With in-network providers, 100% covered (no deductible) FL52374HD 0117 Page 2 The HumanaDental Prepaid plans …

General anesthesia—first 30 minutes (limited to the removal of partial, or complete No copay

major dental procedure, you know what to expect from HumanaOne Dental Value Plan. Note: Limitations and exclusions may apply.

conscious sedation—first 30 minutes (limited to the removal of partial, or

Learn more about the different types of insurance. 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.

per quadrant, Alveoloplasty not in conjunction with extractions—per quadrant, Alveoloplasty not in conjunction with extractions—one to three teeth or tooth spaces, Offered or administered by HumanaDental Insurance Company, the Dental Concern, Inc., 100% covered

“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”).

Vision Plans. With in-network providers, Cleanings 100% covered 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, Discounted 20-40% on average

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). There are no yearly maximums, no deductibles to meet and no waiting periods. CompBenefits of Alabama, Inc., CompBenefits of Georgia, Inc., American Dental Providers The HD plan … Office visit (after regularly scheduled hours). Humana legal entities that offer, underwrite, administer or insure insurance products and services, View a complete list of the legal entities.

Humana individual vision plans are insured by Humana Insurance Company, The Dental Concern, Inc., or Humana Insurance Company of New York, or Humana Health Benefit Plan of Louisiana, Inc. Arizona residents insured by Humana Insurance Company. With in-network providers, Cleanings • No waiting periods • No claims to file • No annual maximums. View plans and prices available in your area. no claim forms to file, no annual maximum and no dental fee surprises. Know what your plan … and semi-precious (noble) metal. X-ray bitewings, vertical—seven to eight films (two per calendar year). Whether you simply need quality routine dental . 100% covered Get the most out of your plan. * The above copayments do not include the additional cost of precious (high noble) Emergency visit during regularly scheduled hours, by report.

No waiting periods, Check to see if your current dentist is in our network. Association membership and fees may be required in some states. Dental and vision plans, excluding Dental Savings Plus, may have a minimum one-year initial contract period. Members may see a participating primary care dentist as often as necessary.

Deductible does not apply, *Waived with proof of dental insurance for previous 12 months, None for preventive services and teeth whitening allowances. treatment). In the event of a dispute, the policy as written in English is considered the controlling authority. Whether you need routine care or a Please enter the age and zip code of the primary policy holder, and we will check availability of this plan in your area and calculate the plan costs for you and your family. Copyright 2019 Bloom Insurance LLC; in California by S. Rogers' Insurance Agency LLC.

The HumanaOne Dental Value Plan HI215 plan is affordable, dependable coverage that helps you get the Palliative (emergency) treatment of dental pain—minor procedure. None for in-network preventive services, otherwise: Cleanings

Humana individual dental plans are insured or offered by Humana Insurance Company, HumanaDental Insurance Company, Humana Insurance Company of New York, The Dental Concern, Inc., CompBenefits Insurance Company, CompBenefits Company, CompBenefits Dental, Inc., Humana Employers Health Plan of Georgia, Inc., Humana Health Benefit Plan of Louisiana, Inc., or DentiCare, Inc. (DBA CompBenefits). Our dental plans and vision plans have exclusions, limitations and terms under which the coverage may be continued in force or discontinued. The HD205 Prepaid Plan focuses on maintaining oral health, prevention and cost containment. Current Dental Technology © 2007 American Dental Association. With in-network providers, X-rays complete bony impacted teeth), Analgesia (nitrous oxide), per 15 minutes, I.V. FL52374HD 0117 Page 1 ... available at Disclosure.Humana.com. Humana individual vision plans are insured by Humana Insurance Company, The Dental Concern, Inc., or Humana Insurance Company of New York, or Humana Health Benefit Plan of Louisiana, Inc. Arizona residents insured by Humana Insurance Company.

exceed $125 per unit and $75 per unit for semi-precious metal.. bony impacted teeth), General anesthesia—additional 15 minutes (limited to the removal of partial, or

Texas residents insured or offered by Humana Insurance Company, HumanaDental Insurance Company, or DentiCare, Inc. (DBA CompBenefits). Premium includes a $1 administrative fee. dental treatment you need, when you need it. Plans, products, and services are solely and only provided by one or more Humana Entities specified on the plan, product, or service contract, not Humana Inc. Not all plans, products, and services are available in each state. Broken appointments (without 24 hr. No charge will be made due to emergencies, Limited/comprehensive/detailed and extensive oral eval, Oral evaluation for a patient under three years of age and counseling with primary care or unexpected dental treatment, you know what to expect with Humana dental.

The Humana Dental Value Plan (HI215) has you covered for any circumstance. 100% covered Our dental plans and vision plans may also have waiting periods. For costs and complete details of coverage, call or write Humana or your Humana insurance agent or broker. All Rights Reserved, Humana — HumanaOne Dental Value Plan (HI215), The Insurance Store - Get the right dental plan at the right price.

Resin based composite—one surface, anterior, Resin based composite—two surfaces, anterior, Resin based composite—three surfaces, anterior, Resin based composite—four or more surfaces or involving incisal angle (anterior), Resin based composite—one surface, posterior, Resin based composite—two surfaces, posterior, Resin based composite—three surfaces, posterior, Resin based composite—four or more surfaces, posterior, Inlay—porcelain/ceramic, three or more surfaces, Onlay—porcelain/ceramic, four or more surfaces, Inlay—resin based composite, two surfaces, Inlay—resin based composite, three or more surfaces, Onlay—resin based composite, two surfaces, Onlay—resin based composite, three surfaces, Onlay—resin based composite, four or more surfaces, Crown—3/4 resin based composite, indirect, Crown—resin with predominantly base metal, Crown—porcelain fused to high noble metal, Crown—porcelain fused to predominantly base metal, Recement cast or prefabricated post and core, Prefabricated stainless steel crown—primary tooth, Prefabricated stainless steel crown—permanent tooth, Prefabricated stainless steel crown with resin window, Prefabricated esthetic coated stainless steel crown—primary tooth, Pin retention—per tooth, in addition to restoration, Prefabricated post and core in addition to crown, Each additional prefabricated post—same tooth, base metal post, Labial veneer (resin laminate)—laboratory, Labial veneer (porcelain laminate)—laboratory, Additional procedure—new crown existing partial denture, Cast post and core, in addition to fixed partial denture retainer, Prefabricated post and core in addition to fixed partial denture retainer, base

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