Special Health Care Needs Benefit

Medicare Advantage Plans header

Reducing barriers to care

For 6.5 million people in the U.S. with intellectual or developmental disabilities, oral health care can be inaccessible or overwhelming. Delta Dental is changing that. Effective January 1, 2022, employee benefit plans may include an enhanced benefit for covered members with qualifying special health care needs. 

What are special health care needs? 

As defined by the American Academy of Pediatric Dentistry, special health care needs include any physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairment or limiting condition that requires medical management, health care intervention, and/or use of specialized services or programs. The condition may be congenital, developmental, or acquired through disease, trauma or environmental cause, and may impose limitations in performing daily self-maintenance activities or substantial limitations in a major life activity.

What is included in the benefit? 

If your employer has opted to offer enhanced benefits for covered members with special health care needs, you and/or a covered dependent may qualify for: 

  • Additional visits to the dentist’s office and/or consultations that can be helpful prior to the first treatment to help patients learn what to expect and what is needed for a successful dental appointment. 
  • Up to four total dental cleanings in a benefit year. 
  • The use of silver diamine fluoride that can be applied to cavities for patients who can’t tolerate the use of dental instruments. 
  • Treatment delivery modifications necessary for dental staff to provide oral health care for patients with sensory sensitivities, behavioral challenges, severe anxiety or other barriers to treatment. 

If you are unsure of whether your employer-provided Delta Dental benefit plan includes this enhanced benefit, you should contact your human resources department for additional information.