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2.5. Dental Services

Dental Services in the VA are provided to Veterans with certain eligibility requirements and they differ significantly from eligiblity requirements for all other types of medical care.  The dental benefits are categorized into eligibility classes.  Categories Class I, IIA, IIC, or IV are eligible to receive any necessary dental care to maintain or restore oral health and masticatory function, including repeat care.   Other classes have time and/or service limitations.   

If eligible, You can ask your VA primary care physician to obtain a referral to the outpatient dental clinic at the nearest VA medical facility or  by using VA Form 10-10EZ "Application for Health Benefits" to apply online at https://www.1010ez.med.va.gov. 

If you are not eligible for one of the classes, you may obtain dental services and treatment via the VA  comprehensive national VA Dental Insurance Program, VADIP, which provides enrolled VA Healthcare Veterans and CHAMPVA receipients with the opportunity to purchase reduced cost dental insurance either with Delta Dental or MetLife.   Participation is voluntary.  Purchasing a plan does not affect the Veterans current eligibility for VA dental services and treatment.

You are eligible for outpatient dental care if you meet one of the following criteria: 

If you:	You are eligible for:	Through
Have a service-connected compensable dental disability or condition.	Any needed dental care	Class I
Are a former prisoner of war.	Any needed dental care.	Class IIC
Have service-connected disabilities rated 100% disabling, or are unemployable and paid at the 100% rate due to service-connected conditions.	Any needed dental care. [Please note: Veterans paid at the 100% rate based on a temporary rating, such as extended hospitalization for a service-connected disability, convalescence or pre-stabilization are not eligible for comprehensive outpatient dental services based on this temporary rating].	Class IV
Apply for dental care within 180 days of discharge or release (under conditions other than dishonorable) from a period of active duty of 90 days or more during the Persian Gulf War era.	One-time dental care if your DD214 certificate of discharge does not indicate that a complete dental examination and all appropriate dental treatment had been rendered prior to discharge.*	Class II

Have a service-connected noncompensable dental condition or disability resulting from combat wounds or service trauma.	Any dental care necessary to provide and maintain a functioning dentition. A Dental Trauma Rating (VA Form 10-564-D) or VA Regional Office Rating Decision letter (VA Form 10-7131) identifies the tooth/teeth/condition(s) that are trauma rated.	Class IIA
Have a dental condition clinically determined by VA to be associated with and aggravating a service-connected medical condition.	Dental care to treat the oral conditions that are determined by a VA dental professional to have a direct and material detrimental effect to your service connected medical condition.	Class III
Are actively engaged in a 38 USC Chapter 31 vocational rehabilitation program.	Dental care to the extent necessary as determined by a VA dental professional to: Make possible your entrance into a rehabilitation program Achieve the goals of your vocational rehabilitation program Prevent interruption of your rehabilitation program Hasten the return to a rehabilitation program if you are in interrupted or leave status Hasten the return to a rehabilitation program of a Veteran placed in discontinued status because of illness, injury or a dental condition, or Secure and adjust to employment during the period of employment assistance, or enable you to achieve maximum independence in daily living.	Class V
Are receiving VA care or are scheduled for inpatient care and require dental care for a condition complicating a medical condition currently under treatment.	Dental care to treat the oral conditions that are determined by a VA dental professional to complicate your medical condition currently under treatment.	Class VI
Are an enrolled Veteran who may be homeless and receiving care under VHA Directive 2007-039.	A one-time course of dental care that is determined medically necessary to relieve pain, assist you to gain employment, or treat moderate, severe, or complicated and severe gingival and periodontal conditions.	Class IIB

 

VA Dental Insurance Program (VADIP)

VADIP was created to assess Veterans' interest in and the effectiveness of providing a premium-based dental insurance plan to eligible individuals. The program is mandated by Public Law 111-163, Caregivers and Veterans Omnibus Health Services Act of 2010. The three-year, national pilot program was launched January 1, 2014.

Eligibility for VADIP

Veterans enrolled in the VA health care program and CHAMPVA beneficiaries are eligible to participate in VADIP. Participation in VADIP does not affect Veterans' eligibility for VA dental services and treatment. Dependents of Veterans, except those eligible under CHAMPVA, are not eligible for VADIP.

Dental Plan Information

VA has contracted with Delta Dental and MetLife, private insurers, to administer VADIP. Individuals interested in participating in VADIP can complete an application online, over the phone or by mail. A direct link to each provider's VADIP webpage is available from www.va.gov/healthbenefits/VADIP. The following table shows contact information for each provider.

PROVIDER	TOLL-FREE NUMBER	WEBSITE	MAILING ADDRESS
Delta Dental	1-855-460-3302	www.deltadentalvadip.org	Delta Dental of California Federal Government Programs PO Box 537009 Sacramento, CA 95853-7009
MetLife	1-888-310-1681	www.metlife.com/VADIP	MetLife Dental Claims PO Box 981282 El Paso, TX 79998-1282

 

Coverage will be provided throughout the United States and its territories. The initial participation period will be at least 12 calendar months. Afterward, VADIP beneficiaries can renew their participation for another 12-month period or be covered month-to-month, as long as the participant remains eligible for coverage and VA continues VADIP. Multiple plan options allow participants to select a plan that provides benefits and premiums that meet their dental needs and budget. Offered plans vary and may include diagnostic, preventative, surgical, emergency and endodontic/restorative treatment. Each participant will pay a fixed monthly premium for coverage, in addition to any copayments required by his or her plan. 

For more information on VADIP, visit www.va.gov/healthbenefits/VADIP and click the insurer's link for specific information regarding registration, rates and services, or call Delta Dental at 1-855-370-3303 or MetLife at 1-888-310-1681.

 

Notes

a. Veterans paid at the 100% rate based on a temporary rating, such as extended hospitalization for a service-connected disability, convalescence or pre-stabilization are not eligible for comprehensive outpatient dental services based on this temporary rating.

b. Public Law 83 enacted June 16, 1955 amended Veterans' eligibility for outpatient dental services. As a result, any Veteran who received a dental award letter from VBA dated before 1955 in which VBA determined conditions to be noncompensable are no longer eligible for Class II outpatient dental treatment.