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
Deductibles  None
Copays  Costs vary based on service provided (including cleanings and oral exams). See the Dental Care Schedule on the HumanaDental website for details.
Maximum benefit  Unlimited annual and lifetime benefit
Cleanings/Oral Exams 

Varies according to service. Allows 2 exams per calendar year at no cost. Allows 2 cleanings per year with $12 copay.

Specialty dentistry  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.
Orthodontic coverage 

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.

Filing Claims

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.