About Enhanced Benefits Program

November 20, 2009

Oral Health Meets Overall Health with Delta Dental of Illinois' Enhanced Benefits Program
Offering enhanced benefits for those with high-risk medical conditions

Delta Dental of Illinois' Enhanced Benefits Program integrates medical and dental care - where oral health meets overall health. This program enhances coverage for individuals who have specific health conditions that can be positively affected by additional oral health care. These enhancements are based on scientific evidence that shows treating and preventing oral disease in these situations can improve overall health.

If you or your covered dependents have one or more of the medical conditions covered under Delta Dental of Illinois' Enhanced Benefits Program, you and your covered dependents will become eligible for additional benefits. To receive these additional benefits, you can enroll yourself and/or your dependents at https://www.deltadentalil.com/subscriber/ebd (you must log in to the Subscriber Connection to enroll*) or by calling our Customer Service Department at 800-323-1743. Once you are enrolled, you are immediately eligible for the enhanced benefits.

Those eligible for Delta Dental of Illinois' Enhanced Benefits Program include:
• People with periodontal (gum) disease.
• People with diabetes.
• Pregnant women.
• People with high-risk cardiac conditions.**
• People with kidney failure or who are undergoing dialysis.**
• People undergoing cancer-related chemotherapy and/or radiation.**
• People with suppressed immune systems due to HIV positive status, organ transplant, and/or stem cell (bone marrow) transplant.**
• People at risk for oral cancer.**

Our Enhanced Benefits Program includes additional cleanings and/or applications of topical fluoride. The program addresses the unique health challenges faced by people with conditions that put them at risk for oral health disease, and can also play an important role in the management of an individual's medical condition.

The costs of the additional cleanings and fluoride treatments will be applied to your annual maximum. 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 if and when treatment is right for you.

**Effective July 1, 2009.

Benefits for people with periodontal (gum) disease. For enrollees with a history of susceptibility to periodontal diseases or periodontal surgery, periodontal maintenance needs to be conducted at more frequent intervals than the traditional two cleanings per year. The additional cleanings are not only more economical than periodontal surgery, but also they are health-preserving and reduce tooth loss compared to those periodontal patients who do not receive these therapies. Periodontal disease can lead to tooth loss, and tooth replacement costs are much greater than preventive measures, like additional cleanings. Enrollees with periodontal disease are eligible for four teeth cleanings, either prophylaxis (general cleaning) or periodontal maintenance, in a benefit year. Additionally, the enrollee is eligible for fluoride applications; frequency is determined by their group contract.

Benefits for people with diabetes. Diabetes is the sixth leading cause of death in the United States, and it has a total economic cost in medical expenditures and lost productivity estimated at $132 billion per year. Glycemic control has proven to be one of the best ways to prevent complications of diabetes. The relationship between diabetes and oral health, specifically periodontal disease, is recognized in the medical and dental communities. Research has confirmed that diabetes worsens with periodontal disease, and it strongly suggests that severe periodontal disease increases the severity of diabetes. A number of studies strongly indicate that when diabetics receive more professional teeth cleanings, their blood glucose levels are much better controlled. Enrollees with diabetes are eligible for four teeth cleanings, either prophylaxis (general cleaning) or periodontal maintenance, in a benefit year.

Benefits for pregnant women. Scientific evidence indicates that women with periodontal disease are up to 7.5 times more likely to give birth to premature babies. According to the National Institutes of Health, as many as 19 percent of the 250,000 premature, low birthweight infants born in the United States each year may be attributed to infectious oral disease. Clinical studies of pregnant women with periodontal disease strongly suggest that more frequent professional teeth cleanings will benefit the health of both the baby and the mother. Pregnant enrollees are eligible for one additional prophylaxis (general cleaning) or periodontal maintenance visit during the time of the pregnancy.

Benefits for people with high-risk cardiac conditions. A recent guideline released by the American Heart Association indicates that an individual's overall oral health may be an important factor in avoiding infective endocarditis. Infective endocarditis occurs when bacteria, often from the mouth, enters the bloodstream and attacks the lining of the heart. The benefit was developed to help at-risk individuals better maintain their oral health to reduce bacteria levels in the mouth in an effort to lower their risk for infective endocarditis. People with high-risk cardiac conditions are eligible for four teeth cleanings, either prophylaxis (general cleaning) or periodontal maintenance, in a benefit year. Conditions include: a history of infective endocarditis; certain congenital heart defects such as having one ventricle instead of the normal two; individuals with artificial heart valves; heart valve defects caused by acquired conditions like rheumatic heart disease; hypertropic cardiomyopathy, which causes abnormal thickening of the heart muscle; individuals with pulmonary shunts or conduits; mitral valve prolapse with regurgitation (blood leakage).

Benefits for people with kidney failure or who are undergoing dialysis. According to the National Kidney Foundation one out of nine Americans has chronic kidney disease. Dental infections increase the risk of systemic infection in people with kidney disease, and systemic infection increases the risk of serious side effects. These individuals may benefit from having their teeth cleaned professionally at more frequent intervals to reduce the build up of bacteria in the mouth. This can help lower the risk of bacteria that will enter the bloodstream, create infection and futher complromise thier health. People with kidney failure or who are undergoing dialysis are eligible for four teeth cleanings, either prophylaxis (general cleaning) or periodontal maintenance, in a benefit year.

Benefits for people undergoing cancer-related chemotherapy and/or radiation. People undergoing chemotherapy and/or radiation are at increased risk for infection because their immune system response has been weakened due to their serious health condition. Head and neck radiation cause some specific oral health problems. According to the National Institute of Dental and Craniofacial Research (NIDCR), prevention of problems in the mouth is critical to obtaining the maximum benefit from cancer treatment, and people are encouraged to see a dentist before beginning treatment. Because a common side effect of head and neck radiation is an increase in cavities, the NIDCR recommends fluoride treatment and the use of prescription-strength fluoride toothpaste for those undergoing this treatment. Prescription-strength fluoride toothpaste and mouth rinses are often covered by medical/prescription drug benefit plans. Enrollees who are undergoing cancer-related chemotherapy and/or radiation are eligible for four teeth cleanings, either prophylaxis (general cleaning) or periodontal maintenance, in a benefit year. Additionally, the enrollee is eligible for fluoride applications; frequency is determined by their group contract.

Benefits for people with suppressed immune systems due to HIV positive status, organ transplant, and/or stem cell (bone marrow) transplant. It is well established scientifically that people with serious health conditions like HIV positive status and organ failure are at increased risk for infection generally because of their weakened immune system. These individuals may benefit from having their teeth cleaned professionally at more frequent intervals to reduce the build up of bacteria in the mouth. This can help lower the risk of bacteria that will enter the bloodstream, create infection and further compromise their health. Enrollees who have suppressed immune systems due to HIV positive status, organ transplant, and/or stem cell (bone marrow) transplant are eligible for four teeth cleanings, either prophylaxis (general cleaning) or periodontal maintenance, in a benefit year. Additionally, the enrollee is eligible for fluoride applications; frequency is determined by their group contract.

Benefits to help in the fight against oral cancer. This year in the United States, 8,000 people will die from oral cancer and over 30,000 new cases will be diagnosed. The OralCDx brush biopsy is a powerful tool in the early detection of oral cancer/precancerous cells - and represents a major breakthrough in the fight against oral cancer. The procedure is indicated to evaluate unexplained tiny white and red lesions - and the software used to analyze the samples can spot a precancerous/cancerous cell even if it is partially obscured by other cells. Helping to save lives by differentiating a pre-cancer or early cancerous spot from a benign one, the brush biopsy analysis method from OralCDx has been extensively studied and is approved by the American Dental Association. All Delta Dental of Illinois plans cover the OralCDx brush biopsy, if oral surgery coverage is included in your dental benefit plan.

Coverage will be at the group-contracted benefit level, with the additional frequency allowance being the only change. There is no end date on this additional coverage, no age requirement and the patient may be the subscriber, spouse or other covered dependent. Check your plan description to see if you have this coverage.