Dental FAQs

Humana Federal Dental High PPO FAQs

Here are answers to many common questions about our dental plans and services. If you don't see the information you need, go to "Contact us" to reach us by phone or email.

As a Humana Federal Dental participant, can I enroll in the FSAFEDS program?

Yes. Federal Employees are free to make an FSA election amount during your annual open season to use for qualified dental expenses.

How can I contact FSAFEDS ?

The FSAFEDS can be contacted at 1-877-FSAFEDS (1-877-372-3337), TTY: 866-353-8058 or at www.fsafeds.com (link opens in new window).

Can I enroll in the FSAFEDS paperless process to have my eligible out of pocket Humana Federal Dental plan expenses electronically sent to the FSAFEDS for processing?

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.

How do I submit my Orthodontic dental claims to the FSAFEDS via paper?

You can download an FSAFEDS claim form at www.fsafeds.com (link opens in new window)  or click on the following link: https://www.fsafeds.com/file (link opens in new window) . Instructions on how to submit the claim, including submission methods, are included.

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 (link opens in new window) .

Note: Not all dental procedures are eligible covered expenses under the FSAFEDS rules. Please contact www.fsafeds.com (link opens in new window)  for further details about qualified expenses.

Where do I submit my FSA claims?

You are able to submit your FSA claims by toll-free fax to 1-866-643-2245 or

Mail FSAFEDS Program - Claims P.O. Box 14127Lexington, 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) (link opens in new window) .

If I discover an issue with my FSA account balance, who should I contact?

Contact FSAFEDS at 1-877-FSAFEDS (1-877-372-3337), TTY: 866-353-8058 or at www.fsafeds.com (link opens in new window) .

Does Humana cover implants?

Yes. Please refer to your contract brochure for details.

Are orthodontics covered for both children and adults?

Yes, the Humana Dental Federal High PPO plan provides orthodontic services for adults and children. Like every other dental procedure in this affordable plan, you know exactly how much you will pay because it is listed on the copayment schedule.

http://apps.humana.com/marketing/documents.asp?file=3060096 (link opens in new window) 

What if my medical plan covers preventive care services?

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 payor benefit" under FEDVIP. So be sure to present both your medical and dental identification cards at your dental appointment. How does the plan differ from other dental plans?

The Humana Dental Federal 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 orthodontics and is available as soon as the plans’ 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.

What is Humana?

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.

How do I enroll in the plan?

You must use BENEFEDS to enroll or change enrollment in the Humana Dental Federal High PPO Plan. BENEFEDS is a secure enrollment website sponsored by 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 1-877-888-FEDS (1-877-888-3337), TTY number 1-877-889-5680, 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 (link opens in new window) 

When is my dental plan effective?

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.

How does the Humana Dental Federal High PPO Plan work?

With the Humana Dental Federal High PPO Plan, you receive a wide range of benefits whether or not you and/or each eligible dependent visit an in-network dentist, plus referrals are not necessary for specialty care. However, when you visit an in-network dentist, your out-of-pocket expenses are usually lower. If you choose an out-of-network dentist, 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.

http://apps.humana.com/marketing/documents.asp?file=4098081 (link opens in new window) 

How do I select a dentist?

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. You can access a list of current Humana Dental Federal High PPO network dentists.

Find a Dentist (link opens in new window) 

How do I make an appointment with my dentist?

Making an appointment is easy. Simply check the list of Humana Dental Federal High PPO network dentists or contact any dentist of your choice and make an appointment with the one you think will be best for you.

Find a Dentist (link opens in new window) 

How do I know if my dentist is in the network?

Simply check the list of Federal High PPO in-network dentists.

Find a Dentist (link opens in new window) 

What if I need the care of a specialist?

The Humana Dental Federal High PPO Plan includes coverage for specialty care. You can go to any one of the Humana Dental Federal 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.

How much will this plan cost?

The premiums that will be deducted from your paycheck vary based on where you are located and how often you are paid. To view plan rates go to View rates

How to file a claim for covered services?

To obtain claim forms or other claim filing advice or answers about your benefits, contact us at 877-692-2468 or go to our web site

What if I have a dental emergency?

Your Humana Dental Federal 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 utilize 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.

Do I have coverage if I go out of the state?

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.

Do I have coverage if I go out of the country?

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.

Are my dependents eligible?

When you enroll in the Humana Dental Federal High PPO 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.

Are pre-existing conditions covered?

The Humana Dental Federal High PPO Plan covers pre-existing conditions. You can view the plan coverage to see what you will pay for each dental procedure.

http://apps.humana.com/marketing/documents.asp?file=4098081 (link opens in new window) 

Will this plan coordinate with other dental coverage?

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.

Do I have to enroll in a medical plan to get dental benefits?

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 (link opens in new window) 

If I do not enroll now, will I have a chance to enroll in a dental benefits plan in the future?

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.

Will I receive dental identification cards from Humana?

Yes, an identification card is included in your welcome packet when you enroll in the Humana Dental Federal High PPO Plan. The packet also includes instructions about how to use your new Humana Dental Federal High PPO Plan.

Can I add family members during the contract year?

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

Is there a waiting period before I can use my benefits?

No

What is the waiting period for orthodontia?

None.

I am currently wearing braces. How will my dental benefits work?

It is always best to discuss any change to your treatment plan with your orthodontist. You should review the Humana Dental Federal High PPO Plan with your orthodontist before you make any decisions about coverage.

What if I want to go to a dentist that is not in your network?

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. You can find in-network plan providers by visiting our web site