TRICARE DENTAL PLAN (TDP-7) HIGH LEVEL OBJECTIVES.pdf

TRICARE DENTAL PLAN SEVENTH GENERATION CONTRACT HIGH LEVEL

OBJECTIVES

• Scope: The TRICARE Dental Program (TDP) offers worldwide dental coverage to all eligible family members of Uniformed Service active-duty personnel, members of the

Selected Reserve, the Individual Ready Reserve (IRR), the National Guard, and their eligible family members. Active-duty service members, former spouses, parents, in-laws, disabled veterans, foreign personnel, and retirees and their families are not eligible for the

TDP.

o There are roughly three million eligible beneficiaries with 1.7M enrollees in the

TDP.

• The TDP geographic area of coverage is the “Continental United States” (CONUS), as that term is defined in 32 CFR 199.13(a), which includes the 50 United States, the

District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands. Outside the

Continental United States (OCONUS), the service area includes all other countries, island masses and territorial waters. To fulfill DHA’s mission, the TRICARE Dental Plan

Seventh Generation (TDP-7) contract requires contractors to provide general and specialty dental care to TDP enrollees by establishing and maintaining provider networks in the 50 United States, District of Columbia, U.S. Virgin Islands, Guam, and Puerto

Rico. In addition, the contractors shall develop and maintain agreements with and credential OCONUS providers, referred to as TRICARE OCONUS Preferred Dentists

(TOPDs), who will provide general and specialty dental care to enrollees.

o TDP-7 will include 2-4 dental carriers.

• Contract Objectives o Dental Services.

▪ Provide worldwide cost-effective dental care services for enrollees, utilizing diagnostic and preventive services.

• Comply with the most current version of American Dental

Association's (ADA) Current Dental Terminology (CDT) manual for covered services and update its required systems.

• Provide and maintain access to general and specialty network providers for enrollees.

• Deploy Mobile Dental Units (MDUs) in accordance with the contract Section J, Attachment J-5.

o Dental Administration. Establish data systems to monitor dental health plan data and outcome measures for all dental care rendered.

▪ Contractors shall be responsible for program operations and administration. This includes administrative services, such as: customer service, benefit management, provider network management, claims processing, and beneficiary and provider education, consistent with commercial best practices and industry standards.

o Basic Plan. Create and offer a basic dental plan with coverage in accordance with

32 Code of Federal Regulations (CFR) 199.13(e)(iv)(2) with a global premium for standard plans.

o High-Option Plan. Create and offer a high-option dental plan which will include all care included under the basic plan along with additional coverage as each contractor sees fit.

o Agreements with the Third-Party Administrator (TPA). Dental carriers will be required to sign a Memorandum of Understanding (MOU) or Service Level

Agreement (SLA) with the TPA regarding, but not limited to, premiums transfer to carriers, reconciliations, data sharing, and systems interfaces.

o Open Season Enrollment. The TDP-7 will have an annual open-season enrollment period that matches the TRICARE Health Plan open-season enrollment period. Carriers will need to market and educate potential enrollees on their plans, premiums, services offered under each plan, and their dental networks.

▪ Enrollment will be managed by the TPA.

▪ No automatic enrollment at start of contract

▪ Open season aligned with TRICARE open season