Benefits for those with high-risk medical conditions
Customers can now add enhanced coverage for their employees who have certain high-risk medical conditions. Scientific evidence shows that improving oral health can help patients better manage these conditions. People with certain heart conditions may avoid a deadly heart infection by keeping their teeth and gums healthy.Patients must have one of the following conditions to qualify:
- Diabetes and periodontal (gum) disease
- Pregnancy and periodontal (gum) disease
- Kidney failure or individuals who are undergoing dialysis
- Suppressed immunity due to
chemotherapy and/or radiation treatment, HIV
positive status,
organ transplant, and/or stem cell (bone marrow) transplant. - Heart conditions that place patients at high or moderate risk for developing a
- heart infection (infective endocarditis):
- History of infective endocarditis
- Certain congenital heart defects (such as having one ventricle instead of the normal two)
Artificial heart valves
Heart valve defects caused by acquired conditions like rheumatic heart disease - Hypertropic cardiomyopathy, which causes abnormal thickening of the heart muscle
- Pulmonary shunts or conduits
- Mitral valve prolapse with regurgitation (blood leakage)
The benefit
The enhanced benefits include coverage of up to four
teeth cleanings (either routine cleanings or periodontal
maintenance cleanings) per benefit year instead of the
typical two. The routine cleanings will be covered at the
same copayment level as other preventive services. The
periodontal maintenance cleanings will be covered at the
same percentage as other periodontal services, unless the
group’s contract covers this service at the preventive level.
In addition, for people undergoing head and neck radiation, fluoride applications by your dentist will also be covered twice per benefit year. (This service typically is covered only to age 19.) (If you are having this type of radiation, you may also want to ask your dentist if prescription strength fluoride toothpaste would help you. This product often is covered by medical/prescription drug benefit plans.)
The costs of the additional cleanings and fluoride treatments will be applied to the annual maximum.
Enrollees: Not all Delta Dental contracts cover these benefits. Check your plan description to see if you have this coverage.
Customers: Ask your Delta Dental representative for details.
Dentists: Check enrollee's eligibility first; after treatment, write the medical diagnosis in the remarks section of the claim form
Keep in mind that the timing of treatment is very important when serious medical conditions exist. If you have one of these conditions, talk with your dentist and physician about when and if treatment is right for you.