| See a partcipating dentist | See a nonpartcipating dentist | |
|---|---|---|
| Preventive services | 100% no deductible | 100% no deductible of maximum allowable fee |
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| Basic services | 80% after deductible | 80% after deductible of maximum allowable fee |
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| Major services | 50% after deductible | 50% after deductible of maximum allowable fee |
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| Calendar-year deductible | Individual | Family | Individual | Family |
|---|---|---|---|---|
| (excludes orthodontia services) | $50 | $150 | $50 | $150 |
| Annual maximum (excludes orthodontia services) |
$1,000 | |||
| Orthodontia | Orthodontia discount -- members can receive up to a 20 percent discount if they visit an orthodontist from the HumanaDental PPO Network and ask for the discount. | |||
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Non-participating dentists can bill you for charges above the amount covered by your HumanaDental plan. To ensure you do not receive additional charges, visit a participating PPO Network dentist. Waiting periods and frequency/age limits may apply. |
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BENEFIT PROVIDERS INC.
P O Box 3008 (Mailing Address) |
EMAIL ADDRESS |
