With in-network providers, X-rays General anesthesia—first 30 minutes (limited to the removal of partial, or complete
There are no yearly maximums, no deductibles to meet and no waiting periods. Whether you need routine care or a
A $35 one-time, non-refundable enrollment fee applies (The fee is non-refundable as allowed by state requirements).
treatment).
The HumanaOne Dental Value Plan HI215 plan is affordable, dependable coverage that helps you get the dental treatment you need, when you need it. View plans and prices available in your area.
No copay Office visit (after regularly scheduled hours).
Register for a MyHumana account today. View a complete list of the legal entities that offer, underwrite, administer or insure insurance products and services. Know what your plan … Amalgam—four or more surfaces, primary or permanent.
With in-network providers, X-rays
Deductible does not apply, *Waived with proof of dental insurance for previous 12 months, None for preventive services and teeth whitening allowances.
Association membership and fees may be required in some states.
With in-network providers, Cleanings The additional cost of precious metal shall not
For costs and complete details of coverage, call or write Humana or your Humana insurance agent or broker. CompBenefits Insurance Company, CompBenefits Company, CompBenefits Dental, Inc.,
Texas residents insured by Humana Insurance Company. NOTE: Members can receive a 25 percent savings by visiting an in-network orthodontist. Dental and vision plans, excluding Dental Savings Plus, may have a minimum one-year initial contract period. per quadrant, Alveoloplasty not in conjunction with extractions—per quadrant, Alveoloplasty not in conjunction with extractions—one to three teeth or tooth spaces,
Get the most out of your plan. 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.
of Arkansas, Inc., American Dental Plan of North Carolina, Inc., or DentiCare, Inc.
The HD205 Prepaid Plan focuses on maintaining oral health, prevention and cost containment. Prophylaxis (routine cleanings) – two per calendar year, Topical fluoride application (up to age 16) – two per calendar year, Topical fluoride application (adult) – two per calendar year, by primary care dentist, Bitewing X-rays (up to a set of four) – two per calendar year, Full-mouth X-rays (panoramic film) – once per three calendar years. With in-network providers, X-rays
Our dental plans and vision plans have exclusions, limitations and terms under which the coverage may be continued in force or discontinued. The Humana Dental Value Plan (HI215) has you covered for any circumstance. Vision Plans. Individual applications are subject to eligibility requirements.
100% covered (no deductible) Treatment of root canal obstruction—non-surgical access. 100% covered Dental benefits.
Premium includes a $1 administrative fee. Broken appointments (without 24 hr. * The above copayments do not include the additional cost of precious (high noble)
exceed $125 per unit and $75 per unit for semi-precious metal..
Whether you need routine care or a major dental procedure, you know what to expect from HumanaOne Dental Value Plan. Note: Limitations and exclusions may apply. FL52374HD 0117 Page 1 ... available at Disclosure.Humana.com.
Texas residents insured by Humana …
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. 100% covered (no deductible) caregiver, Re-evaluation—problem focused (not post-operative visit), X-ray intraoral—complete series including bitewings, X-ray intraoral—periapical, each additional film, X-ray bitewings—three films (two per calendar year).
complete bony impacted teeth), I.V. d/b/a CompBenefits. Offered or administered by HumanaDental Insurance Company, the Dental Concern, Inc.,
Palliative (emergency) treatment of dental pain—minor procedure. Humana legal entities that offer, underwrite, administer or insure insurance products and services, View a complete list of the legal entities. None for in-network preventive services, otherwise: Cleanings HumanaDental Prepaid HS205 Plan. 100% covered
or complete bony impacted teeth), Case presentation, detailed and extensive treatment planning. “Humana” is the brand name for plans, products and services provided by one or more of the subsidiaries and affiliate companies of Humana Inc. (“Humana Entities”). With in-network providers, 100% covered (no deductible)
major dental procedure, you know what to expect from HumanaOne Dental Value Plan. 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). With in-network providers, $100 Allowance (in-office) The HumanaOne Dental Value Plan HI215 plan is affordable, dependable coverage that helps you get the
Note: Limitations and exclusions may apply. With in-network providers, Discounted 20-40% on average
With in-network providers, 100% covered Discount plans are offered by HumanaDental Insurance Company, Humana Insurance Company, or Texas Dental Plans, Inc. Arizona residents insured by Humana Insurance Company. Limitations and exclusions may apply.
per quadrant, Removal of benign odontogenic cyst or tumor—up to 1.25 cm, Removal of benign odontogenic cyst or tumor—greater than 1.25 cm, Removal of lateral exostosis (maxilla or mandible), Incision and drainage of abscess—intraoral soft tissue, Replace missing or broken teeth—complete denture (each tooth), Replace all teeth and acrylic framework—maxillary, Replace all teeth and acrylic framework—mandibular, Reline complete maxillary denture (chairside), Reline complete mandibular denture (chairside), Reline maxillary partial denture (chairside), Reline mandibular partial denture (chairside), Reline complete maxillary denture (laboratory), Reline complete mandibular denture (laboratory), Reline maxillary partial denture (laboratory), Reline mandibular partial denture (laboratory), Pontic—resin with predominantly base metal, Retainer—cast metal, resin bonded fixed prosthesis, Retainer—porcelain/ceramic, resin bonded fixed prosthesis, Inlay—cast high noble metal, two surfaces, Inlay—cast high noble metal, three or more surfaces, Inlay—cast predominantly base metal, two surfaces, Inlay—cast predominantly base metal, three or more surfaces, Inlay—cast noble metal, three or more surfaces, Onlay—porcelain/ceramic, three or more surfaces, Onlay—cast high noble metal, two surfaces, Onlay—cast high noble metal, three or more surfaces, Onlay—cast predominantly base metal, two surfaces, Onlay—cast predominantly base metal, three or more surfaces, Onlay—cast noble metal, three or more surfaces. HS205 Dental Plan Section Advantage Dental Plan Section PPO Dental Plan Section Vision Plan Section . Copyright 2019 Bloom Insurance LLC; in California by S. Rogers' Insurance Agency LLC. 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,
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