Have a Chronic Condition? Get More Dental Coverage with SmileWay

Wellness July 3, 2025

Protect Your Overall Health When You’re at Risk

The health of your teeth and gums is tied to your overall wellness. If you’ve been diagnosed with a chronic medical condition and have a higher risk of gum disease, you may benefit from additional teeth and gum cleanings throughout the year with SmileWay Wellness Benefits¹.

ACERA’s Delta Dental PPO™² plan offers SmileWay Wellness Benefits — expanded dental coverage if you or a covered dependent have been diagnosed with one of the following chronic medical conditions:

Amyotrophic lateral sclerosis (ALS)
Cancer
Chronic kidney disease
Diabetes
Heart disease
HIV/AIDS
Huntington’s disease
Joint replacement
Lupus
Opioid misuse and addiction
Parkinson’s disease
Rheumatoid arthritis
Sjögren’s syndrome
Stroke

More Covered Cleanings Every Year

If you qualify for SmileWay Wellness Benefits, you can receive enhanced dental cleaning coverage through your Delta Dental PPO plan — at no extra cost to you.³ (Please note: SmileWay is not available to Delta Dental HMO members.)

SmileWay benefits allow for up to a total of five covered cleanings or related procedures per calendar or contract year. This includes the two standard cleanings already covered by your PPO plan, plus additional cleanings based on your specific chronic condition.

Here’s what that means:

You automatically get two routine cleanings per year through your PPO plan.
SmileWay may cover up to three additional cleanings or similar procedures per year, depending on which of the 14 qualifying chronic conditions you have.
All of these procedures are covered at 100% and do not count against your annual $1,900 maximum benefit.

Procedure	Procedure code⁴	Coverage per calendar/contract year
One periodontal scaling and root planing (deep cleaning to treat gum disease) — per quadrant	D4341 (4 or more teeth) D4342 (1 to 3 teeth)	100% coverage
Plus up to four procedures from the following list (any combination) depending on qualifying condition
Prophylaxis (teeth cleaning)	D1110 (adult) D1120 (child)	100% coverage
Periodontal maintenance (cleaning to monitor and treat inflammation and infection after past gum surgery or treatment)	D4910	100% coverage
Scaling in presence of moderate or severe gingival inflammation (plaque removal)	D4346	100% coverage

How Opt in to (Enroll in) SmileWay

You’ll need to opt in to access the expanded coverage.

To opt in for yourself or a covered dependent, log in to your Delta Dental account and select SmileWay Wellness Benefits from the main menu.
Select the Opt in button next to the eligible member’s name.
Complete and submit the form, including the treating physician’s name and phone number.
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?

A: No formal approval is required. To opt in, simply log in to your account at deltadentalins.com, and follow the instructions above. That’s it!

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

A: 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?

A: Once logged in to your account at deltadentalins.com, you can easily access the SmileWay Wellness Benefits page. There, you’ll see your enrollment status and a description of your available extra benefits.

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

A: Simply let your dental provider know that you’re enrolled in SmileWay. You can then schedule your additional cleaning or other qualifying service. No extra paperwork is needed — within 24 hours after enrollment, your provider will see your eligibility in Delta Dental’s Provider Tools system and submit the claim as usual.

Q: Can I use SmileWay benefits with any dentist?

A: 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?

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

Footnotes

_{SmileWay Wellness Benefits are not included under all plans. Known as SmileWay® Enhanced Benefits in Texas.}
_{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.}
_{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.}