Humana Dental Traditional Preferred - Miami Dade College

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SGB0186AHumana Dental TraditionalPreferredFLORIDAIf you use anIN-NETWORK dentistIf you use anOUT-OF-NETWORK dentistCalendar-year deductibleIndividual FamilyIndividualFamily(excludes orthodontia services) 50 50 150 150Deductible applies to all services excluding preventiveservices.Calendar-year annual maximum 1,500(excludes orthodontia services)Preventive services Routine oral examinations (3 per year) Bitewing x-rays (2 films under age 10, up to 4 filmsages 10 and older) Routine cleanings (3 per year) Fluoride treatment (1 per year, through age 15) Sealants (permanent molars, through age 15) Space maintainers (primary teeth, through age 15) Oral Cancer Screening (1 per year, ages 40 and older)Basic services Emergency care for pain relief Periodontal cleanings (4 per year) Amalgam fillings (1 per tooth every 2 years,composite for anterior/front and posterior teeth) Oral surgery (tooth extractions including impactedteeth) Stainless steel crowns Harmful habit appliances for children (1 per lifetime,through age 14) Periodontics (scaling/root planing and surgery 1 perquadrant every 3 years)80% no deductible80% no deductible80% after deductible80% after deductible50% after deductible50% after deductiblex 1Endodontics(root canals 1 per tooth per lifetime andre-treatment)Major services Crowns (1 per tooth every 5 years)Inlays/onlays (1 per tooth every 5 years)Bridges (1 per tooth every 5 years)Dentures (1 per tooth ever 5 years)Denture relines/rebases (1 every 3 years, following 6months of denture use) Denture repair and adjustments (following 6 monthsof denture use) Implants (crowns, bridges, and dentures each limitedxto 1 per tooth every five years)1-800-233-4013 Humana.comPage 1 of 5

Humana Dental Traditional PreferredIf you use anIN-NETWORK dentistIf you use anOUT-OF-NETWORK dentistAdult/child orthodontia. - Plan pays 50 percent (nodeductible) of the covered orthodontia services, up to: 1,500 lifetime orthodontia maximum.Orthodontia servicesNon-participating dentists can bill you for charges above the amount covered by your HumanaDental plan. To ensureyou do not receive additional charges, visit a participating PPO Network dentist. Members and their families benefitfrom negotiated discounts on covered services by choosing dentists in our network. If a member visits a participatingnetwork dentist, the member will not receive a bill for charges more than the negotiated fee for covered services. If amember sees an out-of-network dentist, coinsurance will apply to the usual and customary charge. Out-of-networkdentists may bill you for charges above the amount covered by your dental plan.Waiting periodsEmployer-sponsored funding: 10 enrolled employeesEnrollment typePreventiveInitial enrollment, open enrollmentand timely add-onNoLate applicant 1, 2No12BasicMajorOrthodontiaNoNoNo12 months12 months12 monthsLate applicants not allowed with open enrollment option.Waiting periods do not apply to endodontic or periodontic services unless a late applicant.1-800-233-4013 Humana.comPage 2 of 5

Humana Dental TraditionalPreferredQuestions?Feel good about choosinga HumanaDental planUse your HumanaDentalbenefitsMake regular dental visits a priorityFind a dentistRegular cleanings can help manage problemsthroughout the body such as heart disease, diabetes,and stroke.* Your HumanaDental Traditional Preferredplan focuses on prevention and early diagnosis,providing four exams and cleanings every calendar year:two regular and two periodontal.* www.perio.orgWith HumanaDental's Traditional Preferred plan, you cansee any dentist. Members and their families benefit fromnegotiated discounts on covered servcies by choosingdentists in the HumanaDental Traditional PreferredNetwork. To find a dentist in HumanaDental's TraditionalPreferred Network, log on to Humana.com or call1-800-233-4013.Go to MyDentalIQ.comKnow what your plan coversTake a health risk assessment that immediately ratesyour dental health knowledge. You'll receive apersonalized action plan with health tips. You can print acopy of your scorecard to discuss with your dentist atyour next visit.The other side of this page gives you a summary ofHumanaDental benefits. Your plan certificate describesyour HumanaDental benefits, including limitations andexclusions. You can find it on MyHumana, your personalpage at HumanaDental.com or call 1-800-233-4013.Tips to ensure a healthy mouth Use a soft-bristled toothbrush Choose toothpaste with fluoride Brush for at least two minutes twice a day Floss daily Watch for signs of periodontal disease such as red,swollen, or tender gums Visit a dentist regularly for exams and cleaningsSee your dentistDid you know that 74 percent of adult Americans believe anunattractive smile could hurt a person's chances for careersuccess?* HumanaDental helps you feel good about your dentalhealth so you can smile confidently.* American Academy of Cosmetic DentistryAfter HumanaDental processes your dental claim, you willreceive an explanation of benefits or claims receipt. Itprovides detailed information on covered dental services,amounts paid, plus any amount you may owe yourdentist. You can also check the status of your claim onMyHumana at Humana.com or by calling1-800-233-4013.Simply call 1-800-233-4013 to speak witha friendly, knowledgeable Customer Carespecialist, or visit Humana.com.Your HumanaDental identification card contains all theinformation your dentist needs to submit your claims. Besure to share it with the office staff when you arrive foryour appointment. If you don't have your card, you canprint proof of coverage at Humana.com.Learn what your plan paidHumana group dental plans are offered by Humana Insurance Company, HumanaDental Insurance Company, Humana InsuranceCompany of New York, Humana Health Benefit Plan of Louisiana, The Dental Concern, Inc., Humana Medical Plan of Utah,CompBenefits Company, CompBenefits Dental, Inc., Humana Employers Health Plan of Georgia, Inc. or DentiCare, Inc. (d/b/aCompBenefits)This is not a complete disclosure of plan qualifications and limitations. Your agents will provide you with specific limitations andexclusions as contained in the Regulatory and Technical Information Guide. Please review this information before applying forcoverage. The amount of benefits provided depends upon the plan selected. Premiums will vary according to the selection made.Humana.comPlan summary created on: 7/9/19 10:01Policy Number: FL-70090-HC L 1/14, FL-70090-HC SB 1/14Page 3 of 5

Humana group dental plans are offered by Humana Insurance Company, HumanaDental Insurance Company, Humana Insurance . CompBenefits Company, CompBenefits Dental, Inc., Humana Employers Health Plan of Georgia, Inc. or DentiCare, Inc. (d/b/a CompBenefits) This is not a complete disclosure of plan qualifications and limitations. Your agents will .

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