Humana Dental Smart Choice - 91604WI0490002 Health Insurance Plan
Humana Insurance Company health insurance plan with the Plan ID 91604WI0490002. The plan is called Humana Dental Smart Choice.
| Health Insurance Plan ID | 91604WI0490002 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | Wisconsin | ||||||||||||||||||
| Health Insurance Issuer | Humana Insurance Company | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 91604WI0490002-00 | ||||||||||||||||||
| Provider Network(s) | PREFERRED | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Thu, 21 Nov 2024 00:44 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Sat, 12 Aug 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Thu, 21 Nov 2024 00:44 GMT |
Benefits of Humana Dental Smart Choice Health Insurance Plan, 91604WI0490002-00
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Accidental Dental
See plan brochure for plan details and limitations and exclusions |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Basic Dental Care - Adult
See plan brochure for plan details and limitations and exclusions |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Basic Dental Care - Child
See plan brochure for plan details and limitations and exclusions |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Complex Oral Surgery
|
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Dental Check-Up for Children
Limit: 1.0 Visit(s) per 6 Months |
YES | No Charge after deductible |
30.00% Coinsurance after deductible |
| Dental X-rays
Limit: 1.0 Visit(s) per 6 Months Panoramic and Complete Series X-Rays have a frequency of 1 per 5 years |
YES | No Charge after deductible |
30.00% Coinsurance after deductible |
| Denture Adjustments
|
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Denture Reline and Rebase
Limit: 1.0 Procedure(s) per 3 Years |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Extractions
|
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Fillings
|
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Immediate Dentures
Benefit is 1 per 5 years |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Implants
Benefit is 1 per 5 years |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Initial Placement of Bridges and Dentures
Benefit is 1 per 5 years |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Major Dental Care - Adult
|
NO | ||
| Major Dental Care - Child
See plan brochure for plan details and limitations and exclusions |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Occlusal Adjustments
Limit: 1.0 Procedure(s) per 3 Years |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Orthodontia - Adult
|
NO | ||
| Orthodontia - Child
Medically necessary orthodontia for child |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Partial Pulpotomy
|
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Periodontal and Osseous Surgery
Limit: 1.0 Procedure(s) per 3 Years |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Periodontal Maintenence
Limit: 4.0 Procedure(s) per Year |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Periodontal Root Scaling and Planing
Limit: 1.0 Procedure(s) per 2 Years |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Periradicular Surgical Procedures
|
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Post and Core Build-up
Benefit is 1 per 5 years |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Recementation of Space Maintainers
|
YES | No Charge after deductible |
30.00% Coinsurance after deductible |
| Removal of Fixed Space Maintainers
|
YES | No Charge after deductible |
30.00% Coinsurance after deductible |
| Restorative Services
|
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Root Canal Therapy and Retreatment
|
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Routine Dental Services (Adult)
Limit: 1.0 Visit(s) per 6 Months |
YES | No Charge after deductible |
30.00% Coinsurance after deductible |
| Sealants
Limit: 1.0 Procedure(s) per 3 Years |
YES | No Charge after deductible |
30.00% Coinsurance after deductible |
| Tissue Conditioning
|
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Topical Fluoride
Limit: 1.0 Procedure(s) per Year |
YES | No Charge after deductible |
30.00% Coinsurance after deductible |
| Vital Pulpotomy
|
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
Humana Dental Smart Choice Health Insurance Plan Variant 91604WI0490002-00 Attributes
| Plan Attribute | Value |
|---|---|
| Begin Primary Care Cost-Sharing After Number Of Visits | 0 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
| Business Year | 2024 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Low Off Exchange Plan |
| Dental Only Plan | Yes |
| EHB Apportionment for Pediatric Dental | 0.9957903641317909 |
| First Tier Utilization | 100% |
| HIOS Product ID | 91604WI049 |
| Import Date | 2023-08-12 01:01:14 |
| Inpatient Copayment Maximum Days | 0 |
| Guaranteed Rate | Guaranteed Rate |
| New/Existing Plan | Existing |
| Issuer ID | 91604 |
| Issuer Marketplace Marketing Name | Humana |
| Market Coverage | Individual |
| Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Group | per group not applicable |
| Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Person | per person not applicable |
| Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out | Not Applicable |
| Medical EHB Deductible, Combined In/Out of Network, Family Per Group | per group not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Family Per Person | per person not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Medical EHB Deductible, In Network (Tier 1), Family Per Group | per group not applicable |
| Medical EHB Deductible, In Network (Tier 1), Family Per Person | per person not applicable |
| Medical EHB Deductible, In Network (Tier 1), Individual | $85 |
| Medical EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Medical EHB Deductible, Out of Network, Family Per Person | per person not applicable |
| Medical EHB Deductible, Out of Network, Individual | $85 |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Group | $800 per group |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person | $400 per person |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual | $400 |
| Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family Per Group | per group not applicable |
| Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family Per Person | per person not applicable |
| Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Individual | Not Applicable |
| Metal Level | Low |
| Multiple In Network Tiers | No |
| National Network | Yes |
| Network ID | WIN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services. |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services. |
| Plan Brochure | URL |
| Plan Effective Date | 2024-01-01 |
| Plan ID (Standard Component ID with Variant) | 91604WI0490002-00 |
| Plan Marketing Name | Humana Dental Smart Choice |
| Plan Type | PPO |
| Plan Variant Marketing Name | Humana Dental Smart Choice |
| QHP/Non QHP | Both |
| Service Area ID | WIS001 |
| Source Name | HIOS |
| Plan ID | 91604WI0490002 |
| State Code | WI |
| URL for Enrollment Payment | URL |
Copay & Coinsurance of Humana Dental Smart Choice Health Insurance Plan, 91604WI0490002
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Humana Dental Smart Choice, 91604WI0490002 Health Insurance Plan, 91604WI0490002
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Does Humana Dental Smart Choice Health Insurance Plan, 91604WI0490002 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (91604WI0490002) Health Insurance Plan, Variant (91604WI0490002-00) have Out Of Country Coverage?
Does (91604WI0490002) Health Insurance Plan, Variant (91604WI0490002-00) have Out of Service Area Coverage?
Disclaimer: This is based on the import(Date: Thu, 21 Nov 2024 00:44 GMT) of the data from Healthcare Issuers listed by CMS. While we make every effort to ensure that data is accurate, you should assume all results are unvalidated. Source: CMS.gov, HealthPorta HEALTHCARE MRF API