HumanaDental DHMO Coverage
You must select and use a primary care dentist (PCD) from the DHMO Dentist Finder. to receive the following plan benefits.
Table explains the features and coverage for the HumanaDental DHMO
||Costs vary based on service provided (including cleanings and oral exams). See the Dental Care Schedule on the HumanaDental website for details.
||Unlimited annual and lifetime benefit
Varies according to service. Allows 2 exams per calendar year at no cost. Allows 2 cleanings per year with $12 copay.
||You are responsible for 100%; however, the PCD will charge only 75% of his or her usual fee for specialty dentistry. Orthodontic services preformed by a specialist are covered at this level.
Services performed by a general dentist listed in the directory – child - $1,800, adult - $2,100; services performed by specialist – You pay 75% of his/her usual fee. DHMO pays nothing.
You do not have to file claims for the HumanaDental DHMO, except for out-of-area emergency care. HumanaDental pays your dentist directly.
You can appeal a decision with a Texas Employees Group Benefits Program (GBP) insurance carrier. Additional guidelines are provided in writing to members during the appeals process. More information about the appeals process.