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 ("0" treatment code) are $1,800 per child and $2,100 per adult.
|
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.
