Dental
Humana Traditional Preferred PPOHighlights
Click here for Humana PPO Option
Under this option, you can receive services from a PPO Dentist or the dentist of your choice. PPO Dentists will file claims on your behalf and have agreed to charge no more than the predetermined PPO fee schedule.
How It Works
Humana Traditional Preferred (PPO) allows each person covered under the plan to have the freedom to visit any dentist. There may be a savings advantage to receiving care from a PPO Dentist because your out-of-pocket costs tend to be lower than visiting a non-Humana dentist.
When you visit a PPO Dentist, payment is based on the PPO fee schedule. The PPO Dentist has agreed to accept this fee as the approved amount. Although you are responsible for deductibles, coinsurances and any expenses above the maximum, a PPO Dentist cannot bill you for any covered charges above the approved amount.
Humana 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
- You can locate a Humana provider by calling 1-866-424-7478 or a PPO provider by calling 1-866-424-7478. You may also find a provider by using the app, or by going online at humana.com and clicking the “Find a Dentist” link on the homepage.
- To help you maintain your oral health, Humana offers enhanced benefits for pregnant women. This coverage includes an additional exam, cleaning or periodontal procedure as needed, once pregnancy is confirmed.
- You can use the Dental Care Cost Estimator at www.humana.com to get an estimate on your potential procedure expenses.
- You have access to a Member Online Portal.