Special Health Care Needs Benefit

Enhanced benefit for individuals with special health care needs

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.           

Before rendering services, please check the member’s procedure eligibility in the Dental Office Toolkit® (DOT) to verify coverage. If the member’s record has already been updated to allow for additional services under this benefit, there will be a message in DOT confirming this. 

If there is not already a message, but the member says their Delta Dental plan includes the Special Health Care Needs Benefit and they have a qualifying special health care need, you should include code D9997 on the initial claim submission for this patient. After this first claim processes, the member’s procedure eligibility will update accordingly and you will no longer need to include D9997 on future claims for that member.

There is no age limit on these benefits. Note: When looking in DOT, the “Special Health Care Needs Benefit” message is different from the “Handicap” attribute.

What is included in this benefit?

  • Additional visits to the dentist’s office and/or 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, including anesthesia and nitrous oxide, necessary for dental staff to provide oral health care for patients with sensory sensitivities, behavioral challenges, severe anxiety or other barriers to treatment

Training opportunity

With support from the Delta Dental Foundation, Penn Dental Medicine has established a free continuing education series aimed at building awareness of the barriers to equitable oral health care for individuals with disabilities, and developing competency to provide oral health care to this vulnerable population.

Learn more about the Center for Persons with Disabilities Presentation Series.