Page 6 - Humano Employee Benefit Guide 2019

Benefits

Dental Insurance

Anthem Blue Cross | PPO Dental Plan
With the Anthem Blue Cross Preferred Provider Organization (PPO) dental plan, you may visit a PPO dentist and benefit from the
negotiated rate or visit a non‐network dentist. When you utilize a PPO dentist, your out-of-pocket expenses will be less. You may
also obtain services using a non-network dentist; however, you will be responsible for the difference between the covered amount
and the actual charges and you may be responsible for filing claims.

Anthem Blue Cross
Plan Name PPO Plan
Network Name Dental Complete Network Non-Network (90th UCR)
Dental Benefits

Calendar Year Maximum $1,500
Deductible (Annual)
- Individual $50
- Family $150
Preventive (Plan Pays) 100% 100%
Exams, X-Rays, Cleanings Deductible waived Deductible waived
Basic Services (Plan Pays) Deductible, 90% Deductible, 80%
Fillings, Oral Surgery,
Endodontics, Periodontics
Major Services (Plan Pays) Deductible, 60% Deductible, 50%
Crowns, Dentures, Bridges
Orthodontia $1,500 Lifetime benefit
50%

Finding a Dental Provider
Go to www.anthem.com/ca or call (888) 209-7852. PPO participants should refer to the “Dental Complete”
network when prompted.

Note
We strongly recommend you ask your dentist for a predetermination if total charges are expected to exceed $300.
Predetermination enables you and your dentist to know in advance what the payment will be for any service that may be in
question.

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