Special Health Care Needs Benefit

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.

6.5 million people in the U.S. with intellectual or developmental disabilities find oral health care to be inaccessible or overwhelming. Delta Dental is changing that.

Additional Dentist Visits and/or consultations

These can be helpful prior to first treatment to help patients learn what to expect. Additional exam benefits will be allowed for this purpose.

Additional Cleanings

Up to four total dental cleanings will be allowed in a benefit year.

Treatment Delivery Modifications

Including anesthesia necessary for dental staff to provide oral health care for patients with sensory sensitivities, behavioral challenges, severe anxiety, etc.

The special health care needs benefit is a standard benefit on most group and individual dental plans administered by Delta Dental of North Carolina. Exceptions may apply, so check with your benefits administrator or your plan documentation to confirm this benefit is included in your dental plan. Plan Annual Maximums still apply.

The special health care needs benefit provides coverage for qualifying members who receive eligible services April 29, 2024 and later.

Introducing the