Introduction:

Recipients of and candidates for, organ transplant, bone marrow transplant or open heart surgery (for purposes of implanting a prosthetic heart valve), are entitled to dental care as part of the healthcare basket.


Organ, bone marrow and prosthetic heart valve candidates for transplants and recipients taking medication to prevent rejection are entitled to dental and periodontal care.

  • All policyholders are entitled to dental and periodontal care if it is medically determined to be necessary and life-saving.
  • Organ, bone marrow and prosthetic heart valve recipients taking medication to prevent rejection are considered to be a high-risk population for contracting infectious diseases.
  • Infections in the oral cavity are liable to be the source of such diseases.
  • Prevention of such cases through early detection and removal of potential sources of infection is considered to be necessary and life-saving treatment.

Who is Eligible?

  • Patients in any one of the following 3 categories are entitled:
    • Candidates for Organ or bone marrow transplants.
    • Organ or bone marrow transplant recipients.
    • Candidates for open heart surgery (for purposes of implanting a prosthetic heart valve).

How to Claim It?

  • Approval from the health plan (through the patient's primary care clinic) must be obtained before starting treatment.
  • Before beginning dental treatment, the patient must get a written medical diagnosis from his/her attending physician including the proposed date of the surgical procedure/transplant.

Basket of Services Before a Transplant or Heart Surgery (for Purposes of Implanting a Prosthetic Heart Valve)

  • The basket of services before a transplant or heart surgery (for purposes of implanting a prosthetic heart valve) includes the following preservative treatments:
    • Treatment examination and plan including x-rays/visual imaging
    • Root canal treatment including restoration
    • Extraction of teeth that cannot be preserved
    • Removal of tartar and plaque
    • Dental restoration and removal of tooth decay

Basket of Services for Two Years Following the Procedure

  • The basket of services for the two years following the procedure includes the following treatments:
    • First aid if needed
    • Periodic check-up every 6 months
    • Removal of inflamed tissue and irritants such as tartar and plaque
    • Cleanings and instruction on maintaining proper oral hygiene

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