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 or visit our website.

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.

Highlights of your dental plans

Coverage

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. 

Highlights of your dental plan options

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. Once the $5,000 annual benefit maximum has been reached for in- or out-of-network services, members can still receive dental services using the extended max feature. The extended max feature provides coverage with a 30% discount for covered benefits except for orthodontics and is available as soon as the plan’s annual maximum is reached. You can see any dentist or specialist at any time and use the extended max feature for preventive, basic and major services.

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.

View highlights of your dental plan

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.

Highlights of your dental plan

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. 

Find a dentist

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.

Find a dentist

Use our provider search tool to find in-network dentists.

Humana Dental Federal High PPO Plan

Find a dentist

Humana Dental Standard Advantage EPO network dentists.

Find a dentist

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.

Find a dentist

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.

Find a dentist

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 for dental coverage. There is no requirement that you enroll in other FEHB-sponsored plans. You can enroll by visiting the BENEFEDS website.

Visit BENEFEDS

If you are eligible now, you should sign up for the Humana Dental Federal High PPO 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.

You must use BENEFEDS to enroll or change enrollment in the Humana Dental Federal High PPO and Humana Federal Advantage EPO Plan. BENEFEDS is a secure enrollment website sponsored by the Office of Personnel Management (OPM). 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. 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.

Visit 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

See dental plan rates

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 www.fsafeds.com

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 Healthcare Claim Form and follow the instructions on how to submit your claim.

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 www.feds.humana.com

Note: Not all dental procedures are eligible covered expenses under the FSAFEDS rules. Please visit www.fsafeds.com for further details about qualified expenses. 

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 www.fsafeds.com