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Dental plans offering enhanced benefits to bolster oral and overall health

April 12, 2016

By Kelly Soderlund

Photo of Dr. Riggins
Dr. Riggins
More third-party payers are designing benefit plans that connect a person’s oral health to the rest of his or her body, a move the ADA wants dentists to be aware of so they can offer help their patients access the best benefits.

Take Cigna, which took to YouTube to promote its Oral Health Integration Program, where patients who are pregnant or have with certain medical conditions — diabetes, chronic kidney disease, side effects from head and neck cancer radiation, among others — may quality for 100 percent reimbursement for copays or coinsurance for specific dental procedures for periodontal treatment or caries protection. There is no additional charge for the program.

“The research out there does show there are potential associations between those conditions and gum disease,” Dr. Miles Hall, chief clinical director for Cigna Dental, said in the video.

Cigna is among a handful of dental plans newly offering enhanced benefits to patients with various medical conditions in an effort to support improvement in overall health. When a dental office calls the 800 number on the patient’s ID card or uses the plan’s website to verify benefits, it’s important to check if the patient is eligible for additional coverage based on his or her current medical condition, said Dr. Ronald Riggins, chair of the ADA Council on Dental Benefit Programs.

“We’re starting to see this more and more as insurance companies begin to realize how closely oral health is connected to a patient’s overall health,” Dr. Riggins said. “We want dentists to be aware of these benefits so they can alert their patients, who may not be aware these are available to them.”

Aetna began its Dental Medical Integration program in 2007 after a study the company did with Columbia University College of Dental Medicine found that people with diabetes, coronary artery disease and cardiovascular disease who were receiving dental care had risk scores that averaged 27 percent lower from those who did not, according to Aetna’s website. The study also showed that the medical costs for patients with those conditions who had been treated for periodontal disease averaged 12 percent lower medical costs.

The Dental Medical Integration program offers benefits like an extra cleaning and periodontal services covered at 100 percent for plan members who qualify. Since the program began, more than 1.5 million members have been identified and Dental Medical Integration members have received over $30 million in enhanced benefits, according to the website.

Northeast Delta Dental’s HOW program — which stands for “health through oral wellness” — builds on the concept that benefit designs are most effective when they are personalized.

“When it comes to dental benefits, one size definitely does not fit all. Reality is, some people need more care than others to maintain or improve their oral health,” according to a video posted online by the company.

To be eligible for enhanced benefits, the dentist must submit a risk assessment for the patient that indicates his or her level of risk — moderate to very high — for caries and/or periodontal disease. Eligible patients receive up to four prophy or periodontal maintenance visits per year; up to four fluoride varnish treatments annually without age restriction; sealants for adult and deciduous molars without age restriction; oral hygiene instruction, nutrition counseling or tobacco cessation; and caries susceptibility testing.

To learn more about different types of dental plan designs, visit the ADA Center for Professional Success at Success.ADA.org and search for “dental benefit plan designs.” The ADA offers resources on the link between oral health and a patient’s general health at ADA.org by searching for “oral-systemic health.”