Welcome to the Dental section of My Life at Children’s. Here you will find all the information you need about your dental plan options. Select an option from the menu at the left for more details.
2012 Plan Options
You have two dental plan options to choose from — the UnitedHealthcare Dental PPO and the Humana DHMO.
UnitedHealthcare Dental PPO
With the UnitedHealthcare Dental PPO option, you can see any dentist, but you will save money if you use one of the nationwide in-network providers. For some services, you will have to meet a deductible ($50/individual or $150/family) before the plan shares the cost with you. You may cover a same-sex domestic partner under this option.
Special Maternity Dental Benefits
If you are enrolled in the UnitedHealthcare Dental PPO plan option, the plan will pay the full cost of certain dental care during your second and third trimesters of pregnancy at no additional cost to you. Taking care of your teeth and gums during pregnancy is important for your baby’s health as well as your own. Gum disease during pregnancy can increase your risk for pre-term delivery, which increases the risk of neonatal problems and lifelong disabilities. See Prenatal Preventive Care under Resources at the left, or the Maternity Support section for more details.
Humana DHMO
With the Humana DHMO option, you must select and use a primary care dentist from the Humana network of dentists. The Humana DHMO network is a local network with dentists only in the DFW area. This option does not require you to meet a deductible. You pay fixed copays depending on the procedure. A fee schedule is available under Resources at the left. You may not cover a same-sex domestic partner under this option.
What You Will Pay for Dental Care
The chart below shows what you will pay for care in each of the two dental plan options.
|
UnitedHealthcare Dental PPO
(See chart below for plan maximums)
|
Humana DHMO
(No plan maximums apply)
|
| Annual Deductible |
$50 individual/$150 family* |
$0
|
Preventive Services
Exams, cleanings, X-rays |
$0
|
Fixed copay — see fee schedule under Resources
|
Basic Services
Fillings, extractions |
20% after deductible |
Fixed copay — see fee schedule under Resources |
Major Services
Crowns, dentures |
50% after deductible |
Fixed copay — see fee schedule under Resources |
| Orthodontics |
50% after deductible (Dependent children to age 19) |
$2,650 member copay (Adults and dependent children)
|
| *The family deductible is applicable when three or more dependents are covered. The family deductible is met when three covered individuals each meet the $50 deductible. |
UnitedHealthcare Dental PPO Plan Maximums
|
Annual Maximum Benefit
(The most the plan will pay each year per covered member)
|
Lifetime Maximum Benefit
(The most the plan will pay per member in his/her lifetime)
|
All services excluding Orthodontics
|
$1,500 per member |
Not applicable |
| Orthodontics |
See Lifetime Maximum Benefit |
$1,500 per member |
Find an In-Network Dentist
Humana DHMO
You cannot use your Humana DHMO benefits until you have enrolled with a network dentist as your primary care dentist. To enroll with a primary care dentist, you can call the Humana contact number (see Contacts at the left).
To see a list of network dentists in the DFW area, you can visit the Humana Dental Web site (see Contacts at the left) and click on "Find a Dentist." You may enter as a visitor. Choose "DHMO" and enter your ZIP code. Then, select "HS205 DHMO/Prepaid Network." Then you can search for dentists based on location. Please note that some of the dentists listed in-network may not be open to new patients. You have not enrolled with a primary care dentist until you call Humana (see Contacts at the left).
UnitedHealthcare Dental PPO
To find an in-network dentist, visit the UnitedHealthcare Dental Web site (see Contacts at the left) and click on Locate Dentist. Select the plan name “Dental Options PPO.” You can then search by location, specialty or dentist name. With the UnitedHealthcare Dental PPO option, you can see any dentist, but you will save money if you use an in-network provider because they have contracted with UnitedHealthcare Dental to accept discounted rates for services.