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HumanaDentalPPO

Coinsuranceoptions

Seeaparticipatingdentist

Seeanonparticipatingdentist

Preventive

100% 100% 100% 100% 100%

Basic

100% 90% 90% 80% 50%

Major

60% 60% 50% 50% 50%

Preventive

100% 100% 80% 80% 80%

Basic

80% 80% 80% 50% 50%

Major

50% 50% 50% 50% 30%

q q q q q Summaryofservices

Preventive

Oralexaminations X-rays Cleanings Topicalfluoridetreatment Sealants Basicservice Majorservice Seeaparticipatingdentist

Basic

Spacemaintainers Emergencycareforpainrelief Oralsurgery Fillings Routineextractions Denturerepairandadjustments Appliancesforchildren Prefabricatedstainlesssteelcrowns

Major

Crowns Inlaysandonlays Bridgework Dentures Denturerelinesandrebases

Periodontic&Endodontic options(gumtherapy&rootcanals) Calendar-year deductibleoptions

(excludesorthodontiaservices)

q q

Seeanonparticipatingdentist

Individual

$ 25 $ 50 $ 50

Family

$ 75 $150 $150

Individual

$ 50 $ 50 $100

Family

$ 150 $ 150 $ 300

q q q

Preventiveservices deductibleoptions Annualmaximumoptions

(excludesorthodontiaservices)

Thereisnodeductibleonin-networkpreventiveservices. q Applydeductibleonpreventiveout-of-networkservices q Waivedeductibleonpreventiveout-of-networkservices

q q

$1,000

q

$1,500

q

$2,000

q

$2,500

Orthodontiaoptions

q

q

Childorthodontia--Availableforgroupswith10ormoreenrolled employeesatanadditionalcost.Agelimitvariesbystate. Adult/childorthodontia--Availableforemployer-sponsoredgroups with25ormoreenrolledemployeesatanadditionalcost. Orthodontiadiscount--Ifyoudonotchooseorthodontiacoverage,employees canstillreceiveupto20percentsavingsbyvisitingparticipatingorthodontists andaskingforthediscount.

Lifetimeorthodontia maximumoptions

Planpays50percent(nodeductible)ofthecoveredorthodontiaservices,upto: q $1,000 q $1,500 q $2,000(availabilityvaries) q None,discountonly

Non-participatingdentistscanbillyouforchargesabovetheamountcoveredbyyourHumanaDentalplan. Toensureyoudonotreceiveadditionalcharges,visitaparticipatingPPONetworkdentist. Waitingperiodsandfrequency/agelimitsmayapply.

1-800-233-4013·www.humanadental.com

Choose HumanaDentalbenefits

Behealthy

Good dental health is a reflection of good overall health. For example, the Academy of General Dentistry says there is a link between gum disease and heart problems, and the American Academy of Periodontology says severe gum disease can increase blood sugar, increasing the risk among diabetics. HumanaDental's PPO plan focuses on prevention, providing two exams and cleanings per calendar year.

Befinancially-savvy

Your dentist can often detect medical issues before they become severe. HumanaDental's PPO plan offers you a long list of covered services to take care of your health and your pocketbook.

Useyour HumanaDentalbenefits

Findadentist

With HumanaDental's PPO plan, you can see any dentist. You save more money and you receive more benefits when you visit a dentist in HumanaDental's PPO Network. To find a dentist in HumanaDental's PPO Network, log on to www.humanadental.com or call 1-800-233-4013.

Besuccessful

Did you know 74 percent of adult Americans believe that an unattractive smile could hurt a person's chances for career success? That's according to the American Academy of Cosmetic Dentistry. HumanaDental's PPO plan helps you maintain a healthy and attractive smile.

Knowwhatyourplancovers

The other side of this page gives you a summary of HumanaDental benefits. Your plan certificate describes in detail your HumanaDental benefits. You can find it on www.humanadental.com or call 1-800-233-4013.

Questions?

Checkoutwww.humanadental.com Call1-800-233-4013anytime forautomatedinformationlineor 8a.m.to6p.m.foracustomer servicerepresentative.

Seeyourdentist

Simply present your HumanaDental identification (ID) card when you see your dentist. It contains all the information your dentist needs to submit your claims.

Learnwhatyourplanpaid

After HumanaDental processes your dental claim, you will receive an explanation of benefits. An explanation of benefits provides detailed information on covered dental services, amounts paid, plus any amount you may owe your dentist. You can also check the status of your claim on www.humanadental.com or by calling 1-800-233-4013.

InsuredoradministeredbyHumanaDentalInsuranceCompany

Thisisnotacompletedisclosureofplanqualificationsandlimitations.Yourbrokerwillprovideyouwithspecificlimitationsandexclusionsascontainedinthe RegulatoryandTechnicalInformationGuide.Pleasereviewthisinformationbeforeapplyingforcoverage.Theamountofbenefitsprovideddependsuponthe planselected.Premiumswillvaryaccordingtotheselectionmade. Policynumber:CA-70090-HD,FL-70090-HD,GN-70090-HD,IN-70090-HD,KS-70090-HD, LA-70090-HD,MN-70090-HD,MO-70090-HD,OK-70090-HD,VA-70090-HD

GN-50820-HD6/06

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