* The above copayments do not include the additional cost of precious (high noble) and semi-precious (noble) metal. The additional cost of precious metal shall not exceed $125 per unit and $75 per unit for semi-precious metal.

NOTE:

1. NOT ALL PARTICIPATING DENTISTS PERFORM ALL LISTED PROCEDURES, INCLUDING AMALGAMS. PLEASE CONSULT YOUR DENTIST PRIOR TO TREATMENT FOR AVAILABILITY OF SERVICES.
2. UNLISTED PROCEDURES ARE AT THE DENTIST’S USUAL FEE LESS 25 percent INCLUDING, BUT NOT LIMITED TO, MAXILLOFACIAL PROSTHETICS, ENAMEL MICROABRASION, AND BLEACHING.
3. WHEN CROWN AND/OR BRIDGEWORK EXCEEDS SIX UNITS IN THE SAME TREATMENT PLAN, THE PATIENT MAYBE CHARGED AN ADDITIONAL $50.00 PER UNIT.

Preventive care

• Routine oral exams
• Prophylaxis (cleaning and scaling of teeth) – two per year
• Topical fluoride application (up to age 16 and not including prophylaxis) – two per calendar year

Diagnostic care

• Intra-oral occlusal film
• Bitewing X-rays (up to a set of four)
• Full-mouth X-rays (panoramic film)

Endodontics care

• Root canal therapy
• Pulpal debridement, primary and permanent teeth
• Apexification/recalcification
• Apicoectomy/periradicular surgery

Periodontics care

• Gingivectomy/gingivoplasty
• Osseous surgery
• Pedicle/free soft tissue grafts
• Periodontal scaling and root planing

Orthodontia

• NOTE: Members can receive a 25 percent savings by visiting an in-network orthodontist.

DHMO (Dental C550) effective dates are calculated as follows:

• If application is received between the 1st and 15th of the month, the policy effective date will be the 1st of the following month ¹. Example: Application received on May 10th will have an effective date of June 1st.
• If application is received between the 16th and end of the month, the policy effective date will be the 1st of the 2nd following month (the month after the following month) ¹. Example: Application received May 18th for processing will have a policy effective date of July 1st.

The reason for the difference in effective dates is due to the member having to select a primary care dentist and being included in the monthly membership rosters sent to providers.

No, there is a one year contract with these plans. However, Dental C550 members can terminate their coverage within the first 30 days of their effective date, but they will only be refunded their premium (not enrollment fee) and will be responsible for any claims incurred during this time. After the 30 day window, cancellations are not accepted unless for approved exceptions.

Payment options include monthly and annual bank draft, monthly and annual credit card payments (Visa and MasterCard), and monthly and annual bills.

After enrollment, members will receive a welcome packet and ID cards 7-10 days after the application is received and enrollment is processed, and should bring their ID cards with them when visiting the dentist. Members should inform their provider of their plan when scheduling their appointment to avoid any issues at the time of service.

Dental Preventive Plus effective dates are calculated as follows:

• Regardless of when an application is received for these plans, the policy will have an effective date of the 1st of the following month.
  • Example: Application received on May 10th will have an effective date of June 1st.
• If application is received between the 16th and end of the month, the policy effective date will be the 1st of the 2nd following month (the month after the following month).
  • Example 1: Application received May 18th for processing will have a policy effective date of July 1st.
  • Example 2: Application received on May 31st will have an effective date of June 1st.

No, there is a one year contract with these plans. However, Dental Preventive Plus, Vision Care Plan and Vision Focus Plan members can terminate their coverage within the first 10 days of their effective date, but they will only be refunded their premium (not enrollment fee) and will be responsible for any claims incurred during this time. After the 10 day window, cancellations are not accepted unless for approved exceptions.

Payment options include monthly and annual bank draft, monthly and annual credit card payments (Visa and Mastercard), and monthly and annual bills.

After enrollment, members will receive a welcome packet and ID cards 7-10 days after the application is received and enrollment is processed, and should bring their ID cards with them when visiting the dentist. Members should inform their provider of their plan when scheduling their appointment to avoid any issues at the time of service.

• First, sign up for coverage.
• Find a participating vision provide located near your home or office by visiting Humana’s Vision Finder.
• When you see a Humana participating provider, you’ll receive immediate benefits including:
• Low exam copayments
• Eyeglass lenses are covered 100 percent after materials copayment
• $40 wholesale allowance for frames
• Medically necessary contact lenses are covered 100% after materials copayment
• $115 allowance for elective contact lenses
• Discounts on LASIK/PRK and second pair of glasses
• One eye exam per year
• You pay only the fees listed on the schedule of benefits .

Cost Scenario

How much will you save with a Humana vision plan? Take a look at what some common procedures can cost without insurance:

• Eye Exam: $90
• Frames: $90
• Sigle vision lenses: $70
• Total Cost: $280

Your cost with a Humana vision plan, here are your costs for the same services:

• Eye Exam: $10 co-payment
• Frames: $0
• Sigle vision lenses: $25 co-payment
• Total Cost: $35

You can save up to $245 with the HumanaOne Vision Care Plan

Benefits include a wholesale frame allowance. If the wholesale cost exceeds the frame allowance, members pay twice the wholesale difference. They never pay full retail.

Members receive substantial reductions when procedures are done by network providers. Members can expect to pay no more than $1,800 per eye for conventional Lasik procedures and $2,300 per eye for custom Lasik from network providers. Members also receive benefits on services performed by preferred TLC Select Lasik Plan providers at the following fixed prices:.

Vision effective dates are calculated as follows:

• If application is received between the 1st and 15th of the month, the policy effective date will be the 1st of the following month. 1. Example: Application received on May 10th will have an effective date of June 1st.
• If application is received between the 16th and end of the month, the policy effective date will be the 1st of the 2nd following month (the month after the following month). 1. Example: Application received May 18th for processing will have a policy effective date of July 1st.

Payment options include monthly and annual bank draft, monthly and annual credit card payments (Visa and Mastercard), and monthly and annual bills.

Membership in the People’s Benefit Alliance (PBA) is required at additional cost (your $0.75 association fee covers this) in order to be eligible to apply for this plan. With your membership, you will receive discounts on health, travel, consumer, and business-related services, such as:

• Fitness Programs- Puts benefits for healthier living within reach for you and your family
• Vitamin Discounts- Offers discounts on an extensive selection of vitamins
• Car Rental Discounts- Get great deals on car rentals

The association is a membership organization that provides educational information and discounts on goods and services to its members.