Special Health Care Needs Benefit (SHCNB)
Included services
Eligibility
Frequently asked questions
Using the benefit
Reducing barriers to care.
Additional resources
Using the benefit
Making oral health care more accessible for every smile.
Included services
Additional visits, consultations, and/or exams. These are useful to help patients learn what to expect and understand what is needed for a successful dental appointment.
Additional dental office visits
Up to four total dental cleanings in a benefit year to help minimize plaque build-up and maintain oral health.
Cleanings
Treatment delivery modifications, including extra chair time and limited anesthesia and nitrous oxide (when necessary) to help patients with sensory processing differences, behavioral challenges, or other barriers to treatment.
Treatment modifications
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
Covered members need to let their provider know that they have a qualifying special health care need and their Delta Dental plan** includes the Special Health Care Needs Benefit. The dentist will determine if extra services apply and will note the claim accordingly.
Members
The dentist should verify the benefit coverage and the qualifying health care need before rendering services. Claims forms will need to be completed noting the special condition and the codes.
Providers
Frequently asked questions
*https://publications.ici.umn.edu/risp/infographics/people-with-idd-in-the-united-states-and-the-proportion-who-receive-services
**All Delta Dental of Wisconsin group fully insured plans and Individual & Family Plans include this benefit as of 7/1/25. ASO clients can opt-in to provide the benefit. Coverage can be verified by the provider in their portals at deltadentalwi.com/provider or my.deltadentalcoversme.com/provider or via FaxBack. Exclusions apply.
Download member instruction sheet
Download instructions for your office
View Covered Codes
Why extra care matters
Individuals with special health care needs often require specialized treatment due to:
buildup of calculus
thin or missing enamel
dental caries
crowding of teeth
anomalies in tooth development, size, and shape
Additional resources
*https://publications.ici.umn.edu/risp/infographics/people-with-idd-in-the-united-states-and-the-proportion-who-receive-services
**All Delta Dental of Wisconsin group fully insured plans and Individual & Family Plans include this benefit as of 7/1/25. ASO clients can opt-in to provide the benefit. Coverage can be verified by the provider in their portals at deltadentalwi.com/provider or my.deltadentalcoversme.com/provider or via FaxBack. Exclusions apply.
Title
Title
Title
Developmental disabilities and oral health
Oral health resources
Additional resources
Frequently asked questions
Why are my benefits through Delta Dental of Wisconsin?
Even if you live in a different state, your benefits are through Delta Dental of Wisconsin because your employer is most likely located in Wisconsin.
Delta Dental is a nationwide organization with local member companies in multiple different states. Typically, wherever your employer is located is the Delta Dental state that will administer your benefits.
Finding a dentist in your state
Don’t worry, our network has the most dentists nationwide which means you can still see an in-network dentist in your state. You can find one near you using our provider search.
Explaining networks and why it matters
Explaining networks and why it matters
Coordinating more than one dental plan
Coordinating more than one dental plan
Treatment in progress
Treatment in progress
Why are my benefits through Delta Dental of Wisconsin?
Why are my benefits through Delta Dental of Wisconsin?
Explaining networks and why it matters
Networks were created to save you money when you see the dentist. And our Delta Dental PPO Plus Premier™ network has the most providers of any insurer. Our dentists agree to lower their fees for Delta Dental members, so it will benefit you most to see an in-network provider.
We technically have two networks: PPO and Premier.
PPO providers agree to the largest discounts, saving you the most money.
Premier providers offer slightly smaller discounts, but there are additional dentists to choose from.
No matter which network you choose, you will still be saving money off retail. And there are other added benefits like treatment guarantees and claims being sent in for you (so you don’t have to worry about paperwork or getting reimbursed).
Want to see if your dentist is in-network? Our provider search can help.
Two networks to choose from
Coordinating more than one dental plan
Coordinating more than one dental plan
Treatment in progress
Treatment in progress
Why are my benefits through Delta Dental of Wisconsin?
Why are my benefits through Delta Dental of Wisconsin?
Explaining networks and why it matters
Explaining networks and why it matters
Coordinating more than one dental plan
Sometimes people have more than one dental plan (for instance: spouses each having dental coverage through their employers, or a child having coverage through both parents). This is called dual coverage and requires a coordination of benefits to process claims. There is a process we follow to decide which plan is considered primary, leaving the other plan…well…secondary.
Generally, coverage through your plan will pay primary for you.
For children, the plan of the parent whose birthday comes first during the calendar year is designated as primary; the other parent’s plan is secondary.
If you still have questions, here is more information on coordination of benefits.
Primary and secondary plans
Treatment in progress
Treatment in progress
FAQ four
Why are my benefits through Delta Dental of Wisconsin?
FAQ three
Explaining networks and why it matters
FAQ two
Coordinating more than one dental plan
FAQ one
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Please note: In order for the treatment to be covered, your provider must be a Delta Dental network dentist. You can look them up in our Provider Search to check.
Using the benefit
Covered members need to let their provider know that their Delta Dental plan (group or individual**) includes the Special Health Care Needs Benefit and that they have a special health care need. The dentist will determine if extra services apply and will note the claim accordingly.
Download member instruction sheet
Members
Download detailed instructions for your office
View list of Special Conditions
The dentist should verify the benefit and the special health care need before rendering services. Claims forms will need to be completed including noting the special condition and the codes.
Providers
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EMPLOYER CTA HERE
Employers
Broker CTA here
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Brokers
Eligibility
All covered members (both child and adult) 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.
Included services
Want to add this to a policy?
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Additional visits, consultations, and/or exams. These are useful to help patients learn what to expect and understand what is needed for a successful dental appointment.
Additional dental office visits
Treatment delivery modifications, including limited anesthesia and nitrous oxide (when necessary for patients with sensory sensitivities, behavioral challenges, or other barriers to treatment).
Treatment modifications
Up to four total dental cleanings in a benefit year to help minimize plaque build-up and maintain oral health.
Cleanings
More than 8 million people in the U.S. have an intellectual or developmental disability.*
For these individuals, receiving proper oral health care can be overwhelming, or sometimes even inaccessible. To help everyone get the dental care they deserve, Delta Dental of Wisconsin is proud to offer its Special Health Care Needs Benefit program, which offers additional services at the dentist for eligible members, both children and adult.**
Individuals with special health care needs often require specialized treatment due to:
buildup of calculus
thin or missing enamel
dental caries
crowding of teeth
anomalies in tooth development, size, and shape
Addressing treatement needs
Additional resources
Additional resources
Frequently asked questions
Frequently asked questions
Using the benefit
Using the benefit
Eligibility
Eligibility
Included services
Included services
Included services
More than 8 million people in the U.S. have an intellectual or developmental disability.* For these individuals, receiving proper oral health care can be overwhelming, or sometimes even inaccessible.
To help, Delta Dental of Wisconsin is proud to offer its Special Health Care Needs Benefit program, which covers additional services at the dentist for eligible members, both children and adults.**
Eligibility
Frequently asked questions
Additional resources
Special health care needs resources
Download program flyer
Special health care needs resources
Access your
online account
Access your
online account
Benefit
fact sheet
Benefit
fact sheet
Find a
provider
Find a
provider
Sign in to verify eligibility
Oral health resources
Oral health resources
Program flyer
Program flyer
Interested in learning how to add SHCNB to an existing Delta Dental employer-sponsored plan? Contact your account manager to learn more.
Download program flyer
Intellectual and neurodevelopmental disabilities
Environmental or congenital injuries leading to disability
Chromosomal abnormalities
Syndromes or sequences with craniofacial or airway abnormalities
Other sequences that require special dental care needs
Any other syndrome, sequence, or abnormality that limits the ability to perform daily self-care or creates substantial limitations in a major life activity
Note: People with standalone anxiety, depression, or a fear of dentists or dental treatment (odontophobia) which is not a part of the covered condition are not eligible for the additional special health care needs benefits.
Delta Dental of Wisconsin members or their enrolled dependents on an eligible plan and diagnosed with a special health care need that impacts their ability to get routine covered dental care may be eligible for additional services.
Effective 7/1/2025, DDWI fully insured and Individual & Family** dental plans will automatically include the Special Health Care Needs Benefit. Self-funded (ASO) employer groups can request to add the benefit to their plan at any time.
Who qualifies for this benefit?
What kinds of conditions apply?
How do I get these extra services?
It is the dentist's responsibility to discuss with the patient, confirm the qualifying condition, and determine whether they need to change their treatment approach, increase procedure time, and/or require additional therapeutic regimes and/or techniques to treat the patient.
If the member’s plan includes the SHCN benefit, and the provider feels the patient would benefit from the extra services, they will submit the claim noting code D9997 and include the reason/condition in the narrative section of the claim form.
What kinds of conditions apply?
How do I get these extra services?
Who qualifies for this benefit?
Who qualifies for this benefit?
What kinds of conditions apply?
How do I get these extra services?
Frequently asked questions
Any Delta Dental of Wisconsin member or their enrolled dependents on an eligible plan and diagnosed with a special health care need that impacts their ability to get routine covered dental care may be eligible for additional services.
Effective 7/1/2025, DDWI fully insured and Individual & Family** dental plans will automatically include the Special Health Care Needs Benefit (ASO groups can request to add the benefit to their self-funded plan at any time).
Who qualifies for this benefit?
What kinds of conditions apply?
How do I get these extra services?
Any Delta Dental of Wisconsin member or their enrolled dependents on an eligible plan and diagnosed with a special health care need that impacts their ability to get routine covered dental care may be eligible for additional services.
Effective 7/1/2025, DDWI fully insured and Individual & Family** dental plans will automatically include the Special Health Care Needs Benefit (ASO groups can request to add the benefit to their self-funded plan at any time).
Who qualifies for this benefit?
How do I get these extra services?
Intellectual and neurodevelopmental disabilities
Environmental or congenital injuries leading to disability
Chromosomal abnormalities
Syndromes or sequences with craniofacial or airway abnormalities
Other sequences that require special dental care needs
Any other syndrome, sequence, or abnormality that limits the ability to perform daily self-care or creates substantial limitations in a major life activity
Note: People with standalone anxiety (not part of a covered condition), depression, or a fear of dentists or dental treatment (odontophobia) are not eligible for the additional special health care needs benefits.
What kinds of conditions apply?
Members without CheckUp Plus™: Services will apply to annual plan maximums for members who do not have CheckUp Plus.
Members with CheckUp Plus™: Members who have CheckUp Plus on their group plan will have annual plan maximums apply accordingly.
Members can see if their plan includes CheckUp plus by logging in to their online account.
How does this impact annual maximums?
How does this impact annual maximums?
How does this impact annual maximums?
All dental professionals receive training to be able to treat patients with special health care needs. However, it is always best to discuss your circumstance and specific health care needs with your provider.
When making your appointment, ask if your dental office can accommodate patients with special health care needs and/or are familiar with the Delta Dental of Wisconsin Special Health Care Needs Benefit.
You can also search for Delta Dental in-network providers and refine your search to include providers that are handicap accessible, treat disabled children, and treat disabled adults.
Does my provider offer these extra services?
Does my provider offer these extra services?
Does my provider offer these extra services?
How do I get these extra services?
How does this impact annual maximums?
Who qualifies for this benefit?
What kinds of conditions apply?
How do I get these extra services?
How does this impact annual maximums?
Does my provider offer these services?
Any Delta Dental of Wisconsin member or their enrolled dependents on an eligible plan and diagnosed with a special health care need that impacts their ability to get routine covered dental care may be eligible for additional services.
Effective 7/1/2025, DDWI fully insured and Individual & Family** dental plans will automatically include the Special Health Care Needs Benefit (ASO groups can request to add the benefit to their self-funded plan at any time).
Who qualifies for this benefit?
What kinds of conditions apply?
How do I get these extra services?
How does this impact annual maximums?
Does my provider offer these services?
Any Delta Dental of Wisconsin member or their enrolled dependents on an eligible plan and diagnosed with a special health care need that impacts their ability to get routine covered dental care may be eligible for additional services.
Effective 7/1/2025, DDWI fully insured and Individual & Family** dental plans will automatically include the Special Health Care Needs Benefit (ASO groups can request to add the benefit to their self-funded plan at any time).
How does this impact annual maximums?
Does my provider offer these services?
How does this impact annual maximums?
Does my provider offer these services?
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.
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.
Note: People with standalone anxiety, depression, or a fear of dentists or dental treatment (odontophobia) which is not a part of the covered condition are not eligible for the additional special health care needs benefits.