Total Health Solutions Program
The Total Health Solution (THS) program provides education, targeted outreach, and condition-specific services to Enhanced Dental Benefit members who are pregnant, or have diabetes, coronary artery disease, oral cancer, stroke, Sjogren’s syndrome, intellectual and/or developmental disabilities2, or mental health conditions2.
Enhanced Dental Benefits
Enhanced Dental Benefits offer full coverage for certain preventative and periodontal services connected to the total health of individuals with the conditions shown below. These benefits are paid at 100 percent and are not subject to deductibles, coinsurance, or calendar year maximums when performed by a participating or preferred dental provider.
| Condition | One cleaning or periodontal maintenance1 4 per calendar year | Periodontal scaling once per quadrant every 24 months1 | Oral cancer screening twice per calendar year | Fluoride treatment 4 per calendar year |
|---|---|---|---|---|
| Diabetes |
✔ |
✔ |
|
|
| Coronary artery disease |
✔ |
✔ |
|
|
| Intellectual and/or developmental disabilities 2,3 |
✔ |
|
✔ |
✔ |
| Mental health conditions 2,3 |
✔ |
|
✔ |
✔ |
| Pregnancy |
✔ |
✔ |
|
|
| Oral cancer |
✔ |
|
✔ |
✔ |
| Stroke |
✔ |
✔ |
|
|
| Sjogren’s syndrome |
✔ |
|
✔ |
✔ |
1. Available with plans that offer periodontal maintenance; standard waiting periods apply. There must be at least three months between a periodontal maintenance cleaning and any other cleanings.
2. Self-enrollment is required for this condition.
3. Added on renewal on or after October 1, 2023 and for Dental Blue 65 on January 1, 2024.
Please note: Certain dental plans cover preventive dental services and Enhanced Dental Benefits at different frequency intervals. Please verify the member’s benefits and eligibility prior to scheduling services.
Help your patients take advantage of Enhanced Dental Benefits
If you have a patient with one of the conditions above who is not yet enrolled, follow these steps to get them started:
| Dentists: | Primary care providers: |
|---|---|
|
|
Submit your dental claim electronically or by mail in the same manner as all other dental claims.
Resources
- Fact sheet for providers to help them identify patients who may be eligible for Enhanced Dental Benefits.
- Member fact sheet to hand out to your patients describing the enhanced dental benefits available to them and the importance of good oral hygiene.
- Give the Enhanced Dental Benefits Member Self-Enrollment Form or the Dental Blue 65 Enhanced Dental Benefits Enrollment Form to your patient to have his/her doctor certify a diagnosis that may be eligible for the enhanced dental benefits.
- Dental Blue Book provider manual
