Delta Dental TRICARE Retiree Dental Program Overseas Claim Submission

Required Information

*Select Overseas Country

*Enter Subscriber Email Address:

*Enter Subscriber Date of Birth: / / MM/DD/YYYY

*Enter Subscriber ID: (use either your 9-digit SSN or 11-digit Defense Benefits Number, excluding hyphens and spaces)

Required File Attachments

All overseas claims submitted via this form MUST include a scanned image file of your 1) dentist's payment receipt along with your 2) completed TRDP Claim Form. Accepted image file types are pdf, jpg, jpeg, tif and tiff.

*

Dentist Payment Receipt:

TRDP Claim Form:

Additional Information

Enter any additional related information that may be helpful in processing your claim:

Comments

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TRICARE Retiree Dental Program (TRDP) Overseas Claim Submission

Required Information

Required File Attachments

Additional Information

Security Question

TRICARE Retiree Dental Program (TRDP)
Overseas Claim Submission