Humana
Loyalty Plus
The Humana Dental Loyalty Plus plan offers loyal members increasing benefits from plan years one to three. These increasing benefits include paying less out-of-pocket for services like fillings, root canals, crowns, and other services; an increase in plan year annual maximums; a one-time deductible for as long as you’re on the plan; and no copayments or waiting periods. Most preventive services are covered at 100 percent. Also, the plan pays the same percentage no matter which dentist you visit. You can save even more by choosing one of the more than 200,000 dentist locations in the Humana Dental Loyalty Plus network.
- Loyalty benefits – There is confidence in knowing your dental plan…and your dental plan knowing you. Now, the longer you are a member, the greater your benefits, such as:
- Increased coverage for procedures such as fillings, root canals, and crowns
- Increased maximum amounts that the plan will pay annually
- One-time deductible for as long as you stay on the plan
- Choice – Freedom to visit the dentist you like most
- Access to benefits – With no waiting periods, you can get the dental work you need upon your effective date and your plan benefits will help cover the cost
- Helps maintain good oral health – Most preventive services are covered at 100 percent
| Common procedures: | |
|---|---|
| Cleaning: | 100% |
| White Filling: | 40%-70% |
| Crown: | 20%-50% |
| Root Canals: | 20%-50% |
| Simple Extractions: | 40%-70% |
| Plan Maximum: | First year $1000 per individual on the plan Second year $1250 per individual on the plan Subsequent years $1500 per individual on the plan |
| Waiting Periods: | None |
| Deductible: | One-time Deductible for as long as you stay on the plan Individual – $150 Individual + One – $300 Family – $450 |
| Details: |
|---|
| Fee Schedule: N/A | Dentist Search | Exams: |
| Routine oral examinations (limit two per year) Plan Pays 100% No waiting period | Cleanings: |
| Plan Pays 100% (limit two per year) No waiting period | X-Rays: |
| Miscellaneous x-rays (limit one per year), Bitewing x-rays (limit one set per year), Full mouth or panoramic x-rays (limit one per five years) 1st Year Plan Pays – 40% 2nd Year Plan Pays – 55% 3rd Year and after Plan Pays – 70% One time deductible applies No waiting period | Fillings: |
| Fillings (Limit two per year, composite covered on front teeth only*) 1st Year Plan Pays – 40% 2nd Year Plan Pays – 55% 3rd Year and after Plan Pays – 70% One time deductible applies No waiting period | Extractions: |
| Extractions and root removal (limit two per year) 1st Year Plan Pays – 40% 2nd Year Plan Pays – 55% 3rd Year and after Plan Pays – 70% One time deductible applies No waiting period | Crowns: |
| Crowns (limit one per tooth per five years) 1st Year Plan Pays – 20% 2nd Year Plan Pays – 30% 3rd Year and after Plan Pays – 50% One time deductible applies No waiting period | Root Canals: |
| Root canals (limit one per tooth per two years, permanent teeth only) 1st Year Plan Pays – 20% 2nd Year Plan Pays – 30% 3rd Year and after Plan Pays – 50% One time deductible applies No waiting period | Dentures: |
| Complete and partial dentures (limit one per five years). Denture repair and adjustments (limit one per year) 1st Year Plan Pays – 20% 2nd Year Plan Pays – 30% 3rd Year and after Plan Pays – 50% One time deductible applies No waiting period | Deep Cleanings: |
| Periodontal cleanings (limit two per year) 1st Year Plan Pays – 20% 2nd Year Plan Pays – 30% 3rd Year and after Plan Pays – 50% One time deductible applies No waiting period | Implants: |
| Not Covered | Braces/Orthodontia: |
| Not Covered. Member may receive a discount on these non-covered services. You may contact your participating provider to determine if any discounts are available on non-covered services | Teeth Whitening: |
| Not Covered | Additional Network Information: |
Under our Loyalty Plus dental plan, you can choose to visit any dentist from the Humana network, no primary care dentist required. There are more than 270,000 dentist locations on the Humana Dental PPO network. Simply present your Humana Dental identification (ID) card when you see your dentist. It contains all the information your dentist needs to submit your claims. You can visit an in-network or out-of-network dentist, with the same coverage for services. Out-of-network dentists can bill you for charges above the amount covered by your Humana Dental plan. To ensure you do not receive additional charges, visit a dentist in the Humana Dental Loyalty Plus network. Limitations and exclusions may apply; please see your policy for coverage details. In Texas, the plans provide benefits for contracted and non-contracted dentists. Non-contracted dentists have not agreed to provide services at contracted fees. If a member sees a non-contracted dentist their out of pocket costs may be higher than that charged by contracted dentists. You may sometime see this referenced with the terms of in and out of network. Exclusions and Limitations: N/APrivacy Policy Plan Brochure | Notes: |
* Composite (white) fillings are only covered on anterior (front) teeth. An alternate benefit is allowed for composite fillings on posterior (back) teeth where the plan will cover the cost of an amalgam (silver) filling and the member is responsible for any cost over the covered amount. |
FAQ:
Can I change my dentist once I am in the plan?
Yes. You can change dentist or dental office at any time. Please contact Member Services for help locating participating provider in your area.
What is a pre-existing condition versus work-in-progress? Is it covered?
What is a pre-existing condition versus work-in-progress? Is it covered? A pre-existing condition is an oral health condition, which existed before your enrollment in a dental program. The plan does not include an exclusion for pre-existing conditions.
Work in progress is dental work that was started prior to joining the plan. The dentist who started the dental work must complete work in progress after joining the dental plan. Work in progress is not covered.
What provider options do I have?
Under our Loyalty Plus dental plan, you can choose to visit any dentist from the Humana network, no primary care dentist required. There are more than 270,000 dentist locations on the Humana Dental PPO network. Simply present your Humana Dental identification (ID) card when you see your dentist. It contains all the information your dentist needs to submit your claims. You can visit an in-network or out-of-network dentist, with the same coverage for services. Out-of-network dentists can bill you for charges above the amount covered by your Humana Dental plan. To ensure you do not receive additional charges, visit a dentist in the Humana Dental Loyalty Plus network. Limitations and exclusions may apply; please see your policy for coverage details.
When can I start using my Plan?
You can start using your plan once it goes into effect - usually the 1st of the month following your enrollment (as long as the enrollment and payment is received within the enrollment deadline). Incomplete enrollment forms or failure to submit the required initial premium amount may cause an initial delay in issuance of insurance. Do not cancel any other insurance or assume you are insured under the Plan until you receive your certificate of insurance.
When will I receive my new member kit and what will it include?
After a member enrolls in this dental plan, an ID card will be sent via postal mail. Additional member materials, such as Certificate of Coverage and Summary of Benefits, are available to the member on Humana Member Account Portal
Who can enroll in this plan?
You may enroll yourself and your dependents, provided you reside or work in the service area. The Service Area is the geographical area in which Humana has a panel of Contracted Dentists.
Dependents are:
- Your unmarried children up to age 19 or age 26* if a full-time student and dependent upon you for support;
- Your children who are incapable of self-sustaining employment due to developmental disability or physical handicap and who depend on you for their support and maintenance. You must furnish Humana with proof of dependent status, as provided by law.
(*limiting age may vary based upon state of residence)
As long as you meet the plan’s general eligibility requirements and pay the applicable premium, your acceptance is automatic.
P.O. Box 14283
Lexington, KY 40512-4283
Disclaimers and Disclosures:
This website provides a very brief description of some of the important features of this plan. It is not the insurance contract, nor does it represent the insurance contract. A full description of benefits, exclusions and limitations is contained in the Schedule of Benefits and your policy.
Rates shown are based upon the information you provided, and are subject to change based on the dental and/or vision plan's underwriting practices and your selection of available optional benefits, if any. Final rates and effective dates are subject to underwriting and are always determined by the dental insurance and/or vision insurance company. To be considered for reimbursement, expenses must qualify as covered expenses.
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