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Humana Extend 2500 plan

Protect your smile, eyes and ears in 1 easy-to-use dental, vision and hearing plan.

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Get peace of mind with the Humana Extend 2500 plan

Get dental, vision and hearing insurance coverage for the basics and more. The Humana Extend 2500 plan is focused on preventing problems before they start and getting you efficient care when issues do arise.

Humana Extend 2500 plan highlights:

  • Preventive dental exams and cleanings are 100% covered twice per year with no waiting period
  • $1000 annual maximum benefit for dental implants*
  • $100 teeth whitening allowance each year with no waiting period when performed in the dentist office
  • Preventive vision and hearing exams are covered 100% once per year with a network provider
  • $2500 calendar year maximum per covered person

* Subject to 12 month waiting period, $2,000 lifetime maximum and $2,500 annual maximum for all dental benefits combined

Plan details and benefits

Dental

Deductible: $75 deductible per person must be satisfied each year before dental benefits are payable

Calendar year maximum: $2500 calendar year maximum per covered person for benefits covered under this plan

Preventive dental care

In-network coverage: 100% covered subject to calendar year maximum (deductible does not apply)

Out-of-network coverage: Deductible applies*

Waiting period: None

Preventive dental services include:

  • 2 routine oral examinations per calendar year
  • 2 preventive cleanings per calendar year
  • 2 topical fluoride treatments per calendar year
  • 1 comprehensive oral examination every 3 calendar years
  • 1 comprehensive periodontal evaluation every 3 calendar years
  • 1 panoramic X-ray or 1 intraoral complete series X-ray every 5 calendar years
  • Bitewing X-ray: 1 set of 2 films per calendar year for ages 10 and under and 1 set of 4 films per calendar year for ages 11 and older
  • 1 sealant per primary tooth per lifetime, for those age 14 and under only
  • $100 teeth whitening allowance per year when performed in a dentist office (not subject to calendar year maximum)

* Deductible is waived on non-network preventive services in Georgia, Kansas and Texas.

1 sealant per primary tooth per lifetime, for those under age 19 in Illinois.

Basic dental care

In-network and out-of-network coverage: 80% covered after deductible and subject to calendar year maximum

Waiting period: 90 days*

Basic dental services include:

  • 1 filling per tooth every 2 calendar years
  • Initial placement for space maintainers for ages 14 and under when primary tooth is prematurely lost
  • Anesthesia in conjunction with covered oral surgery

* Waiting period is 30 days in Pennsylvania.

Composite restorations allowed on anterior teeth only. Alternate benefit of amalgam for composite allowed on pre-molar and molar teeth. The covered person will be responsible for the cost difference between the amalgam and composite filling for composite restorations on posterior teeth.

Initial placement for space maintainers until age 19 in Illinois when primary tooth is prematurely lost.

Major dental services

In-network and out-of-network coverage: 50% covered after deductible and subject to calendar year maximum

Waiting period: 12 months

Major dental services include:

  • $1000 annual maximum for dental implants,* subject to 12 month waiting period, $2,000 lifetime maximum and $2,500 annual maximum for all dental benefits combined
  • Surgical extractions (excluding elective removal of non-pathologic impacted teeth)
  • Root canal treatment for permanent teeth once per tooth per lifetime
  • Complete and partial dentures once every 5 years
  • Crowns, onlays and inlays, 1 per tooth per 5 years
  • Periodontal maintenance twice per calendar year and periodontal scaling and root planing once per quadrant every 3 calendar years (waiting periods do not apply)

*Implants and implant supported prostheses covered under this plan are limited to the replacement of permanent teeth extracted while insured under this plan, or for replacement of a prior prosthesis if it has been at least 5 years since the prior insertion, and is not, and cannot be made serviceable. Dental implant services do not include the following:

  1. Interim abutment
  2. Semi-precision attachment abutment
  3. Implant/abutment supported interim fixed denture for edentulous arch—mandibular
  4. Implant/abutment supported interim fixed denture for edentulous arch—maxillary
  5. Provisional implant crown
  6. Remove broken implant retaining screw
  7. Unspecified implant procedure, by report

Vision

Eye Exam

In-network coverage: $10 copay

Out-of-network coverage: $30 allowance

Waiting period: None

  • 1 routine vision exam every 12 months from the last date of service

Contact lens standard fit and follow-up

In-network coverage: $40 copay

Out-of-network coverage: Not covered

Waiting period: None

  • 1 standard contact lens fit and follow-up every 12 months from the last date of service*

* Contact lens fit and follow-up is not covered in Arizona, Georgia, Maryland, North Carolina and Texas.

Eyeglass frames

In-network coverage: $100 allowance

Out-of-network coverage: $50 allowance

Waiting period: None

  • 1 pair of frames every 24 months from the last date of service

Eyeglass lenses

In-network coverage for standard plastic lenses:
Single vision: $25 copay
Bifocal: $25 copay
Trifocal: $25 copay
Lenticular*: $25 copay

Out-of-network coverage for standard plastic lenses:
Single vision: $25 allowance
Bifocal: $40 allowance
Trifocal: $55 allowance
Lenticular:* not covered

Waiting period: None

  • 1 pair eyeglass lenses every 12 months from the last date of service

* Lenticular lenses are not covered in Arizona, Georgia, Maryland, North Carolina and Texas.

Contact lenses (in lieu of eyeglass lenses)

In-network coverage:
Conventional: $100 allowance
Disposable: $100 allowance
Medically necessary: $0 copay

Out-of-network coverage:
Conventional: $80 allowance
Disposable: $80 allowance
Medically necessary: $200 allowance

Waiting period: None

  • Contact lenses (in lieu of eyeglass lenses), 1 every 12 months from the last date of service

Hearing

In-network coverage: $0 copays except for hearing aids

Waiting period: None

Hearing services include:*

  • 1 routine hearing exam per year from an in-network provider
  • Subject to the applicable copay, up to 2 hearing aids (1 per ear) each year from the following in-network provider options:
    • Advanced level hearing aid ($699 copay per ear)
      • Various styles and colors
      • Disposable battery-powered options only
    • Premium level hearing aid ($999 copay per ear, $50 additional copay for rechargeable aids)
      • Various styles and colors
      • Disposable battery-powered and rechargeable options are available

* Hearing services are not available in New York.

Hearing exams are covered for out-of-network providers with a $45 allowance in Arizona, Georgia, Maryland, North Carolina and Texas.

Hearing aids are not covered in Arizona, Georgia, Maryland, North Carolina and Texas.

This dental, vision and hearing insurance plan is not available in all states.

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