A healthy family with good teeth and healthy smiles are enjoying dinner in their yard.
/  Providers Guide to Oral Health for Total Health

Provider’s Guide to Oral Health for Total Health

At HMSA, we deliver innovative health plans and programs to people in the communities we serve. Because of our commitment to the people of Hawaii and the health of our members, HMSA provides Oral Health for Total Health,SM, a program that connects medical and dental plans to improve the total health of participating members. For members with both HMSA 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.

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

At our practice, we treat our patients like family. We encourage them to practice preventive measures for optimal health. Routine dental care is a part of that. Oral Health for Total Health recognizes that some people need routine dental care more frequently than others, which is a big win for our patients. Dr. William Sicilia, HMSA participating dentist

Condition-specific benefits at no additional cost

HMSA members who are enrolled in Oral Health for Total 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 HMSA care coordination programs.

Two additional cleanings or periodontal maintenance visits, plus:
Eligible medical conditionsPeriodontal scaling covered 100%Enhanced cleaning to remove excess plaque buildupOral health screenings; fluoride treatments
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)

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

Your partnership with HMSA

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 Total Health, you have the opportunity to:

  • Help your patients achieve better total heath.
  • 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 these additional dental benefits. Members with an eligible health condition who have both HMSA medical and dental plans are automatically enrolled based on claims information. Members who are pregnant or only have a dental plan with HMSA must self-enroll. While we do send communications to enrolled members, offering reminders or assistance while they’re getting care at your office will encourage them to use the enhanced dental benefits. Here are some tools that might help:

Verifying patient enrollment

Visit our online provider portal 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 an HMSA Customer Relations representative at 808-948-6440 on Oahu or 1-800-792-4672 toll-free.