Humana Dental
Preventive Plus Plan & Dental Loyalty Plus
for Individuals & Families

Humana Dental Preventive Plus Plan
	In - Network	Out - of - Network
Calendar Year Deductible	Individual - $50 Family - $150	Individual - $50 Familiy - $150
Annual Maximum Benefit Per Family Member Important to Note:  Annual Maximum Benefit does not apply to discount services.  There is no limit to the amount of discount services you may receive.	$1000	$1000
Preventive Services: Oral examinations Cleanings Topical fluoride treatment (through age 14, one per calendar year) Sealants (through age 14) Bitewing x-rays	Covered at 100% Deductible waived for preventive services No waiting period - coverage for preventive services begins as soon as your preventive plus dental insurance plan becomes effective.	Covered at 70% of in-network fee schedule* (after deductible) No waiting period - coverage for preventive services begins as soon as your preventive plus dental insurance plan becomes effective. * The 70% coinsurance will be applied to a pre-determined average for the cost of services within your area; not necessarily what your dentist charges.  That means your dentist can "balance bill" you for additional charges above the amount covered by this plan.  To ensure you don't receive additional charges, visit a network provider (dentist).
Basic Services: Emergency care for pain relief Non-surgical extractions Fillings (amalgam, composite for anterior teeth) Space maintainers Oral surgery Pre-fabricated stainless steel crowns Important to Note: 6 month waiting period applies to these services.  Coverage will begin for these services 6 months after plan inception date.	Covered at 50% after $50 deductible is met 6-month waiting period	Covered at 30% of  the in-network fee schedule* after $50 deductible is met 6-month waiting period * The 30% coinsurance will be applied to a pre-determined average for the cost of services within your area; not necessarily what your dentist charges.  That means your dentist can "balance bill" you for additional charges above the amount covered by this plan.  To ensure you don't receive additional charges, visit a network provider (dentist).
Discount Services: Appliances for children (through age 14) Denture repair and adjustments Denture relines and rebases Dentures Endodontics (root canals) Periodontics (gum therapy) Crowns Inlays Onlays Bridgework Implants	These services are NOT COVERED under this plan, however, as a member of the Humana Preventive Plus Dental Insurance Plan, you can receive discounts on these services when you see a networked dentist.  Out-of-pocket expenses do not apply towards the deductible or the annual maximum benefit. Average Discount is 28%. No waiting period for discounted services	No discount
Orthodontia	Members can receive up to a 20 percent discount if they visit an orthodontist from the Humana Dental PPO Network and ask for the discount.	No discount
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