Additional visits, consultations, and/or exams designed to support patients ahead of treatment, helping them feel informed, comfortable, and prepared for a successful dental visit.
Special Health Care Needs benefit
Making oral health more accessible
Millions of people in the U.S. live with a wide range of physical, developmental, mental, sensory, behavioral, cognitive and emotional conditions. For many of these individuals, receiving appropriate oral health care can be challenging or at times inaccessible. To help, Northeast Delta Dental is proud to offer the Special Health Care Needs benefit.
Included services
Additional dental office visits
Cleanings
Coverage for up to four dental cleanings per benefit year, helping patients maintain oral health through regular preventative care.
Treatment modifications
Treatment delivery modifications (including anesthesia), as needed, to help ensure patients with sensory sensitivities, behavioral needs, or other barriers to care can receive safe, comfortable, and effective oral health services.
Eligibility
Covered members (both children and adults) with a qualifying special health care need are eligible for this benefit.
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.
Using the benefit
Members
Covered members enrolled in a plan that includes the Special Health Care Needs benefit should notify their dental provider of any qualifying health care needs. The provider will assess whether additional services are appropriate and submit an attestation on the patients behalf if enhanced benefits are needed.
Providers
Dental providers should verify benefit coverage and confirm the presence of a qualifying health care need prior to delivering services. Benefits can be accessed through attestation submission in the PreViser portal. Additional information and resources are available on the provider page.
*American Academy of Pediatric Dentistry. Definition of special health care needs. The Reference Manual of Pediatric Dentistry. Chicago, IL: American Academy of Pediatric Dentistry; 2025:15.