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Disenrolling from TRICARE Dental Program

You can disenroll from TRICARE Dental Program by completing a new TRICARE Dental Program Enrollment/Change Authorization Form.*

Your coverage ends depending on when your form is received. See below for more details.

Date Application Received  Coverage Ends 
December 21-January 20 February 1 
January 21-February 20 March 1 
February 21-March 20  April 1 
March 21-April 20  May 1 
April 21-May 20   June 1 
May 21-June 20  July 1 
June 21-July 20  August 1 
July 21-August 20   September 1 
August 21-September 20  October 1 
September 21-October 20  November 1 
October 21-November 20  December 1 
November 21-December 20  January 1 

* Must meet 12-month lock-in except under certain circumstances.

Last Updated 4/27/2017

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United Concordia

CONUS: 844-653-4061 
OCONUS: 844-653-4060 
OCONUS Toll: 717-888-7400


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