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TRICARE Dental Program Forms

Claims Submission Document (CONUS)

TRICARE Dental Program participating dentists will file claims on your behalf, but if you need to submit a dental claim, mail or fax the completed Dental Expense Claim Submission Document to MetLife:

TRICARE Dental Program
P.O. Box 14181
Lexington, KY 40512

Fax: 1-855-763-1333

Claims Submission Document (OCONUS)

TRICARE Dental Program participating dentists will file claims on your behalf, but if you need to submit a dental claim, mail or fax the completed Dental Expense Claim Submission Document to MetLife:

TRICARE Dental Program
P.O. Box 14182
Lexington, KY 40512

Fax: 1-855-763-1334

For assistance, send an e-mail to: OCONUSDentalClaims@metlife.com

Credit Card/Electronic Funds Transfer Authorization

This form is used to establish your automatic payment method for ongoing TRICARE Dental Program monthly premiums. Please send signed Authorization and voided check or bank letter, if necessary, to the below address:

MetLife TRICARE Dental Program
Enrollment and Billing Services
P.O. Box 14185
Lexington, KY 40512

Department of Defense Active Duty/Reserve Forces Dental Examination Form (DD Form 2813)

This form is used to used to assist active duty and National Guard and Reserve members in documenting dental health for worldwide duty. It should be downloaded and given to the dental provider to complete.

Enrollment/Change Authorization

This form is used to enroll in the TRICARE Dental Program with MetLife. To enroll, submit this form and mail it along with your initial monthly premium payment (check, money order or credit card) to MetLife:

MetLife TRICARE Dental Program
Enrollment and Billing Services
P.O. Box 14185
Lexington, KY 40512

You will also use this form if you need to make changes to your existing TRICARE Dental Program enrollment.

Overseas Non-Availabilty and Referral Form

The Non-Availability and Referral Form (NARF) must be completed for orthodontic services in all OCONUS Service Area locations. The NARF will be issued by the TRICARE Area Office (or designee) or the overseas dental treatment facility in non-remote areas.

You will send the NARF along with a completed TDP OCONUS Claim Submission Document, and the provider’s bill for total orthodontic services to MetLife:

MetLife TRICARE Dental Program
P.O. Box 14182
Lexington, KY 40512
USA

Last Updated 9/3/2013