Dental
Humana DHMO – PrepaidHighlights
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Under this option, you select a Primary Care Provider from the Humana provider list. No claim forms to complete. No copays for basic cleanings.
How It Works
The Humana Plan features includes:
- No maximum benefit, except for accidental injury
- No claim forms to complete
- Budgetable and predictable
- Copay for orthodontics – No waiting periods
- No copays for basic cleanings (two per calendar year)
- Specialty care is covered by referral from your primary dentist at the same defined copays as general dentists
Humana Dental Plans: Rate Comparison Chart
| RATES | Humana DHMO - Prepaid | Humana PPO | ||
|---|---|---|---|---|
| 20 PAY | 24 PAY | 20 PAY | 24 PAY | |
| Employee* | $9.14 | $7.62 | $25.86 | $21.55 |
| Employee + One* | $18.11 | $15.09 | $51.94 | $43.28 |
| Employee + Family* | $32.18 | $26.82 | $64.68 | $53.91 |
| *Premiums may be deducted pretax or post-tax. |
Humana Plan Benefits Comparison Chart
You have a Calendar Year plan and these benefits are for a Calendar Year, which is January 1st through December 31st of the current Plan Year.
Humana Humana PPO YOU PAY PLAN PAYS BENEFITS Dentist Choose A Panel Dentist Use Dentist Of Choice** Deductible* None $75 Per Year, Individual & $150 Per Year, Per Family Calendar Year Maximum None $5,000 Per Person Claim Forms None None If Using Humana Dentists PROCEDURES Office Visit $0 - $20 100% Routine Exams No Cost 100% Prophylaxis (Cleaning) Basic - No Cost (1 Per 6 Months) Basic - 100%(2 in a calendar year) X-Ray and Complete Series No Cost (Including Bitewings)1 100% (1 every 3 Years - Full), Under 18: 2 Per 12 Months - Bitewing, Over 18: 1 Per Calendar Year - Bitewing Fluoride Application No Charge To Age 19 (One Per 6 Months) 100% (2 Per Calendar Year, Children Under 19 Only) BASIC/RESTORATIVE PROCEDURES Simple Extractions $6 80% Amalgam Fillings No Cost - 1 Surface Perm, Resin Based Fillings - Posteriors $15 - $35 80% Root Canal Anterior2 $75; Molar2 $180 80% MAJOR PROCEDURES Crowns Crowns - Porcelain, Base Metal $195; Crowns - Porcelain, $295 High Noble Metal 50% Dentures Upper Maxillary: $225 / Lower Maxillary: $225 50% Bridges Porcelain, Base Metal $195 (Per Unit)Resin, High Noble Metal $295 (Per Unit) 50% Periodontics Scaling And Root Planing $45 Per Quadrant 50% Implants Covered*** 50% Coins Orthodontics Start Up Fee: $350, Routine 24 Month Fully Banded Case: Adult $2,000, Child $1,800 75% Up To $1,500 Lifetime Maximum (After 1 Year Waiting Period Dependent Children Under Age 19 Only) Waiting Period N/A Applies To New Participants (Orthodontics Only) TMJ BENEFITS TMJ N/A 50% Up To $1,000 Lifetime Maximum (Effective October 2006) * Note the deductible does not apply to diagnostic and preventative services, orthodontics.
**PPO Dentists are limited to the PPO fee. Humana Dentists are limited to the least of: the dentist’s filed fee, submitted fee, or Humana's MPA (Maximum Plan Allowance) fee. Non-Humana Dentists may balance bill for amounts over Humana’s MPA-TJM Benefits (Maximum Plan Allowance) fee.
***See Humana's schedule of benefits for co-payment amounts
1Under the Humana plan, bitewing X-rays (code D0274) are limited to not more than one series of four films in any six-month period.
2Excluding final restoration
- Humana has a dedicated online service available. Please be sure to register online once your benefits take effect to allow you access to your portal and services