Evidence-Based Integrated Care Plan (EBICP)

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1 Evidence-Based Integrated Care Plan (EBICP) Wouldn t it be nice if those who needed extra care could get extra care for no extra cost? With Delta Dental, they can. s Evidence-Based Integrated Care Plan (EBICP) provides extra benefits for individuals with certain medical conditions that have oral health implications. Research has shown that increased frequency of cleanings and/or topical fluoride applications greatly impact oral health, and sometimes even play an important role in managing conditions such as: High-risk cardiac conditions Maintaining good oral health and eliminating oral disease decreases a cardiac-risk patient s chances of contracting Infective Endocarditis (IE), a disease where bacteria colonize in the tissues of the heart. * Suppressed immune systems Oral complications can increase both treatment costs and morbidity rates in individuals with suppressed immune systems. Even common conditions like dry mouth and dental decay can be indicators of more serious problems. ** Kidney failure or dialysis Studies have shown that individuals with kidney disease have a higher prevalence of periodontal disease and tooth loss, and that the severity of these oral health problems is typically related to the level of kidney dysfunction. * Cancer therapy Oral health tends to be a difficult challenge for some cancer patients. Oral pain, gum infections, rapid tooth decay and dry mouth are among the side effects associated with radiation and chemotherapy. ** Periodontal disease Studies have shown that a greater frequency of maintenance can reduce the need for repeating periodontal surgery. ** Diabetes Evidence has shown a greater prevalence, incidence, severity, extent and/or progression of periodontal disease in diabetics. * Pregnancy Ongoing studies link periodontal disease in pregnant women to the incidence of preterm, low-birth-weight babies. It is beneficial for pregnant women to maintain good oral health. * *additional cleanings **additional cleanings and topical fluoride treatments

2 Expanded Sealant Coverage Sealants generally stop the need for the first filling. And that can save thousands. Delta Dental recommends that groups choose to cover sealants on primary and permanent molars for dependent children ages Adding sealants to a group s diagnostic and preventive coverage increases premiums only 0.5%. Sealants are cost-effective preventive measures that work. Simple as that. Did you know? Cavities are almost entirely preventable. Cavities remain the single most common chronic childhood disease. Sealants reduce the need for fillings by about 72%. 88.8% of children s cavities occur on molars. Children who have received a molar filling are 90% more probable to receive fillings on all other molars within five years. The lifetime cost of a single cavity is more than $2,000.

3 Reduced X-ray Frequency You don t need to have so many x-rays. That s according to the Food & Drug Administration and the American Dental Association. And we agree. At Delta Dental, our goal is to provide what you need from your dental plan, without making you pay for something you don t. Taking into account the advancements made in dentistry and radiography, the American Dental Association and the Food & Drug Administration recommend that individuals with low risk of oral diseases (such as cavities and periodontal disease) receive less frequent x-rays. This helps keep costs down and lowers exposure to radiation, while still ensuring diagnostic accuracy. Delta Dental suggests that: Bitewing x-rays be limited to one time per 12-month period, and Full-mouth x-rays be limited to once every five years. The cost impact is a 0.5% decrease in premiums.

4 CheckUp PlusTM At Delta Dental, we believe preventive care is so important, we practically give it away! Our CheckUp Plus TM plan option allows enrollees to get diagnostic and preventive dental services without those costs getting applied to the individual annual maximum. Preventive care saves money over the long-term by reducing the need for more expensive services. The charts show the impact of CheckUp Plus TM on an enrollee s individual annual maximum compared to a traditional plan. (Plan benefit and dentist charges vary. Example assumes two routine check-ups, covered at 100%, and a $1,000 annual maximum.) Delta Dental CheckUp Plus TM Enrollee Maximum Remaining Delta Dental Traditional Dental Plan Enrollee Maximum Remaining $300 $0 $1,000 $300 $0 $700 CheckUp Plus TM lets you keep your annual maximum for the things you need, not the things you deserve. *CheckUp Plus TM cannot be added to plans offering Maximum Benefit Bonus

5 Coverage for Dental Implants Through, dental implants are standard. Having implants as part of the standard prosthetic coverage gives dentists and patients another option when evaluating which procedure best fits an individual s needs. The condition of a patient s mouth, medical history, supporting jaw bones, and the way teeth fit together are important factors in the decision. We believe dentists should be able to recommend the most appropriate options for treatment without regard to a patient s dental coverage. Implants: Allow replacement of a single missing tooth without the need to crown adjacent teeth, as is done with traditional bridges. Generally feel more natural and comfortable than traditional partial dentures or dentures when multiple teeth are replaced. Have a five-year success rate greater than 90%, according to the latest research.

6 Maximum Benefit Bonus Get rewarded for just going to the dentist. How s that for an incentive? Proactive people who see their dentist for checkups and cleanings generally don t use their entire annual maximum. Through Delta Dental s Maximum Benefit Bonus (MBB), enrollees who see the dentist for preventive care can roll over a portion of their unused benefit to be used in future years, should more costly procedures be needed. It s like a savings account for your mouth. The chart shows MBB allowances, based on the plan s annual maximum. (MBB allowances for PPO occur only if the group has a PPO plan and all services are provided by a Delta Dental PPO provider.) Eligibility: Plan Annual Maximum MBB Allowance PPO MBB Allowance Non-PPO $1,000 $350 $250 $1,200 $420 $300 $1,250 $438 $313 $1,500 $525 $375 $2,000 $700 $500 MBB is available for groups offering an annual maximum of $1,000 - $2,000 that have either self-insured or individually rated and fully-insured plans. The member must have been covered under the plan at least one full benefit year, with coverage for major services. The member must have completed any plan benefit waiting periods before beginning to accrue MBB benefits. The member must have submitted at least one claim for a covered service (non-orthodontic) during the benefit year. The total cost of the claim(s) applied to the member s annual maximum must be below 50% of the member s annual maximum. The MBB allowance varies according to the plan s annual maximum and whether or not all services were provided by a Delta Dental PPO dentist. The allowance is 35% of the annual maximum if all of the member s claims came from a PPO provider and the group has a PPO plan, and 25% of the annual maximum if all or some of the claims came from a non-ppo provider, or if the group does not have a PPO plan. The total amount available in the member s MBB account can grow to an amount equal to the plan s annual maximum. Each covered family member will have their own MBB account. *MBB cannot be added to plans offering CheckUp Plus.