data, including, without limitation, for information storage and other similar purposes. These services providers are located in the United States. These service providers will be bound by sufficient guarantees to implement appropriate technical and organizational measures in such a matter that their processing will meet the requirements of applicable law.
Your Personal Data will remain on file for: any period required by applicable law; and, to the extent necessary for any purpose(s) provided directly or indirectly herein or as may be reasonably inferred from the content contained in this notice or the website, but no longer than permitted by applicable law. After that, all Personal Data will be deleted or the documents with such data will be anonymized. If you have questions regarding how we process your Personal Data and what we store about you, please contact PrivacyInternational@HighmarkHealth.org or write us:
Data Protection OfficerHighmark HealthTricare Dental Copay
120 Fifth Avenue, Suite 2114Pittsburgh, PA 15222, USATricare Dental Cost Per Month
Consent
By agreeing to the terms and conditions set out in this Data Protection Statement, and by providing us with your Personal Data, you consent to the collection, use and disclosure of any information you provide in accordance with the above purposes and this Data Protection Statement.
You also explicitly consent to the automated decision making by us, which may include the processing of your health data, to the extent that it is necessary to process your health claim swiftly and efficiently.
Notes: This consent is given voluntarily and can be revoked at any time in writing by sending an email to PrivacyInternational@HighmarkHealth.org If you want to exert your withdrawal right or your rights to access, rectify, block, transfer or delete your personal data pursuant to the GDPR, please contact us and provide us at least with your full name, address and the data processing you are inquiring about. If you are not satisfied with our data processing you have the right to lodge a complaint to the data protection authority in your country of residence.
Costs
Find your TRICARE costs, including copayments,enrollment fees, and payment options.
You'll pay cost-shares for covered dental services, as well as your monthly premiums. Your cost-shares depend on:
- Your sponsor's pay grade and
- Where you live, the CONUS Service AreaUnited States, District of Columbia, Guam, Puerto Rico and the U.S. Virgin Islands or the OCONUS Service AreaAreas outside of the United States, District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands..
| Covered Services | CONUS Service Area | OCONUS Service Area | |
|---|---|---|---|
| Pay Grades E-1 - E-4 | Pay Grades E-5 and above | Command-Sponsored Beneficiaries1 | |
| Diagnostic | 0% | 0% | 0% |
| Preventive2 | 0% | 0% | 0% |
| Sealants (Sealants included at 0% after May 1st, 2017) | 20% | 20% | 0% |
| Consultation/Office Visit | 20% | 20% | 0% |
| Post-Surgical Services | 20% | 20% | 0% |
| Basic Restorative | 20% | 20% | 0% |
| Endodontic | 30% | 40% | 0% |
| Periodontic | 30% | 40% | 0% |
| Oral Surgery | 30% | 40% | 0% |
| General Anesthesia | 40% | 40% | 0% |
| Intravenous Sedation | 50% | 50% | 0% |
| Miscellaneous Services(occlusal guard, athletic mouth guard) | 50% | 50% | 0% |
| Other Restorative | 50% | 50% | 50% |
| Implant Services | 50% | 50% | 50% |
| Prosthodontic | 50% | 50% | 50% |
| Orthodontic3 | 50% | 50% | 50% |
- Doesn’t apply to Selected Reserve and Individual Ready Reserve members (other than Special Mobilization Category) and their families. They will pay CONUS cost-shares.
- We fully cover space maintainers for posterior teeth for patients under age 19. We cover them at a 20% cost-shareA percentage of the total cost of a covered health care service that you pay. for patients under age 19 when replacing anterior teeth only. We cover sealants at 20% as noted above.
- Available for enrolled family members. We cover:
- Children up to age 21 or 23, based on your student status: >>Learn more
- Spouses up to age 23
- National Guard/Reserve sponsors up to age 23
Your dental coverage has specific limits and exclusions. You can get details at TRICARE Dental Program Benefit Booklet.
Last Updated 9/3/2020