of age) (two per calendar year), Topical application of fluoride—adult (two per calendar year, by primary care dentist), Topical fluoride varnish (for child <16) (two per calendar year), Nutrition counseling for the control or avoidance of dental disease, Tobacco counseling services for the control or prevention of oral disease, Sealant—per tooth (permanent teeth only to age 16), Space maintainer—fixed, unilateral (through age 14), Space maintainer—fixed, bilateral (through age 14), Space maintainer—removable, unilateral (through age 14), Space maintainer—removable, bilateral (through age 14), Amalgam—one surface, primary or permanent, Amalgam—two surfaces, primary or permanent, Amalgam—three surfaces, primary or permanent. With in-network providers, X-rays
In the event of a dispute, the policy as written in English is considered the controlling authority.
Vision Plans. * The above copayments do not include the additional cost of precious (high noble) Premium includes a $1 administrative fee. CompBenefits of Alabama, Inc., CompBenefits of Georgia, Inc., American Dental Providers With in-network providers, 100% covered exceed $125 per unit and $75 per unit for semi-precious metal.. Our dental plans and vision plans have exclusions, limitations and terms under which the coverage may be continued in force or discontinued. of Arkansas, Inc., American Dental Plan of North Carolina, Inc., or DentiCare, Inc. Humana individual vision plans are insured by Humana Insurance Company, The Dental Concern, Inc., or Humana Insurance Company of New York, or Humana Health Benefit Plan of Louisiana, Inc. Arizona residents insured by Humana Insurance Company.
Texas residents insured by Humana Insurance Company. View plans and prices available in your area. Learn more about the different types of insurance.
Get the most out of your plan. 100% covered (no deductible) Incomplete endodontic therapy—inoperable or fractured tooth, Internal root repair of perforation defects, Apexification/recalcification—initial visit, Apexification/recalcification—final visit, Apicoectomy/periradicular surgery—anterior, Apicoectomy/periradicular surgery—bicuspid (first root), Apicoectomy/periradicular surgery—molar (first root), Apicoectomy/periradicular surgery (each additional root), Root amputation—per root (not covered in conjunction with procedure D3920), Surgical procedure to isolate tooth with rubbed dam, Hemisection not included in root canal therapy, Root canal prepare and fit preformed dowel/post, Gingivectomy/gingivoplasty—four or more teeth, per quadrant, Gingivectomy/gingivoplasty per tooth—one to three teeth, per quadrant, Gingival flap, including root planing—four or more teeth, per quadrant, Gingival flap, including root planing—one to three teeth, per quadrant, Osseous surgery—four or more teeth or bounded spaces, per quadrant, Osseous surgery—one to three teeth, per quadrant, Bone replacement graft—first site in quadrant, Bone replacement graft—each additional site in quadrant bone, Biological materials which can aid soft and osseous tissue regeneration, Guided tissue regeneration—resorbable barrier, per site, Guided tissue regeneration—nonresorbable barrier, per site (includes membrane removal), Free soft tissue graft procedure (including donor site surgery), Subeptithelial connective tissue graft, tooth, Periodontal scaling and root planing, per quadrant, Periodontal scaling and root planing 1 to 3 teeth per quadrant, Full mouth debridement to enable comprehensive evaluation and diagnosis, Localized delivery of chemotherapeutic agents (per tooth), Extraction, erupted tooth or exposed tooth, Removal of impacted tooth—completely bony, Removal of impacted tooth—completely bony, unusual complications by report, Tooth stabilization of accidentally avulsed or displaced tooth, Surgical access of an unerupted tooth (excluding wisdom teeth), Mobilization of erupted or malposed tooth to aid eruption, Exfoliative cytological sample collection, Brush biopsy—transepithelial sample collection, Alveoloplasty in conjunction with extractions—per quadrant, Alveoloplasty in conjunction with extractions—one to three teeth or tooth spaces, Humana individual vision plans are insured by Humana Insurance Company, The Dental Concern, Inc., or Humana Insurance Company of New York, or Humana Health Benefit Plan of Louisiana, Inc. Arizona residents insured by Humana Insurance Company. The Humana Dental Value Plan (HI215) has you covered for any circumstance. Humana legal entities that offer, underwrite, administer or insure insurance products and services, View a complete list of the legal entities. Deductible does not apply, *Waived with proof of dental insurance for previous 12 months, None for preventive services and teeth whitening allowances. Dental benefits. For costs and complete details of coverage, call or write Humana or your Humana insurance agent or broker.
All rights reserved. • No waiting periods • No claims to file • No annual maximums. 100% covered and semi-precious (noble) metal. FL52374HD 0117 Page 2 The HumanaDental Prepaid plans … Know what your plan … All Rights Reserved, Humana — HumanaOne Dental Value Plan (HI215), The Insurance Store - Get the right dental plan at the right price.
Statements in languages other than English contained in the advertisement do not necessarily reflect the exact contents of the policy written in English, because of possible linguistic differences. Resin based composite—one surface, anterior, Resin based composite—two surfaces, anterior, Resin based composite—three surfaces, anterior, Resin based composite—four or more surfaces or involving incisal angle (anterior), Resin based composite—one surface, posterior, Resin based composite—two surfaces, posterior, Resin based composite—three surfaces, posterior, Resin based composite—four or more surfaces, posterior, Inlay—porcelain/ceramic, three or more surfaces, Onlay—porcelain/ceramic, four or more surfaces, Inlay—resin based composite, two surfaces, Inlay—resin based composite, three or more surfaces, Onlay—resin based composite, two surfaces, Onlay—resin based composite, three surfaces, Onlay—resin based composite, four or more surfaces, Crown—3/4 resin based composite, indirect, Crown—resin with predominantly base metal, Crown—porcelain fused to high noble metal, Crown—porcelain fused to predominantly base metal, Recement cast or prefabricated post and core, Prefabricated stainless steel crown—primary tooth, Prefabricated stainless steel crown—permanent tooth, Prefabricated stainless steel crown with resin window, Prefabricated esthetic coated stainless steel crown—primary tooth, Pin retention—per tooth, in addition to restoration, Prefabricated post and core in addition to crown, Each additional prefabricated post—same tooth, base metal post, Labial veneer (resin laminate)—laboratory, Labial veneer (porcelain laminate)—laboratory, Additional procedure—new crown existing partial denture, Cast post and core, in addition to fixed partial denture retainer, Prefabricated post and core in addition to fixed partial denture retainer, base
Collect microorganisms culture & sensitivity, Oral cancer screening using a special light source, Pathology report—gross examination of lesion, Pathology report—microscopic examination of lesion, Pathology report—microscopic examination of lesion and area, Prophylaxis—adult, routine (two per calendar year, by primary care dentist), Prophylaxis—child, routine (two per calendar year), Topical application of fluoride (not including prophylaxis)—child (up to 16 years Members may see a participating primary care dentist as often as necessary. per quadrant, Alveoloplasty not in conjunction with extractions—per quadrant, Alveoloplasty not in conjunction with extractions—one to three teeth or tooth spaces, Humana individual dental plans are insured or offered by Humana Insurance Company, HumanaDental Insurance Company, Humana Insurance Company of New York, The Dental Concern, Inc., CompBenefits Insurance Company, CompBenefits Company, CompBenefits Dental, Inc., Humana Employers Health Plan of Georgia, Inc., Humana Health Benefit Plan of Louisiana, Inc., or DentiCare, Inc. (DBA CompBenefits). With in-network providers, Cleanings With in-network providers, X-rays With in-network providers, Discounted 20-40% on average Note: Limitations and exclusions may apply. Texas residents insured by Humana … Plans, products, and services are solely and only provided by one or more Humana Entities specified on the plan, product, or service contract, not Humana Inc. Not all plans, products, and services are available in each state. Emergency visit during regularly scheduled hours, by report. 100% covered Texas residents insured or offered by Humana Insurance Company, HumanaDental Insurance Company, or DentiCare, Inc. (DBA CompBenefits).
NOTE: Members can receive a 25 percent savings by visiting an in-network orthodontist. Current Dental Technology © 2007 American Dental Association. conscious sedation—additional 15 minutes (limited to the removal of partial, appointment.
Limitations and exclusions may apply. bony impacted teeth), General anesthesia—additional 15 minutes (limited to the removal of partial, or Individual applications are subject to eligibility requirements. General anesthesia—first 30 minutes (limited to the removal of partial, or complete Check to see if your current dentist is in our network. There are no yearly maximums, no deductibles to meet and no waiting periods. Our dental plans and vision plans may also have waiting periods. Please enter the age and zip code of the primary policy holder, and we will check availability of this plan in your area and calculate the plan costs for you and your family. Discount plans are offered by HumanaDental Insurance Company, Humana Insurance Company, or Texas Dental Plans, Inc. Arizona residents insured by Humana Insurance Company. Offered or administered by HumanaDental Insurance Company, the Dental Concern, Inc., With in-network providers, X-rays The HumanaOne Dental Value Plan HI215 plan is affordable, dependable coverage that helps you get the 100% covered (no deductible) Office visit (after regularly scheduled hours). View a complete list of the legal entities that offer, underwrite, administer or insure insurance products and services. notice, per 15 min) —maximum $40 per broken Register for a MyHumana account today. complete bony impacted teeth), I.V. Consultation (diagnostic service provided by dentist other than practitioner providing metal post, Each additional prefabricated post—same tooth, Pontic—porcelain fused to high noble metal, Pontic—porcelain fused to predominantly base metal, Recement fixed partial denture (per unit), Core buildup for retainer, including any pins, Maxillary partial denture—cast metal framework, resin denture bases, Mandibular partial denture—cast metal framework, resin denture bases, Maxillary partial denture—flexible (including clasps, rests and teeth), Mandibular partial denture—flexible (including clasps, rests and teeth), Removable partial denture—one piece cast metal, Pulp cap—direct (excluding final restoration), Pulp cap—indirect (excluding final restoration), Pulpal debridement, primary and permanent teeth, Pulpal therapy (resorbable filling)—anterior, primary tooth (excluding final restoration), Pulpal therapy (resorbable filling)—posterior, primary tooth (excluding final restoration), Root canal therapy—anterior (excluding final restoration), Root canal therapy—bicuspid (excluding final restoration), Root canal therapy—molar (excluding final restoration).
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