DHMO Certificate of Benefits - Lake County

More documents

Recommendations

Info

Notice of Privacy Practices (continued)• Send your opt-out request to us in writing:Humana Privacy OfficeP. O. Box 1438Louisville, KY 40202Humana follows all federal and state laws, rules,and regulations addressing the protection of personaland health information. In situations when federal andstate laws, rules, and regulations conflict, Humanafollows the law, rule, or regulation which providesgreater protection.The following affiliates and subsidiaries also adhere toHumana’s privacy policies and procedures:American Dental Providers of Arkansas, Inc.American Dental Plan of North Carolina, Inc.Cariten Insurance CompanyCariten Health PlanCarePlus Health Plans, Inc.CompBenefits CompanyCompBenefits Dental, Inc.CompBenefits Insurance CompanyCompBenefits of Alabama, Inc.CompBenefits of Georgia, Inc.CorpHealth, Inc.CorpHealth Provider Link, Inc.DentiCare, Inc.Emphesys, Inc.Emphesys Insurance CompanyHumanaDental Insurance CompanyHumana AdvantageCare Plan, Inc. fna Metcare HealthPlans, Inc.Humana Benefit Plan of Illinois, Inc. fna OSF HealthPlans, Inc.Humana Health Benefit Plan of Louisiana, Inc.Humana Employers Health Plan of Georgia, Inc.Humana Health Insurance Company of Florida, Inc.Humana Health Plan of Ohio, Inc.Humana Health Plan of Texas, Inc.Humana Health Plan, Inc.Humana Health Plans of Puerto Rico, Inc.Humana Insurance CompanyHumana Insurance Company of KentuckyHumana Insurance Company of New YorkHumana Insurance of Puerto Rico, Inc.Humana Medical Plan, Inc.Humana MarketPOINT, Inc.*Humana MarketPOINT of Puerto Rico, Inc.*Humana Medical Plan of Utah, Inc.Humana Wisconsin Health OrganizationInsurance CorporationKanawha Insurance Company*Managed Care Indemnity, Inc.Preferred Health Partnership, Inc.*Preferred Health Partnership of Tennessee, Inc.The Dental Concern, Inc.The Dental Concern, Ltd.* These affiliates and subsidiaries are only covered by the PrivacyNotice Concerning Financial Information section.GN14474HH 209
Questions & AnswersDHMOThank you for selecting a CompBenefits dental plan. You and your family can look forward toreceiving affordable care as well as good dental health. CompBenefits’ benefits are designed toencourage preventive care which will keep your teeth and gums free of dental disease. When youreceive care from one of our Participating General Dentists or Participating Specialists, simply consultyour Schedule of Benefits to determine the amount you will pay for a specified procedure. Thisamount is referred to as a “copayment” or “surcharge”.From time to time, you may have questions about your dental benefits. We have anticipated what someof those questions may be and have provided the answers for you below. Understanding how your newdental program works will allow you to get the best care possible for both you and your family. Pleasetake a moment now to read through this brochure and learn more about your dental plan.Where can I receivebenefits?Benefits are provided by Participating GeneralDentists and Participating Specialists. TheParticipating General Dentist you have selectedis printed on your Certificate of Dental Benefits. Ifyou have not already chosen a ParticipatingGeneral Dentist, please contact MemberServices in order to do so.Please note that some Participating GeneralDentists may have more than one office. Pleasebe sure to go only to the physical office locationyou choose. Each month, your dentist will receivea list with your name on it. It is a good idea for youto check with your dentist’s office staff to be sureyour name is on their list beforeyou receive services.How do I obtain adental appointment?Simply call your selectedParticipating General Dentistand make an appointment.Please take a moment toconfirm the effective date ofyour coverage, which is printedon your Certificate of DentalBenefits. If you receive yourCertificate of Benefits prior toyour effective date, please waituntil your effective date to make an appointment.How do I obtain a list ofParticipating Dentists?Simply call Member Services. We will be happy tomail one to you.What should I do if I need tocancel my appointment?If you need to cancel an appointment, please callyour Participating General Dentist at least 24hours before your appointment. Dentists work onan appointment basis and need to know yourchange of plans. If you break an appointmentwithout giving 24-hour notice to your ParticipatingGeneral Dentist’s office, you may be charged fora broken appointment at the rate shown on yourSchedule of Benefits.When I go to my selectedParticipating General Dentist,what treatment will I receive?Your Participating General Dentistwill evaluate your total dentalneeds. The two of you will thenagree on a treatment plan tocorrect any existing problems andget you started on a program ofgood oral hygiene to help keepyour teeth healthy and sound. Besure you understand therecommended treatment plan andany associated charges. You mayrequest a written copy of yourtreatment plan.Your dentist is a dental careprofessional. Please do not ask him or her toprovide only the “no charge” benefits and neglecttreatment which is in the best interest of your ownoral health. If you have any questions about yourtreatment plan, discuss them with yourParticipating General Dentist. If you havequestions regarding your Schedule of Benefits,contact Member Services.
Page 1 and 2: CS150 Dental PlanFlorida
Page 3 and 4: I. “Effective Date” is the firs
Page 5 and 6: the right to collect from the Membe
Page 7 and 8: paid. Transfers are limited to one
Page 9 and 10: Dental records concerning services
Page 11 and 12: formal written grievance with Compa
Page 13 and 14: CS 150Schedule of Benefits and Subs
Page 15 and 16: ADA CODE PROCEDURE PATIENT PAYS ADA
Page 17 and 18: NoticesThe following pages contain
Page 19 and 20: • Procedure or nature of the trea
Page 21 and 22: The notice will describe the plan's
Page 23 and 24: state Medicaid law regarding medica
Page 25 and 26: COBRA continuation coverage general
Page 27 and 28: Of elected, continuation coverage u
Page 29 and 30: Notice of Privacy Practicesfor your
Page 31: Notice of Privacy Practices (contin
Page 35: Is your dental plan adental insuran

DHMO Certificate of Benefits - Lake County

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?