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Dental
Humana
ABOUT DENTAL
Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, dental treatment and disease.
For full plan details, please visit your benefit website: www.mybenefitshub.com/legacypca
EMPLOYEE BENEFITS
Employee Only Employee and Spouse Employee and Child(ren) Employee and Family Dental Monthly Rate Traditional Plus Ortho Traditional Plus
$39.16 $78.28 $109.76 $151.66 $23.20 $46.36 $59.14 $82.30 Preventative Plus $15.78 $35.76 $41.90 $66.06
Dental Plan Highlights
TRADITIONAL PLUS ORTHO 100/80/50 ORTHO 1.5K U&C + Plan Highlights Preventive services coinsurance % 100 Basic services coinsurance % 80
Major services coinsurance % Individual Deductible Family Deductible Waive deductible on preventive Annual maximum Extended annual max Waive preventive on annual maximum TRADITIONAL PLUS 100/80/50 INFS + Plan Highlights Preventive services coinsurance %
50 $50.00 $150.00 Yes $1500.00 Yes Not Selected
100
Basic services coinsurance % 80
Major services coinsurance % Individual Deductible Family Deductible Waive deductible on preventive Annual maximum Extended annual max Waive preventive on annual maximum PREVENTIVE PLUS 100/80/00 INFS + Plan Highlights Preventive services coinsurance %
50 $50.00 $150.00 Yes $1000.00 Yes Not Selected
100
Basic services coinsurance % Individual Deductible Family Deductible Waive deductible on preventive
80 $50.00 $150.00 Yes Endodontics Periodontics Composite fillings for molars Complex surgical extractions Implants Orthodontia Orthodontia coinsurance % Orthodontia lifetime maximum Voluntary
Major Major Basic Basic Not Selected Adult/Child 50 $1500.00 Not Selected
Endodontics Periodontics Composite fillings for molars Complex surgical extractions Implants Orthodontia Orthodontia coinsurance % Orthodontia lifetime maximum Voluntary
Major Major Basic Basic Not Selected Not Available 0 $0.00 Not Selected
Annual maximum
$1000.00 Waive preventive on annual maximum Not Selected
Composite fillings for molars Basic
