Metlife Wins New Tricare Contract

After 15 years of processing claims for the world’s largest dental plan–the TRICARE Dental Program (TDP)–United Concordia will finally be passing the baton. MetLife has been awarded the new Department of Defense contract and will begin handling TDP claims beginning May 1, 2012.

TDP covers over two million beneficiaries, including family members of uniformed services active duty personnel in the United States plus members of the selected reserve and individual ready reserve (and their eligible family members) around the world. The TDP is a voluntary premium-based program; the U.S. government pays 60% of the premium and enrollees pay 40%. Of the 4.4 million people who are eligible for the TDP, two million are currently enrolled.

At the ADA’s National Dental Benefits Conference in August 2011, Col. Jeffrey Chaffin, DDS (Chief of the TMA Dental Care Branch) provided an overview of the TDP program and several interesting utilization facts. According to Dr. Chaffin, 62.1% of TDP enrollees received an exam and 58.5% received a cleaning during 2010. However, only 1% of TDP enrollees reached their $1,200 annual maximum. Dr. Chaffin also noted that the new TDP contract provides an incentive to the insurer for achieving certain utilization goals, one of which is to increase utilization of examinations and prophylaxis visits.

It is also interesting to note that the TDP contract requires the insurance carrier to provide access to a general dentistry network provider within 35 miles of the enrollee’s residence, and the enrollee must be able to obtain an appointment within 21 calendar days of requesting an appointment. The TDP contract requires the insurance company to pay the difference between network and non-network fees in locations that do not meet the TDP access standards.

The new TDP contract also provides several new benefits and enhancements:

  • Increase in the annual dental maximum from $1,200 to $1,300
  • Increase in the lifetime orthodontic maximum from $1,500 to $1,750
  • Coverage for posterior composite/resin fillings
  • Additional $1,200 per year for services related to accidents/injuries
  • Third cleaning for women during pregnancy
  • No cost shares for scaling and root planing for diabetics
  • Reduced premiums for first year enrollees