FYI

Every year, more patients are becoming aware of the connection between common medical conditions and their oral health. February is American Heart Month, and a great time to talk to your patients about how good dental health can help to improve their overall health. For patients who already have medical conditions that can affect their oral health, you can tell them about SmileWay® Wellness Benefits.
 

What is SmileWay Wellness Benefits?

SmileWay Wellness Benefits is a program that allows Delta Dental members with certain pre-existing conditions to get extra gum and teeth cleanings each year. These extra benefits help members with chronic conditions maintain their oral and overall health. These benefits include:
 

• 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)

What conditions qualify patients for SmileWay Wellness Benefits?

In 2023, Delta Dental expanded the coverage for SmileWay Wellness Benefits to include these 14 chronic conditions:
 

• Amyotrohpic 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

What do patients need to do to qualify for and use SmileWay Wellness Benefits?

To qualify for SmileWay Wellness Benefits, a patient must:

1. Be enrolled in a Delta Dental PPO™ plan
2. Belong to a group that offers SmileWay Wellness Benefits
3. Have one of the above qualifying diagnoses
4. Choose to opt into the benefit

Patients can opt in online or by calling Delta Dental’s Customer Service. You can verify patient’s eligibility and benefit status online in Provider Tools. Just look for one of these two notations when reviewing patients’ benefits:
 

• SW. The patient has enrolled in SmileWay Wellness Benefits.
• SW-P. The patient’s dental plan includes SmileWay Wellness Benefits, but they haven’t yet enrolled.

To learn more,  watch this video on SmileWay Wellness Benefits.