Page 9 - Benefits at a Glance Guide 2021-2022

Dental

The Florida Aquarium offers dental coverage through Humana. The Dental DMO Plan is an in-network plan only, whereas the Dental PPO Plan allows you
to use in-network or out-of-network benefits. If out-of-network dentists are used, you will be responsible for paying the difference between Humana’s

allowed amount and what the dentist may charge, also known as “balance billing”. The chart below provides a brief overview of the plans, The Florida
Aquarium pays 100% of the employee only dental cost for either selected plan!

Dental

DMO Plan PPO Plan

In-Network In-Network Out-of Network*
Calendar Year Deductible
Individual Not Applicable $25 $50
Family Not Applicable $75 $150
Annual Maximum
Unlimited $1,500 $1,500
Diagnostic & Preventive
Exams
Cleanings
Fluoride Refer to Fee Schedule Covered in full Covered in full
X-Rays
Sealants
Regular Restorative Services
Amalgam Fillings
Extractions - Single Tooth Refer to Fee Schedule Covered 90% after deductible Covered 80% after deductible
Periodontics (Gum Disease)
Endodontics (Root Canal)
Major Services
Crowns
Bridges Refer to Fee Schedule Covered 60% after deductible Covered 50% after deductible
Dentures
Basic
Adult/Child
Orthodontia Child Only
Refer to Fee Schedule
$1,000 Lifetime Max
• Out of network claims are subject to reasonable and customary charges.
• If you or your dependents do not enroll when first eligible, there is a 12-month waiting period for Basic (fillings/ 6 months) and a 24
month waiting period for Major and Orthodontia coverage.

BASE PREMIUM
Employee Cost Per Pay Period
DMO Plan (HS205) PPO Plan
Employee Only $ 0.00 $ 0.00
Employee + Spouse $ 6.66 $ 12.30
Employee + Child(ren) $ 8.32 $ 21.59
Family $ 17.43 $ 34.41

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