Your Humana Dental PPO Benefits

A great smile opens hearts and doors and makes the important work we do a lot easier! And good oral health is important for our overall health. According to the Academy of General Dentistry, there is a link between gum disease and heart problems, and according to the American Academy of Periodontology, severe gum disease can increase blood sugar, increasing the risk for diabetics.

That's why the Texas Annual Conference of the United Methodist Church (TAC) is offering a comprehensive dental plan that best fits the needs of you and your family. Enrollment is optional and the clergy or lay employee pays the entire cost of coverage (no employer contribution).

The Humana dental PPO has no annual deductible and provides preventive care every six months (cleaning, exams, and x-rays) at no charge.

Who is eligible?

  • Active clergy and TAC Fiscal Office lay employee participants in the Group Health medical plan and their eligible dependents. Eligible dependents may participate in an optional dental plan regardless of whether or not they are enrolled in the medical plan.
  • Retired clergy and their eligible dependents who are enrolled at the time of the clergy's retirement may continue to participate in the dental PPO plan. Once retired clergy or their enrolled dependents terminate coverage in the dental PPO plan, they are not eligible to re-enroll in any dental plan at a future date.

How the Humana Dental PPO plan work

  • The dental PPO has an extensive list of in-network providers, including primary care and specialty dentists. You're covered regardless of what dentist you use, although you'll pay less for a participating in-network provider. There are out-of-network benefits; however, you can be subject to balance billing because Humana will set a Maximum Allowable Charge (MAC) for that service and pay benefits according to that MAC. It is always recommended to ask your dentist’s office to submit a pre-determination form to Humana before you agree to any services. For example, if you go out-of-network and you need an extraction, Humana will set a MAC for that service and only pay 80% of that MAC. Let’s say that your dentist is charging you $1,000 for the extraction out-of-network, Humana will determine what the MAC will be. Let’s say Humana determines that $500 is the MAC, Humana will pay for that claim $400 (80% of $500), then you are responsible $600 (balance billing).
  • You're covered up to $1,500 a year in benefits per participant.
  • There is an additional $1,500 lifetime orthodontia maximum benefit per participant following a 12-month waiting period. The waiting period may be reduced or waived for prior orthodontic coverage.
  • There's no charge for preventive care. You pay a percentage (co-insurance) for other services (see a list of covered services)

 Humana Dental PPO

How much does it cost?

Employee

Employee & Spouse

Employee & Children

Employee & Family

$29.29

$65.31

$62.61

$100.46

Can I go to any dentist?

Yes, but pay less for in-network providers
 

Is orthodontia covered?

Yes (with a 12-month waiting period)

Is there a deductible?

No

How much will it cover?

$1,500 a year

Is preventive care covered?

Yes, at 100% (every 6 months)

How are benefits paid?

Percentage-based or allowance

Have a question?

1-800-233-4013

Find an in-network dentist

Need a dentist? It's easy to find one. Go to www.humana.com and put your cursor over “Shop for Plans” at the top of the page. Under Dental, click on “Find a Dentist.”

  • Select the purple “Find a Dentist” box.
  • On the next page, scroll down and make sure you’re under the “Dentist” tab.
  • Enter your zip code. You can select the number of miles of radius for your search.
  • Select the box under “Select a lookup method” to search by a Humana Dental plan. If you have a Humana Dental ID card, you can enter your member ID card and search for a participating dentist that way.
  • If you do not know your ID number, under “Coverage type,” select the PPO option.
  • A “Network” box will appear after you’ve selected a plan. Choose “PPO/Traditional Preferred” for the Dental PPO and click the purple “Select” button.
  • In the “Search Category” use the drop-down menu to select “Specialty” and enter the text “General” in the box next to it. Underneath, you will see the text “Dentist – General Practice” appear. Click on it to search for your Primary Care Dentist. You can search for other specialties if desired.
  • If you have a particular dentist, you are looking for, select “Name” and search for that dentist. Please note, if the dentist’s name does not display underneath, the dentist is not a participating dentist in your plan.
  • Click the purple “Search” button.
  • You can refine your location by adjusting the radius of your search to the left of your search list.
  • You can also filter your results by gender, languages spoken, board certification, and practice group affiliation.

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