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Frequently Asked Question's

What does my plan cover?

If you are a HumanaDental member with questions about your plan, you can refer to the plan outlines provided on the Miami Dade College website. You may also register and log in to www.humanadental.com and send a secure message, or call HumanaDental at (800) 979-4760.

 
 

How do I order a replacement ID card?

You can order a replacement ID card by registering and logging in to your personal homepage at www.humanadental.com, or by calling HumanaDental at (800) 979-4760.

 
 

How do I change my address on my HumanaDental personal homepage?

Currently, addresses cannot be changed online. Please call HumanaDental at (800) 979-4760 to update your address.

 
 

How can I find a dentist?

You can find a dentist online by visiting www.humanadental.com and selecting “Find a Dentist”, or call HumanaDental at (800) 979-4760 .

 
 

Can I refer a dentist who is not in your network?

Yes. You can refer a dentist online by visiting www.humanadental.com and selecting “Refer a dentist” under Tools & Resources, or call HumanaDental at (800) 979-4760.

 
  What is an alternate service?
The least expensive service when two or more services would correct the same dental condition.
 
DENTAL PPO PLAN
 

Where do I find dental claims forms?

   

If you use a network dentist in the DPPO plan, you do not need a claim form. If you use a non network dentist you will need a dental claim form. You can obtain one in the Miami Dade College website.

Please mail the completed form to:
Humana Specialty Benefits
P.O. Box 8236
Chicago, IL 60680-8236

 

Who can I talk to about my dental insurance claims?

   

Call (800) 233-4013 and a HumanaDental Customer Care specialist will be happy to assist you. Call (888) 884-5672 if you are hearing or speech impaired. HumanaDental's office hours are from 8 a.m. to 6 p.m. Monday through Friday.

     
 

What is a deductible?

   

The portion of the covered expenses that a member pays every year before HumanaDental pays benefits.

     
 

Do I pay my deductible to the insurance company or to the dentist?

   

A deductible is subtracted from any money owed by HumanaDental when a claim is processed. The dentist will require the deductible up front, or bill the member.

 
 

What is coinsurance?

   

The percentage of covered expenses HumanaDental will pay after the deductible is satisfied and until the annual maximum is met.

 
 

What is the $1,500 annual maximum?

   

The maximum amount that may be payable for each person covered under the DPPO plan for expenses incurred during a calendar year. No further benefits are payable for that person that year after the maximum benefit is reached.

 
 

How many cleanings are covered under HumanaDental's DPPO plan?

   

Two routine cleanings are covered per calendar year at 80% coinsurance with no deductible applied. In addition, two periodontal cleanings (“deep cleanings”) are covered per calendar year at 80% coinsurance after the deductible. Both routine and periodontal cleanings can take place at any time during the year.

 
 

When do I need an estimate prior to treatment?

   

Estimates are strongly recommended when services will exceed $300. You should work with your dentist to obtain this information. If you are unsure whether an estimate is required in your case, contact us via secure online messaging , or call HumanaDental at (800) 979-4760.

 
 

Are implants covered under this plan?

   

Yes, your DPPO plan covers the implant surgery, implant post, the abutment (connects the post to the crown), and the implant crown at 50% after the deductible, up to the annual maximum of $1,500.

 
 

What is the missing tooth exclusion?

   

HumanaDental does not pay for a prosthetic device that replaces teeth extracted before the effective date of coverage unless the device also replaces one or more natural teeth lost or extracted after the coverage became effective.

 
 

What is the frequency of crowns, root canals, bridges, etc.?

   

Root canal therapy, including root canal treatments and root canal fillings – procedure available to permanent teeth only, once per tooth in a two-year period. Any X-ray, test, laboratory, exam, or follow-up care is considered integral to root canal therapy.

Replacement of bridges, partials, dentures, inlays, onlays, crowns or other laboratory-fabricated restorations. The existing major restoration or prosthesis can be replaced only if:

  • it has been at least five years since the prior insertion and is not, and can not be made, serviceable;
  • it is damaged beyond repair as a result of an accidental injury (non-chewing injury) while in the oral cavity; or
  • extraction of functioning teeth, excluding third molars or teeth not fully in occlusion with an opposing tooth or prosthesis, necessitates the replacement of the prosthesis.
 

If I am in the middle of a treatment, what is covered?

   

The prior carrier is responsible for work in progress, such as root canals, crowns, dentures, and bridges, if treatment started before coverage with HumanaDental.

     
 

If I am in the middle of orthodontic treatment, what is covered?

   

If you had prior orthodontia coverage, and you did not have a lapse in coverage and are in active treatment, HumanaDental subtracts the amount the prior carrier paid from the amount of its own benefit and covers the remaining benefit amount.

If you did not have prior orthodontia coverage and are in active treatment, HumanaDental will pro-rate the total case fee of treatment. Payments will begin with the first month/quarter after the members' effective date.

     
DENTAL HMO PLAN

With the DHMO Plan, you are required to choose a general dentist. You can change as often as once a month and the request must be made by the 15 th of the month, in order to be effective the 1 st of the following month. If you do not choose a dentist, you will receive a letter, along with your ID card, requesting that you contact customer service with your dental office selection.

   
 

What is an ADA code?

   

This code is established by the American Dental Association for each specific procedure listed on your schedule of benefits.

     
 

What is a copayment?

   

The amount listed in the schedule of benefits that the member is responsible for paying directly to the dentist at the time of service.

     
 

How many cleanings are covered under Humana Dental's DHMO plan?

   

One routine cleaning every six months at no charge. Additional routine cleanings at $20 copayment each. In addition, periodontal cleanings (“deep cleanings”) are covered at $45 copayment per quadrant.

     
 

If I am in the middle of a treatment, what is covered?

   

The prior carrier is responsible for work in progress, such as root canals, crowns, dentures, and bridges, if treatment started before coverage with HumanaDental.

     
 

If I am in the middle of orthodontic treatment, what is covered?

   

If there is no break in coverage and a member/dependent is receiving orthodontic treatment, one of the following scenarios may take place:

Scenario #1 - A current DHMO patient moves to new DPPO plan
The patient is usually responsible for an orthodontic copayment, and the insurance carrier is responsible for an additional supplemental payment to the dentist. All payments should have been made to the DHMO dentist who initiated the orthodontic service, and the DHMO dentist is responsible for completing the member's orthodontic treatment.

Scenario #2 - The DHMO provider does not complete the treatment initiated
The member will need to transfer to one of the new plan's DPPO dentists to complete orthodontic treatment. HumanaDental will cover up to the maximum benefit of the monthly adjustment fees necessary to complete the case.

Scenario #3 - The current DHMO patient joins a new DHMO Plan
The patient is usually responsible for an orthodontic copayment, and the insurance carrier is responsible for an additional supplemental payment to the dentist. If the current DHMO dentist does not complete the case, the member must transfer to a DHMO dentist participating in the new carrier's network to receive coverage. The time remaining on the treatment plan will determine the level of reimbursement negotiated between the new dentist and HumanaDental.

     
 

What is a “lab fee”?

    For services marked with an asterisk (*) on the schedule of benefits such as crowns, dental offices can charge an additional “lab fee” to cover the cost of materials used. Crowns can be made of different types of metals such as base, noble, high noble, and titanium. Base metals are primarily nickel or chromium and cost less. Noble and high noble metals are alloys containing gold and other metals such as copper and cost more to make. The dental office determines the “lab fee” based on the actual cost of metals used, which is in addition to the copayment for the procedure.
     
 

What if a procedure is not listed on the schedule of benefits?

   

The member is entitled to request a 25% discount from the dentist's usual and customary rates.

     
 

Are implants covered under this plan?

   

No. The member is entitled to request a 25% discount.

     
 

What is the missing tooth exclusion?

   

Not applicable under the DHMO plan.

     
 

What is the frequency of crowns, root canals, bridges, etc.?

   

Not applicable under the DHMO plan.

     
 

Is there an Annual Maximum benefit?

   

There is no Annual Maximum under the DHMO plan.

 
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