Protect Your Overall Health When You’re at Risk

Your oral health is deeply connected to your total well-being. As an ACERA retiree, if you or a dependent has been diagnosed with a qualifying chronic health condition, you may be eligible for Delta Dental’s SmileWay® Wellness Benefits — giving you extra dental cleanings and enhanced gum disease treatment through your PPO dental plan.¹

Note: SmileWay Wellness Benefits are available only to retirees and payees enrolled in the Delta Dental PPO plan — not the HMO plan.

 

Qualifying Medical Conditions

SmileWay Wellness Benefits are available to ACERA retirees enrolled in the Delta Dental PPO² plan and their covered dependents who have been diagnosed with one or more of the following chronic conditions:

1. Amyotrophic lateral sclerosis (ALS)
2. Cancer
3. Chronic kidney disease
4. Diabetes
5. Heart disease
6. HIV/AIDS
7. Huntington’s disease
8. Joint replacement
9. Lupus
10. Opioid misuse and addiction
11. Parkinson’s disease
12. Rheumatoid arthritis
13. Sjögren’s syndrome
14. Stroke

 

What You Get with SmileWay Wellness Benefits

If you qualify and opt in, SmileWay adds two valuable enhancements to your dental coverage:

1. Up to Two Additional Cleanings Per Year

Your PPO plan normally covers two preventive cleanings per year. SmileWay gives you up to two more — for a total of up to four cleanings or related procedures per year, in any combination, at no extra cost to you³, from the following list:

Type of Cleaning	Procedure Code⁴	SmileWay Coverage
Routine adult or child cleaning Prophylaxis	D1110 / D1120	Covered 100%
Periodontal maintenance Cleaning to monitor and treat inflammation and infection after past gum surgery or treatment	D4910	Covered 100%
Scaling in presence of moderate or severe gingival inflammation Plaque removal	D4346	Covered 100%

• These procedures do not count toward your $1,900 annual benefit maximum.
• Your dentist will determine the appropriate procedures based on your condition.

2. Annual Periodontal Scaling & Root Planing (Deep Cleaning)

Without SmileWay, this procedure is only covered once every two years. With SmileWay, it’s covered once per year per quadrant (i.e., upper-left, upper-right, lower-left, lower-right).

Procedure	Procedure Code⁴	SmileWay Coverage
One periodontal scaling and root planing per quadrant Deep cleaning to treat gum disease	D4341 (4 or more teeth) D4342 (1 to 3 teeth)	Covered 100% once per year per quadrant

• These procedures do not count toward your $1,900 annual benefit maximum.
• Your dentist will determine the appropriate procedures based on your condition.

 

How to Opt In to (Enroll in) SmileWay

You’ll need to opt in to access SmileWay’s enhanced benefits. It’s easy:

1. Log in to your Delta Dental account
2. Select SmileWay Wellness Benefits from the main menu. 
3. Click the Opt In button next to your name (or your dependent’s). 
4. Complete the form, including the treating physician’s name and phone number.
5. Click Submit.
6. After 24 hours, you can start using your enhanced benefits. 

Note: Adult dependents must opt in themselves through their own online account or by contacting Delta Dental, unless they’ve authorized you to access their protected health information. They can grant authorization to you by logging in to their Delta Dental account, going to My account, and selecting Yes for the “I authorize” statement. They can also mail a completed HIPAA authorization form (PDF, 38 KB) to Delta Dental.

 

Frequently Asked Questions (FAQ)

Q: Do I need to get approved to use the SmileWay Wellness Benefits?

No formal approval is required. To opt in, simply log in to your account at deltadentalins.com, and follow the instructions above, and you’re ready to go within 24 hours. That’s it!

Q: Will I receive a notification that I’ve been approved?

There is no separate approval process, so you won’t receive an email or letter. After you click Submit in your Delta Dental account, you’ll return to a confirmation screen that shows you’re enrolled.

Q: How can I check if I’m enrolled in SmileWay after I register?

After opting in, log back in to your Delta Dental account and go to the SmileWay page to check your status.

Q: After enrolling, how do I use the extra dental cleanings or other SmileWay benefits?

After you opt in, let your dental office know that you’re enrolled in SmileWay Wellness Benefits. Within 24 hours, your enhanced coverage will show up in Delta Dental’s Provider Tools system—no extra paperwork required.

Once your dentist sees you’re eligible, they’ll determine which procedures are appropriate for your condition (such as a standard cleaning, periodontal maintenance, or plaque removal). You can then schedule your additional appointments, and your dentist will submit the claims as usual.

Q: Can I use SmileWay benefits with any dentist?

Yes. SmileWay benefits are available both in and out of network. However, you’ll save the most money if you visit a Delta Dental PPO in-network dentist.

Here’s why: In-network dentists have a contract with Delta Dental that limits what they can charge. That means you’ll never pay more than the agreed-upon rate—and for SmileWay services like extra cleanings, that often means you pay nothing out of pocket.

Out-of-network dentists aren’t bound by those contracts, so they can charge higher rates. Delta Dental will still help cover the service, but only up to the amount they would pay an in-network dentist. You’re responsible for paying the difference—this is called balance billing.

Depending on the out-of-network dentist you see, here’s what might happen:

• You may be asked to pay the full cost up front, and then you will need to submit a reimbursement claim to Delta Dental.
• Some dentists may offer to submit the claim for you as a courtesy, even if you’re paying up front. If they don’t mention it, you can ask if they’re willing to help.
• Other dentists may not require payment up front, but instead send you a bill later for any portion of the cost that Delta Dental doesn’t reimburse.

To avoid surprise bills and paperwork, choosing an in-network PPO dentist is usually the easiest and most cost-effective option.

Q: Can I use SmileWay with the Delta Dental HMO?

No. The SmileWay benefit is only available to ACERA retirees and payees enrolled in the Delta Dental PPO.

 

Footnotes

1. _{SmileWay Wellness Benefits are not included under all plans. Known as SmileWay® Enhanced Benefits in Texas.} 
2. _{Delta Dental PPO plans are underwritten by Delta Dental Insurance Company in AL, DC, FL, GA, LA, MS, MT, NV and UT and by not-for-profit dental service companies in these states: CA – Delta Dental of California; PA, MD – Delta Dental of Pennsylvania; NY – Delta Dental of New York, Inc.; DE – Delta Dental of Delaware, Inc.; WV – Delta Dental of West Virginia, Inc. In Texas, Delta Dental Insurance Company provides a dental provider organization (DPO) plan.} 
3. _{SmileWay Wellness Benefits are subject to any applicable maximums and deductibles under the terms and conditions outlined in your Evidence of Coverage. Please review your plan booklet for specific details about your coverage.}
4. _{Current Dental Terminology (CDT) coding and nomenclature are the copyright and a trademark of the American Dental Association, all rights reserved.}