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FYI

Partnering with you to help create healthy smiles

Delta Dental’s expanded coverage for chronic conditions

Jan 27, 2023

By Delta Dental

As you know, medical conditions can seriously impact oral health. Maintaining dental health is of utmost importance for your patients with chronic conditions.

Because Delta Dental is dedicated to helping our members maintain both their oral and overall health, we offer an optional add-on called SmileWay® Wellness Benefits (known as SmileWay Enhanced Benefits in Texas). This benefit, which groups can choose to include under their Delta Dental PPO™ plans, covers additional gum and teeth cleanings for patients who need them most. And recently, we’ve expanded SmileWay® Wellness Benefits to cover even more conditions.

Better coverage for conditions, better health

The health of teeth and gums is tied to overall wellness, and patients with certain chronic conditions may benefit from additional teeth and gum cleanings.

To better cover these patients, Delta Dental has expanded SmileWay Wellness Benefits to cover members who have been diagnosed with any of these 14 chronic conditions:

  • Amyotrophic lateral sclerosis (ALS)
  • Cancer
  • Chronic kidney disease
  • Diabetes
  • Heart disease
  • HIV/AIDS
  • Huntington’s disease
  • Joint replacement
  • Lupus
  • Opioid misuse and addiction
  • Parkinson’s disease
  • Rheumatoid arthritis
  • Sjögren’s syndrome
  • Stroke

Who qualifies for SmileWay Wellness Benefits?

To qualify for SmileWay Wellness Benefits, a patient must:

  • Be enrolled in a Delta Dental PPO™ plan
  • Belong to a group that offers SmileWay Wellness Benefits
  • Have a qualifying diagnosis
  • Choose to opt into the benefit

How can patients opt in?

Opting in is simple, fast and free. For groups with this benefit, patients who have been diagnosed with one of the qualifying conditions can opt in online or by calling Customer Service.

How to verify patients’ eligibility

SmileWay Wellness Benefits on Provider Tools: SW denotes enrollee participation and SW-P denotes plan participation.

When you review patient benefits online in Provider Tools, you’ll see these notations:

  • SW- P. This means that the dental plan includes SmileWay Wellness Benefits, but the patient has not enrolled. To encourage enrollment, you can share this link or you can share the following SmileWay Wellness Benefits flyer in  English or  Spanish.
  • SW. This means that the patient has enrolled in SmileWay Wellness Benefits.

What’s covered under SmileWay Wellness Benefits?

Once they opt in, qualifying Delta Dental PPO enrollees get the following expanded coverage for additional cleanings:

  • 100% coverage each year for one scaling and root planing procedure per quadrant (D4341 or D4342)
  • and 100% coverage each year for four of the following in any combination:
    • Prophylaxis (D1110 or D1120)
    • Periodontal maintenance procedure (D4910)
    • Scaling in the presence of moderate or severe gingival inflammation (D4346)

SmileWay Wellness Benefits and your patients

If you have patients with medical issues that necessitate extra dental care, find out if they’re eligible for SmileWay Wellness Benefits. These benefits can help keep them smiling and healthy!

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