Reducing barriers to care

The leading unmet health care need for millions of U.S. children and adults with a disability is adequate dental care. Delta Dental’s Special Health Care Need Benefit reduces barriers to care by providing eligible members with enhanced benefits.

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, beginning on January 1, 2024, you and/or a covered dependent may qualify for: 

  • Additional visits to the dentist’s office
    This may include or be in addition to 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. Additional exam benefits will be allowed for this purpose.
  • Up to four total dental cleanings in a benefit year
  • Treatment delivery modifications
    Any accommodations necessary for dental staff to provide oral health care for patients with sensory sensitivities, behavioral challenges, severe anxiety or other barriers to treatment.
  • Any anesthesia needs
    The use of anesthesia necessary to provide dental care.

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. 

How do I/my spouse/my dependent use this benefit?

Members with a qualifying special health care need should let their dentist know that their group Delta Dental plan may include the Special Health Care Needs Benefit and that they have a qualifying special health care need.

To help your dentist better understand the benefit and how to bill Delta Dental for services provided, we suggest you take the “Special Health Care Needs Benefit Provider Instructions” flyer with you to your next dental visit.