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A woman is happily showing her patient a dental x-ray
/  Oral Health for Overall Health

Provider’s Guide to Oral Health for Overall Health

At Florida Blue, we deliver innovative health plans and programs to people in the communities we serve. Because of our commitment to the health of our members, we created Oral Health for Overall HealthSM, a program that connects medical and dental plans to improve the overall health of participating members. For members with both Florida Blue medical and dental plans, we’re able to review their medical claims to identify and automatically enroll those with health conditions that benefit from additional dental services.

With enhanced dental benefits, more patients come to our dental offices for oral examinations, cleanings, and other preventative services. We have noticed that our patients are improving their overall oral health. This reduces the need for invasive dental procedures or hospitalization in patients with comorbidities or high risk. Tim Ngo, Dental Office Administrator

While research is ongoing, the connection between oral health and overall health is well established. The additional dental benefits that Oral Health for Overall Health provides can have a significant impact on a member’s overall health and well-being.

Additional benefits at no additional cost

Florida Blue members who are enrolled in Oral Health for Overall Health receive additional condition-specific dental benefits that are valued at more than $1,000—which is also additional revenue for your practice. These benefits are covered 100% with no out-of-pocket expenses when members see a participating provider. The benefits don’t count toward the calendar year maximum and there are no waiting periods. The program includes education and ties dental into Florida Blue care coordination programs.

We also conduct outreach and education to make sure that members are aware of the relationship between preventive or periodontal dental services and their overall well-being.

Covered Medical Conditions & BenefitsAutomatic Program EnrollmentTwo Additional Cleanings or Periodontal Maintenance Visits per YearOral Health Screenings Once Every 6 Months & Fluoride Treaments Once Every 3 MonthsPerdiodontal Scaling Covered 100% with No Out-of-Pocket Expense
Chronic obstructive pulmonary disease (COPD)
Coronary artery disease (CAD)
Diabetes (DM)
End-stage renal disease (ESRD)
Head and neck cancers (HNC)
Metabolic syndrome (MetS)
Oral cancer (OC)
Pregnancy (PG)
Sjogren’s syndrome (SjS)
Stroke (CVA)

Your partnership with Florida Blue

As Florida’s leading health insurer, our goal is to partner with you to ensure that those who need dental care the most are able to get it. Through Oral Health for Overall Health, you have the opportunity to:

  • Help your patients achieve better overall heath.
  • Easily identify patients eligible to enroll, or already enrolled, in the program and have the information and resources necessary to ensure that they take advantage of these benefits.
  • Provide additional covered services and increase your patient volume. Since many patients in the program are eligible for four visits per year, we recommend that you schedule all four visits at their first visit.
  • Work more closely with other health care providers such as primary care providers.

Help your patients enroll

The program is more successful when dentists participate in member education, so we encourage you and your staff to help your patients understand the value of the enhanced dental benefits. Eligible members with a qualifying health condition who have both Florida Blue medical and dental plans are automatically enrolled based on claims information. Members who are pregnant or only have a dental plan with Florida Blue must self-enroll. While we do send communications to enrolled members, offering reminders or assistance during patients’ visits will encourage them to use the enhanced dental benefits. Here are some tools that might help:

Verifying patient enrollment

Visit MyPatientsBenefits to verify eligibility and benefits. In the patient summary under qualified medical condition reported, the indicator will display Y or N. You may also call Customer Service at 1-866-445-5148.