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Last Updated: 09/15/2022
Claims
Dental High PPO
To obtain claim forms or other claim filing advice or answers about your High PPO Plan benefits, contact us at 877-692-2468.
Dental Standard Advantage EPO
One of the many advantages of membership in the Exclusive Provider Organization (EPO) plan is that you do not file any claims. You pay the amount listed in the copayment schedule for the specific procedures you need done.
Coverage
Yes, Invisalign treatment is covered under the orthodontic benefit (additional fees may apply). Services must be administered by a licensed provider in a brick and mortar building. Refer to your Humana plan brochure for orthodontic coverage benefits. As with any orthodontic treatment, pre-estimates are always recommended.
Yes. Please refer to your contract brochure for details.
Yes, the Humana Dental High PPO plan and the Humana Dental Standard Advantage EPO plan provide orthodontic services for adults and children. Your benefits schedule tells you exactly how much you’ll pay.
Many Federal Employee Health Benefit (FEHB) medical plans offer some level of dental benefits separate from your FEDVIP coverage. When you visit a dental provider, the FEHBP plan will pay first. This is called a "first payer benefit" under FEDVIP. So be sure to present both your medical and dental identification cards at your dental appointment.
Humana Dental High PPO Plan
The Humana Dental High PPO Plan emphasizes flexibility and helps you achieve better oral health. Important features of the plan are:
- Up to 3 free cleanings and exams per year
- Provides out-of-network coverage
- No waiting period for orthodontic or any other services.
No deductible for preventive care or for orthodontic services. In-network and out-of-network amounts cross apply.
There are no referrals.
Dental Standard Advantage EPO
The Humana Dental Standard Advantage EPO emphasizes prevention and cost control. Important features of the plan are:
- No waiting period for orthodontic or any other services.
- No deductibles and $0 copayment for preventive care.
- You can see any network dentist or specialist at any time. There are no referrals.
Humana Inc., headquartered in Louisville, Kentucky, is one of the nation’s largest publicly traded health and supplemental benefits companies. Humana is a full-service benefits solutions company, offering a wide array of health and supplemental benefit plans for employer groups, government programs and individuals. Today, the company is a leader in consumer engagement, providing guidance that leads to lower costs and a better health plan experience.
With the Humana Dental Federal High PPO Plan, you and your family’s preventive care and basic services are covered. Dental PPO plans do not require you to choose a primary care dentist and you don’t need a referral for specialty care. Instead, you can choose any dentist in or out of network, though your costs may be higher with out-of-network dentists. You may also save on services when you see an in-network dentist.
The Humana Dental Advantage EPO lists a copayment for each dental procedure. By checking the copayment schedule, you'll know exactly how much your dental services will cost. There are no deductibles, and you have an unlimited annual maximum. You are free to see any Humana Dental Standard Advantage network dentist or specialist at any time.
Dental High PPO Plan
You are always free to select the dentist of your choice. However, if you choose a dentist who does not participate in Humana Dental Federal High PPO network, your out-of-pocket expenses may be higher, since you will be responsible for any difference between the dentist's fee and your plan's payment. If you receive services from an in-network dentist, you are only responsible for the difference between the negotiated fee and your plan's payment.
Dental Standard Advantage EPO
You don't have to pick a dentist in advance, and you can see any participating dentist at any time with the Humana Dental Standard Advantage Plan. You can search for current Humana Dental Standard Advantage network dentists near you.
Use our provider search tool to find in-network dentists.
Humana Dental Federal High PPO Plan
Humana Dental Standard Advantage EPO network dentists.
Dental High PPO
The PPO plan includes coverage for specialty care. You can go to any one of the Humana Dental High PPO in-network specialists. When you use an out-of-network specialist, you are responsible for the difference between the plan allowance and our payment, plus the difference between the amount the provider bills and the plan allowance. No referral is required.
Dental Standard Advantage EPO
This plan includes coverage for specialty care. You can go to any one of the Humana Dental Standard Advantage EPO network specialists in this affordable plan. No referral is required, and you can see the cost of each procedure in advance.
Humana Dental High PPO
Your Humana Dental High PPO network dentist is qualified to help you in an emergency. You can obtain care from any licensed dentist you choose. All expenses for emergency services are payable as any other expense and are subject to plan limitations such as frequencies, deductibles, and maximums. If you use the services of an out-of-network dentist for emergency services, benefits will be paid under the out-of-network Plan provisions. You are responsible for the difference between our payment and billed charges.
Dental Standard Advantage EPO
Your Humana Dental Standard Advantage EPO network dentist is qualified to help you in an emergency. However, if you are far from home and a Humana Dental Standard Advantage network dentist is not available, you can get emergency care right away. You can then see your dentist when you return home.
Humana Dental High PPO
Yes. You may obtain care from any licensed dentist you choose. If the dentist you use is not part of our network, benefits will be determined based on the out-of-network benefit level of the out-of-network plan allowance.
You are responsible for the difference between our payment and the amount billed.
Dental Standard Advantage EPO
Plan members can go to any participating EPO dentist. Your copayments at the dentist's office are the same in every state, no matter which Humana Dental Standard Advantage network dentist or specialist you choose.
If you are outside the U.S., you can get emergency care right away. Emergency services are defined as treatment due to injury, accident or severe pain requiring the services of a dentist which occurs under circumstances where it is neither medically or physically possible for you to be treated by an in-network plan provider. If you utilize the services of an out-of-network dentist for emergency services the Humana Dental Federal High PPO plan, benefits will be paid under the out-of-network plan provisions. All expenses for emergency services are payable as any other expense and are subject to plan limitations such as frequencies, deductibles, and maximums.
The Humana Dental Federal High PPO Plan and the Humana Dental Standard Advantage EPO cover pre-existing conditions. You can view the plan coverage to see what you will pay for each dental procedure.
The plan will coordinate benefits with your FEHBP medical carrier if embedded dental coverage exists. The plan does not coordinate benefits with any other dental insurance plan.
There’s no waiting period.
It is always best to discuss any change to your treatment plan with your orthodontist. You should review the Humana Dental Plan with your orthodontist before you make any decisions about coverage.
Dental High PPO Plan
You can obtain care from any licensed dentist you choose. You may be able to reduce your out-of-pocket expenses for covered services by selecting an in-network provider.
Dental Standard Advantage EPO
This is an In-network only plan. The only way to take advantage of the rich plan benefits is to receive care from a dentist who has agreed to work with the Humana Dental Standard Advantage program.
Enrollment
When you enroll in your plan, you will have the option to include family members. It is an important feature for families since out-of-pocket expense for dental care can grow quickly.
All eligible federal employees and annuitants can purchase the Humana Dental Federal High PPO Plan or Humana Dental Standard Advantage EPO for dental coverage. There is no requirement that you enroll in other FEHB-sponsored plans. You can enroll by visiting the BENEFEDS website.
If you are eligible now, you should sign up for the Humana Dental Federal High PPO or Humana Dental Standard Advantage EPO Plan during Open Season. If you have a life-status change that would cause you to adjust your coverage, like getting married or having a child, you can make that adjustment within 60 days of that status change.
Yes, an identification card is included in your welcome packet when you enroll in the Humana Dental Federal High PPO Plan or the Humana’s Dental Standard Advantage EPO Plan. The packet also includes instructions about how to use your new plan.
If you are eligible now, you should sign up for your plan during the Open Season for federal employees. If you have a life-status change that would cause you to adjust your coverage, like getting married or having a child, you can make that adjustment within 60 days of that status change.
To enroll, simply enter your name, personal information such as your address and Social Security number, the agency you work for (or retirement system that pays your annuity), and select the Humana Dental Federal High PPO Plan or the Standard EPO Plan. If you do not have access to a computer, call 877-888-FEDS (877-888-3337), TTY number 877-889-5680, to enroll or change your enrollment.
Note: You cannot enroll in a FEDVIP plan using the Health Benefits Election Form (SF 2809) or through an agency self-service system, such as Employee Express, PostalEase, EBIS, MyPay, or Employee Personal Page. However, those sites may provide a link to BENEFEDS.
The premiums that will be deducted from your paycheck vary based on where you are located and how often you are paid. You can view rate information for the Humana Dental Standard Advantage Plan and the Humana Dental Federal High PPO Plan
When enrolling during federal Open Season, the effective date will be January 1st. If enrolling outside of open season, the effective date is the first day of the next pay period.
FSAFEDS
Yes. Federal Employees are free to make an FSA election amount during your annual open season to use for qualified dental expenses.
You may call 877-FSAFEDS (877-372-3337), TTY: 866-353-8058 or go to
Yes. You may enroll in FSAFEDS paperless process and your dental claims, excluding orthodontic, will automatically be sent to FSAFEDS for processing. Once enrolled, there's no need to submit a paper claim.
Download a
Please refer to date shown on your dental Explanation of Benefits (EOB) to review your claim and to determine when Humana processed your claim. You can review/download your dental EOB from the Humana Federal website at
Note: Not all dental procedures are eligible covered expenses under the FSAFEDS rules. Please visit
Submit your FSA claims by toll-free fax to 1-866-643-2245 or
Mail
FSAFEDS Program - Claims
P.O. Box 14127
Lexington, KY 40512-4127
Fax
866-643-2245 (toll-free) or
650-577-5340
If mailing your claim, please send in copies of your receipts and keep the original documents in your files.
Most claims are processed within one to two business days after they are received and verified. Payments are sent shortly thereafter. For additional information, check out the Submitting Claims Quick Reference Guide (PDF)
Contact FSAFEDS at 1-877-FSAFEDS (1-877-372-3337), TTY: 866-353-8058 or at