Humana Dental Smart Choice - 62294MI0420001 Health Insurance Plan

Humana Insurance Company health insurance plan with the Plan ID 62294MI0420001. The plan is called Humana Dental Smart Choice.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 69.18% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 30.82% of the costs of all covered benefits (according to the Issuer).

Health Insurance Plan ID 62294MI0420001
Health Insurance Plan Year 2023
State Michigan
Health Insurance Issuer Humana Insurance Company
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 62294MI0420001-00
Provider Network(s) ['MIN001']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Wed, 27 Mar 2024 12:10 GMT).

Providers Michigan All US States
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A
Available Variants of the Health Plan

Standard Off Exchange Plan - 62294MI0420001-00

Standard On Exchange Plan - 62294MI0420001-01

Last Plan Update Date Mon, 15 Aug 2022 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Benefits of Humana Dental Smart Choice Health Insurance Plan, 62294MI0420001-00

Benefit Covered In Network Out Of Network
Accidental Dental

See plan brochure for plan details and limitations and exclusion

YES

50.00% Coinsurance after deductible

50.00% Coinsurance after deductible
Basic Dental Care - Adult

See plan brochure for plan details and limitations and exclusion

YES

50.00% Coinsurance after deductible

50.00% Coinsurance after deductible
Basic Dental Care - Child

See plan brochure for plan details and limitations and exclusion

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: 2.0 Visit(s) per Year

YES

No Charge after deductible

30.00% Coinsurance after deductible
Dental X-rays

Limit: 1.0 Procedure(s) per Year

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
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 exclusion

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

Limit: 1.0 Procedure(s) per Lifetime

Only allowed as a result of congenital or developmental malformations which are related to or developed as a result of cleft palate, with or without cleft lip.

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

Benefit is 1 per 5 years

YES

50.00% Coinsurance after deductible

50.00% Coinsurance after deductible
Periodontal Maintenance
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

Limit: 1.0 Procedure(s) per Lifetime

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 Space Maintainers
YES

No Charge after deductible

30.00% Coinsurance after deductible
Root Canal Therapy and Retreatment

Limit: 1.0 Procedure(s) per Lifetime

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

30.00% Coinsurance after deductible
Sealants
YES

No Charge after deductible

30.00% Coinsurance after deductible
Tissue Conditioning
YES

50.00% Coinsurance after deductible

50.00% Coinsurance after deductible
Topical Flouride
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 62294MI0420001-00 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 2023
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 0.93989822
First Tier Utilization 100%
HIOS Product ID 62294MI042
Import Date 8/15/2022 20:01
Inpatient Copayment Maximum Days 0
Guaranteed Rate Guaranteed Rate
New/Existing Plan Existing
Issuer Actuarial Value 69.18%
Issuer ID 62294
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 $40
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 $40
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Group $750 per group
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person $375 per person
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual $375
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 MIN001
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 1/1/2023
Plan ID (Standard Component ID with Variant) 62294MI0420001-00
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 MIS001
Source Name SERFF
Plan ID 62294MI0420001
State Code MI
URL for Enrollment Payment URL

Copay & Coinsurance of Humana Dental Smart Choice Health Insurance Plan, 62294MI0420001

Drug Tier Pharmacy Type Copay amount Copay option Coinsurance rate Coinsurance option Mail Order

Frequently Asked Questions(FAQ) about Humana Dental Smart Choice, 62294MI0420001 Health Insurance Plan, 62294MI0420001

  • Does Humana Dental Smart Choice Health Insurance Plan, 62294MI0420001 support Mail Ordering?

    Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.

  • Does (62294MI0420001) Health Insurance Plan, Variant (62294MI0420001-00) have Out Of Country Coverage?

    Yes. Details: 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.

    Does (62294MI0420001) Health Insurance Plan, Variant (62294MI0420001-00) have Out of Service Area Coverage?

    Yes. Details: 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.

 

Disclaimer: This is based on the import(Date: Wed, 27 Mar 2024 12:10 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