Humana One Optional Dental - Illinois
Annual Deductible
$50 (combined network and non-network)
Annual Family Deductible
$150 (combined network and non-network)
Deductible waived for Preventive services
Yes (network and non-network)
Annual Maximum Benefit
$1,000 (combined network and non-network)
• Preventive Services
Coverage begins immediately
• Basic Services
Coverage begins after 6 continuous months of coverage
• Major Services
Coverage begins after 12 continuous months of coverage
Network Benefits versus Non-Network Benefits
Save up to 30% on out-of-pocket costs when you visit one of the more than 75,000 Humana PPO network dentists who've agreed to Humana's dental fee schedule.
Benefits for non-network services are based on Humana's maximum allowable fee.
Non-network dentists may bill you for charges in excess of the maximum allowable fee.
Preventive Services - No benefit waiting period
• Oral examinations
0% - deductible does not apply
0% - deductible does not apply
• Topical fluoride treatment
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Basic Services - 6 month benefit waiting period
• Emergency exams and palliative care for pain relief
50% after deductible
50% after deductible
• Thumb sucking and harmful habit appliances
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• amalgam, composite fillings
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• Extractions (routine)
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• Non-cast stainless steel crowns
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• Partial or complete denture repairs/adjustments
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Teeth Whitening Services - 6 month benefit waiting period
• $200 lifetime maximum for teeth whitening
50% after deductible
50% after deductible
Major Services - 12 month benefit waiting period
• Endodontics (root canal)
50% after deductible
50% after deductible
• Partial or complete dentures
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• Denture relines/rebases
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• Removable or fixed bridgework
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Orthodontia discount
Members can receive up to 20 percent discount if they visit an orthodontist from the Humana Dental PPO Network and ask for the discount.
Dental Limitations and Exclusions
This is an outline of the limitations and exclusions for the Humana One Individual Dental Plan. It is designed for convenient reference.
Consult the policy for a complete list of limitations and exclusions.
Unless stated otherwise, no benefits are payable for expenses arising from:
- The course of any occupation or employment for compensation, profit or gain, for which benefits are provided or payable under any Workers’ Compensation or Occupational Disease Act or Law; or where such coverage was available, regardless of whether the coverage was actually applied for.
- Services and supplies for which no charge is made, or for which the covered person would not be required to pay in the absence of insurance.
- Services furnished by or payable under any plan or law through any Government or any political subdivision.
- Services furnished by any hospital or institution owned or operated by the United States Government.
- War or any act of war, whether declared or not; or any act of international armed conflict or any conflict involving armed forces of any international authority.
- Completion of forms or failure to keep an appointment with a dentist.
- Cosmetic dentistry, except as stated in the policy.
- Any service related to altering vertical dimension; restoration or maintenance of occlusion; splinting teeth; replacing tooth structures lost as a result of abrasion, attrition or erosion; or bite registration or bite analysis.
- Bone grafts, regeneration, augmentation or preservative procedures in edentulous sites.
- Implants, including any crowns or prosthetic device attached to it; precision or semi-precision attachments; overdentures and any endodontic treatment associated with it; or other customized attachments.
- Infection control.
- Fees for treatment by other than a dentist, except as stated in the policy.
- Any hospital, surgical or treatment facility, or for services of an anesthesiologist or anesthetist.
- Prescription drugs or pre-medications, whether dispensed or prescribed.
- Any service not listed as a covered expense.
- Any service not considered a dental necessity, does not offer a favorable prognosis, does not have uniform professional endorsement, or is experimental, investigational or for research purposes.
- Expenses incurred prior to the effective date or after the date coverage is terminated, except for any extension of benefits.
- Services provided by a person who ordinarily resides in the covered person’s home or who is a family member.
- Charges in excess of the reimbursement limit for the service or supply.
- Treatment as a result of an intentionally self-inflicted injury or bodily illness, while sane or insane.
- Local anesthetics, irrigation, nitrous oxide, bases, pulp caps, temporary dental services, study models, treatment plans, occlusal adjustments, or tissue preparation associated with impression or placement of a restoration, charged as a separate service.
- Repair and replacement of orthodontic appliances.
- Sickness or bodily injury for which there is medical payment or expense coverage provided or payable under any automobile, homeowners, premises or any other similar coverage.
Payments
Participating providers agree to accept amounts negotiated with Humana as payment in full. The member is responsible for any required
deductible, coinsurance, or other co-payments. Plan benefits paid to nonparticipating providers are based on maximum allowable fees, as defined in your policy.
Nonparticipating providers may balance bill you for charges in excess of the maximum allowable fee.
You will be responsible for charges in excess of the maximum allowable fee in addition to any applicable deductible, coinsurance,
or co-payment. Additionally, any amount you pay the provider in excess of the maximum allowable fee will not apply to your out-of-pocket limit or deductible.
Participating Providers
Participating providers in Humana’s networks are not the agents, employees or partners of Humana or
any of its affiliates or subsidiaries. They are independent contractors. Humana is not a provider of dental services. Humana does not endorse or
control the clinical judgement or treatment recommendations made by the providers listed in network directories or otherwise selected by you.
This document contains a general summary of benefits, exclusions and limitations. Please refer to the policy for the actual terms and conditions that apply. In the event there are discrepancies with the information given in this document, the terms
and conditions of the policy will govern.
