Complete Dental

Primary Benefits
Plan Type	DPPO
Coinsurance	0% for Preventive, 20% after deductible for Basic, 50% after deductible for Major
Deductible	Individual $50/Family $150
Annual Maximum Benefit	$1,250 year one; $1,500 year two and after, per individual on the plan
Office Visit Find Dentists	N/A
Teeth Cleanings	0% no deductible (limit two every calendar year)
Restorative Dentistry/Fillings	20% after deductible (limit one per tooth every two years, composite covered on front teeth only)
Oral Surgery	50% after deductible
Extractions	20% after deductible
X-Rays	0% no deductible
Crowns	50% after deductible (limit once per tooth per five years)
Root Canals	50% after deductible
Periodontics	50% after deductible. Periodontal maintenance (limit two every calendar year). Periodontal scaling and root planing (limit one per quadrant every three years)
Dentures	50% after deductible. Limit one every five years
Topical Fluoride	0% no deductible (limit two per calendar year)
Sealant	0% no deductible (limit of one per tooth per lifetime, age 14 and under)
Bridges	Not Covered
Endodontics	50% after deductible (limit one per tooth per lifetime)
Additional Information
A.M. Best Rating	A as of 09/28/2023
Electronic Signature for Application Available	Yes
Details and documents about this plan
View Plan Brochure Exclusions and Limitations

The information shown here is a summary of benefits for informational purposes only. Review the official plan documents (such as evidence of coverage, plan brochure, or insurance policy) for a detailed description of coverage benefits, limitations, and exclusions. Only the terms and conditions of coverage benefits listed in the policy are binding.
The benefits listed may be contingent on your use of physicians, hospitals, dentists and services within the specific insurance company's provider network.
The Copayment, Deductible, and Coinsurance amounts are your share of the costs for covered benefits. These amounts are subject to change.
The quotes or rates shown above are estimates only. Your premium is subject to change based on your medical history (pursuant to state law of residence), the underwriting practices of the insurance company, the optional benefits you selected, if any, and other relevant factors, such as changes in rates which take effect before your requested effective date. The insurance company always determines your actual premium. Insurance companies reserve the right to change the terms of a policy upon proper notification.

Humana - Insured by Humana Insurance Company, Humana Health Plan, Inc., Humana Health Insurance Company of Florida, Inc., or Humana Health Benefit Plan of Louisiana, Inc., Or offered by Humana Medical Plan Inc., Humana Employers Health Plan of Georgia, Inc., Humana Health Plan of Texas, Inc. ,Humana Health Plan, Inc. , Humana Medical Plan of Michigan, In,. ,Humana Health Plan of Ohio, Inc., or Humana Medical Plan of Utah, Inc.
Humana - For Arizona residents: Insured by Humana Insurance Company or offered by Humana Health Plan, Inc.. For Texas residents: Insured by Humana Insurance Company or offered by Humana Health Plan of Texas, Inc.
Humana - Our health benefit plans have exclusions and limitations and terms under which the coverage may be continued in force or discontinued. For costs and complete details of the coverage, call or write your Humana insurance agent or broker.
Humana - Insured or offered by Humana Insurance Company, HumanaDental Insurance Company, Humana Insurance Company of Kentucky, Humana Health Insurance Company of Florida, Inc., Humana Insurance Company of New York, The Dental Concern, Inc., CompBenefits Insurance Company, CompBenefits Company, CompBenefits Dental, Inc., CompBenefits of Alabama, Inc., CompBenefits of Georgia, Inc., CompBenefits Direct, Inc., Humana Health Benefit Plan of Louisiana, Inc., DentiCare, Inc. (d/b/a CompBenefits), or Texas Dental Plans, Inc.

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