Page 11 - Anzea 2020 Benefit Guide_Revised 9-25-2020

Dental Options:

Humana

2020 Rate Information-Per Pay Period
Dependent Information
Employee Only $ 1.84 Anzea Textiles offers employees the opportunity

Employee + Spouse $ 7.36 to cover their spouse and dependent children.
Children can join or remain on a parent’s dental
Employee + Child(ren) $11.47
plan until age 26. When a child turns 26, they will
Employee + Family $17.21 lose dental coverage on the last day of their
birth month.

Humana Dental UNLIMITED with $1,000 Child Ortho
Type of Service
Non-Network Dentists - Reimbursed at 90th U&C

Calendar Year Deductible Individual $50 / Family $150

Preventive Services Covered at 100%; No Deductible
Basic Services Subject to $50 Deductible; Covered at 80%

Major Services Subject to $50 Deductible; Covered at 50%

Annual Maximum UNLIMITED

R&C Plan - pays 90% of the Usual and Customary charge for the area
Out of Network
where services are provided.
Orthodontia - Children under 19 Covered at 50% - Lifetime Maximum of $1,000 (No Deductible)
only

Type of Service Benefit Description

Routine Oral Examinations, Bitewing X-rays, 2 annual Routine cleanings,
Preventive Services
Routine Cleanings, Fluoride Treatments Sealants to age 14
Services Include: Fillings, Simple Extractions, Endodontics (including
Root Canal Treatment) Oral Surgery, 4 annual Periodontal Cleanings,
Basic Services
Non-surgical Periodontal Therapy-Scaling and Root Planning,
Periodontal Surgery

Crowns, Inlays, Onlays and most related services, Bridges, Full and
Partial Dentures, Denture Reline and Rebase Services, Implants (1 every
Major Services 5 years limited to crowns, bridges, and dentures. Coverage limited to
equivalent cost of a non-implant service. Implant placement itself is
not covered)

Orthodontia Applies only to children under age 19

Please note: This summary is intended for general information purposes.
It is not a guarantee of benefits. Please reference the benefit summary or contact the carrier for specific details.
For questions, you can call Humana at 800-233-4013
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