what is humana vision plan called

View plan provisions or check with your sales representative. In addition to the annual Open Season, there are certain events that allow you to make specific types of enrollment changes throughout the year. Your reenrollment must be for at least the minimum of $100. In addition to at least 2 drugs per drug category, Part D drug plans must cover all drugs available in the following categories:2, Note: Part D plans must also cover most vaccines (e.g., Please remember that all benefits are subject to the definitions, limitations, and exclusions in this brochure and are payable only when we determine they are necessary for the prevention, diagnosis, care or treatment of a covered condition and meet generally accepted dental protocols. You can obtain care from any licensed dentist you choose. During future annual Open Seasons, you may enroll in a plan, or change or cancel your dental and/or vision coverage. If the dispute is not resolved through the reconsideration process, you may request a review of the denial. 1-888-371-9538 (TTY: 711). In some cases, you may need a referral and/or prior authorization. For costs and complete details of the coverage, refer to the plan document or call or write your Humana insurance agent or the company. Medicare Advantage plans are widely used in the United States. To find a provider in your area, visit the WholeHealth Choices website at https://Humana.wholehealthmd.com. VISION PLAN FOR STATE OF FLORIDA EMPLOYEES PTB 107. Incomplete endodontic treatment when you discontinue treatment, D3355 Pulpal regeneration - initial visit, D3356 Pulpal regeneration - interim medication replacement, D3357 Pulpal regeneration - completion of treatment (does not include final restoration), D4341 Periodontal scaling and root planning-four or more teeth per quadrant Limited to a maximum of once per quadrant in a three year period, D4342 Periodontal scaling and root planning-one to three teeth, per quadrant Limited to a maximum of once per quadrant in a three year period, D4346 Scaling in presence of generalized moderate or severe gingival inflammation full mouth, after oral evaluation - Limited to one per year and cross reduces with codes D1110 and D1120, D5410 Adjust complete denture - maxillary - not covered if done within 6 months of installation, D5411 Adjust complete denture - mandibular - not covered if done within 6 months of installation, D5421 Adjust partial denture - maxillary - not covered if done within 6 months of installation, D5422 Adjust partial denture - mandibular - not covered if done within 6 months of installation, D5710 Rebase complete maxillary denture not covered within first six months of placement, limited to once in a 3 year period, D5711 Rebase lower complete denture -not covered within first six months of placement, limited to once in a 3 year period, D5720 Rebase maxillary partial denture not covered within first six months of placement, limited to once in a 3 year period, D5721 Rebase mandibular partial denture not covered within first six months of placement, limited to once in a 3 year period, D5730 Reline complete maxillary denture (direct) not covered within first six months of placement, limited to once in a 3 year period, D5731 Reline complete mandibular denture (direct) not covered within first six months of placement, limited to once in a3 yearperiod, D5740 Reline maxillary partial denture (direct) not covered within first six months of placement, limited to once in a3 yearperiod, D5741 Reline mandibular partial denture (direct) not covered within first six months of placement, limited to once in a3 yearperiod, D5750 Reline complete maxillary denture (indirect) not covered within first six months of placement, limited to once in a3 yearperiod, D5751 Reline complete mandibular denture (indirect) not covered within first six months of placement, limited to once in a3 yearperiod, D5760 Reline maxillary partial denture (indirect) not covered within first six months of placement, limited to once in a3 yearperiod, D5761 Reline mandibular partial denture (indirect) not covered within first six months of placement, limited to once in a 3 year period, D7251 Coronectomy intentional partial tooth removal, impacted teeth only, D7509 - marsupialization of odontogenic cyst, D7956 - guided tissue regeneration, edentulous area resorbable barrier, per site, D7957 - guided tissue regeneration, edentulous area non-resorbable barrier, per site, D6092 Re-cement Implant / Abutment supported crown, D2610 Inlay - porcelain/ceramic, one surface -Limited 1 every 5 years, D2620 Inlay - porcelain/ceramic, two surfaces -Limited 1 every 5 years, D2630 Inlay - porcelain/ceramic, three or more surfaces -Limited 1 every 5 years, D3310 Anterior root canal (excluding final restoration) - Limited to 1 per tooth per lifetime, D3320 Premolar root canal (excluding final restoration) - Limited to 1 per tooth per lifetime, D3330 Molar root canal (excluding final restoration) - Limited to 1 per tooth per lifetime, D3346 Retreatment of previous root canal therapy - anterior - Limited to 1 per tooth per lifetime, D3347 Retreatment of previous root canal therapy - premolar - Limited to 1 per tooth per lifetime, D3348 Retreatment of previous root canal therapy - molar - Limited to 1 per tooth per lifetime, D3471 Surgical repair of root resorption - anterior, D3472 Surgical repair of root resorption premolar, D3473 Surgical repair of root resorption molar, D4210 Gingivectomy or gingivoplasty- four or more contiguous teeth or bounded teeth spaces, per quadrant - Limited to once in a 3 year period, D4211 Gingivectomy or gingivoplasty- one to three teeth, per quadrant - Limited to 1 per tooth per lifetime, D4212Gingivectomy or gingivoplasty - with restorative procedures, per tooth - Limited to once in a 3 year period, D4240 Gingival flap procedure, including root planing, four of more contiguous teeth or bounded teeth spaces per quadrant- Limited to once in a 3 year period, D4241 Gingival flap procedure, including root planning- one to three teeth per quadrant- Limited to once in a 3 year period, D4249 Clinical crown lengthening-hard tissue- Limited to once in a 3 year period, D4260 Osseous surgery (including flap entry and closure), four or more contiguous teeth or bounded teeth spaces per quadrant - Limited to once in a 3 year period, D4261 Osseous surgery (including flap entry and closure)- one to three teeth per quadrant -Limited to once in a 3 year period, D4268 Surgical revision procedure, per tooth - Limited to once in a 3 year period, D4270 Pedicle soft tissue graft procedure - Limited to once in a 3 year period, D4273 Subepithelial connective tissue graft procedures (including donor site surgery) - Limited to once in a 3 year period, D4275 Soft tissue allograft - Limited to once in a 3 year period, D4276 Combined connective tissue and double pedicle graft, per tooth - Limited to once in a 3 year period, D4277Free soft tissue graft procedure, first tooth or edentulous tooth position in a graft - Limited to once in a 3 year period, D4278 Free soft tissue graft procedure, each additional contiguous tooth or edentulous tooth position in a graft - Limited to once in a 3 year period, D4283 Autogenous connective tissue graft procedure (including donor and recipient surgical sites) each additional contiguous tooth, implant or edentulous tooth position in same graft site - Limited to once in a 3 year period, D4285 Non-autogenous connective tissue graft procedure (including recipient surgical site and donor material) each additional contiguous tooth, implant or edentulous tooth position in same graft site - Limited to once in a 3 year period, D4355 Full mouth debridement to enable comprehensive periodontal evaluation and diagnosis -Limited to once per lifetime, D5225 Maxillary partial denture, flexible base, D5226 Mandibular partial denture, flexible base, D5227 Immediate maxillary partial denture - flexible base (including any clasps, rests and teeth), D5228 Immediate mandibular partial denture - flexible base (including any clasps, rests and teeth), D5765 Soft liner for complete or partial removable denture indirect, D5876 Add metal substructure to acrylic full denture (per arch), D6066 Implant supported single porcelain fused to metal crown titanium, titanium alloy, high noble metal, D6081 Scaling and debridement in the presence of inflammation or mucositis of a single implant, including cleaning of the implant surface, without flap entry and closure -limited to 1 per tooth every 3 years, D6091 Replacement of replaceable part of semi-precision or precision attachment, D6106 - guided tissue regeneration resorbable barrier, per implant, D6107 - guided tissue regeneration non-resorbable barrier, per implant, D6191 Semi-precision abutment placement, D6192 Semi-precision attachment placement, D9932 Cleaning and inspection of removable complete denture, maxillary, D9933 Cleaning and inspection of removable complete denture, mandibular, D9934 Cleaning and inspection of removable partial denture, maxillary, D9935 Cleaning and inspection of removable partial denture, mandibular, D9941 Fabrication of athletic mouthguard - Limited to one per 12 month period, D0350 Oral/facial images (including intra and extraoral images), D0372 - intraoral tomosynthesis - comprehensive series of radiographic images, D0373 - intraoral tomosynthesis - bitewing radiographic image, D0374 - intraoral tomosynthesis - periapical radiographic image, D8210 Removable appliance therapy - Limited to 14 years or younger, 1 per lifetime, D8220 Fixed appliance therapy -Limited to 14 years or younger, 1 per lifetime, D8681 Removable orthodontic retainer adjustment, D9219 Evaluation for moderate sedation, deep sedation or general anesthesia, D9613 Infiltration of sustained release therapeutic drug single or multiple sites, D0120 Periodic oral evaluation established patient (limited to 3 per calendar year), D0145 Oral evaluation for a patient under three years of age and counseling with primary caregiver (limited to1 per patient per lifetime), D0210 Intraoral comprehensive series of radiographic images(limited to1 every 3 years), D1110 Prophylaxis adult(limited to 3 per calendar year), D1120 Prophylaxis child(limited to 3 per calendar year), D1353 Sealant Repair - (Per tooth) Permanent tooth-1 every 3 year period, D1354 Interim caries arresting medicament application - Permanent tooth 1 every 3 years, D1510 Space maintainer fixed unilateral, per quadrant (limited to children under age 19), D1516 Space maintainer fixed bilateral, maxillary (limited to children under age 19), D1517 Space maintainer fixed bilateral, mandibular (limited to children under age 19), D1520 Space maintainer removable unilateral, per quadrant(limited to children under age 19), D1526 Space maintainer removable bilateral, maxillary (limited to children under age 19), D1527 Space maintainer removable bilateral, mandibular (limited to children under age 19), D1551 Re-cement or re-bond bilateral space maintainer, maxillary (limited to children under age 19), D1552 Re-cement or re-bond bilateral space maintainer, mandibular (limited to children under age 19), D1553 Re-cement or re-bond unilateral space maintainer, per quadrant (limited to children under age 19), D1556 Removal of fixed unilateral space maintainer - per quadrant (Limited to children under 19), D1557 Removal of fixed bilateral space maintainer - maxillary per quadrant (Limited to children under 19), D1558 Removal of fixed bilateral space maintainer - mandibular (Limited to children under 19), D1575 Distal shoe space maintainer fixed unilateral, D2390 Resin based composite crown anterior, D3222 Partial pulpotomy for apexogenesis permanent tooth with incomplete root development (limited to1 per tooth per lifetime), D5511 Repair broken complete denture base, mandibular, D5512 Repair broken complete denture base, maxillary, D5611 Repair resin partial denture base, mandibular, D5612 Repair resin partial denture base, maxillary, D5621 Repair cast partial framework, mandibular, D5622 Repair cast partial framework, maxillary, D5630 Repair or replace broken retentive clasping materials -per tooth, D7111 Extraction, coronal remnants primary deciduous tooth, D7251 Coronectomy intentional partial tooth removal,impacted tooth only (limited to 1 per tooth per lifetime), Not covered:Additional Procedures Covered as Major Services, D2510 Inlay - metallic - one surface - (limited to 1 per tooth every 5 years), D2520 Inlay - metallic - two surfaces- (limited to 1 per tooth every 5 years), D2530 Inlay - metallic - three or more surfaces- (limited to 1 per tooth every 5 years), D2542 Onlay - metallic - two surfaces (limited to 1 per tooth every 5 years), D2543 Onlay - metallic - three surfaces (limited to 1 per tooth every 5 years), D2544 Onlay - metallic - four or more surfaces (limited to 1 per tooth every 5 years), D2610 Inlay porcelain/ceramic, one surface (limited to 1 per tooth every 5 years), D2620 Inlay porcelain/ceramic, two surfaces (limited to 1 per tooth every 5 years), D2630 Inlay porcelain/ceramic, three or more surfaces (limited to 1 per tooth every 5 years), D2740 Crown - Crown - porcelain/ceramic substrate (limited to 1 per tooth every 5 years), D2750 Crown porcelain fused to high noble metal(limited to1 per tooth every 5 years), D2751 Crown porcelain fused to predominately base metal(limited to1 per tooth every 5 years), D2752 Crown porcelain fused to noble metal(limited to1 per tooth every 5 years), D2753 Crown porcelain fused to titanium and titanium alloys (limited to 1 per tooth every 5 years), D2794 Crown titanium and titanium alloy (limited to1 per tooth every 5 years), D3320Endodontic therapy, premolar bicuspid tooth (excluding final restorations) -(limitedto 1 per toothper lifetime), D3330Endodontic therapy, molar tooth (excluding final restorations) -(limited to1 per tooth per lifetime), D3347 Retreatment of previous root canal therapy bicuspid premolar, D3355 Pulpal regeneration - initial visit(limited to 1 per tooth per lifetime), D3356 Pulpal regeneration - interim medication replacement (limited to 1 per tooth per lifetime), D3357 Pulpal regeneration - completion of treatment (limited to 1 per tooth per lifetime), D3421 Apicoectomy bicuspid premolar (first root), D3426 Apicoectomy (each additional root), D3471 Surgical repair of root resorption anterior, D4355 Full mouth debridement to enable a comprehensive periodontal evaluation and diagnosis on a subsequent visit (limited to1 per lifetime), D5110 Complete denture maxillary(limited 1 per 5 years), D5120 Complete denture mandibular (limited 1 per 5 years), D5130 Immediate denture maxillary (limited 1 per 5 years), D5211 Maxillary partial denture - resin base (including retentive/clasping materials, rests and teeth) - (limited 1 per 5 years), D5212 Mandibular partial denture - resin base (including retentive/clasping materials, rests and teeth) - (limited 1 per 5 years), D5214 Mandibular partial denture - cast metal framework with resin denture base (including retentive/clasping materials, rests and teeth) (limited 1 per 5 years), D5213 Maxillary partial denture - cast metal framework with resin denture base (including retentive/clasping materials, rests and teeth) (limited 1 per 5 years), D5221 Immediate maxillary partial denture resin base (includingretentive/clasping materials, rests and teeth) -(limited 1 per 5 years), D5222 Immediate mandibular partial denture resin base (including retentive/clasping materials, rests and teeth) - (limited 1 per 5 years), D5223 Immediate maxillary partial denture - cast metal framework with resin denture base (including retentive/clasping materials, rests and teeth) (limited 1 per 5 years), D5224 Immediate mandibular partial denture - cast metal framework with resin denture base (including retentive/clasping materials, rests and teeth) (limited 1 per 5 years), D5225 Maxillary partial denture - flexible base (including any retentive/clasping materials, rests, and teeth) - (limited 1 per 5 years), D5226 Mandibular partial denture - flexible base (including retentive/clasping materials, rests, and teeth) - (limited 1 per 5 years), D5282 Removable unilateral partial denture one piece cast metal (including retentive/clasping materials, rests and teeth), maxillary - (limited to 1 perarch every 5 years), D5283 Removable unilateral partial denture one piece cast metal (including retentive/clasping materials, rests and teeth), mandibular - (limited to 1 perarch every 5 years), D5284 Removable unilateral partial denture one piece flexible base (including retentive/clasping materials, rests, and teeth), per quadrant (limited to 1 per quadrant every 5 years), D5286 Removable unilateral partial denture one piece resin (including retentive/clasping materials, rests, and teeth), per quadrant(limited to 1 per quadrant every 5 years), D6010 Surgical placement of implant body: endosteal implant (limited to 1 per tooth per lifetime), D6013 Surgical placement of mini implant (limited to 1 per tooth per lifetime), D6040 Subperiosteal implant (limited to 1 per tooth per lifetime), D6050 Transosseous mandibular implant (limited to 1 per tooth per lifetime), D6055 Connecting Bar implant supported or abutment supported (limited to 1per tooth every 5 years), D6056 Prefabricated abutment includes modification and placement (limited to 1per tooth every 5 years), D6057 Custom fabricated abutment includes modification and placement (limited to 1per tooth every 5 years), D6058 Abutment supported porcelain/ceramic crown (limited to 1per tooth every 5 years), D6059 Abutment supported porcelain fused to metal crown high noble metal (limited to 1per tooth every 5 years), D6060 Abutment supported porcelain fused to metal crown predominantly based metal (limited to 1per tooth every 5 years), D6061 Abutment supported porcelain fused to metal crown noble metal (limited to 1per tooth every 5 years), D6062 Abutment supported cast metal crown high noble metal (limited to 1per tooth every 5 years), D6063 Abutment supported cast metal crown predominantly based metal (limited to 1per tooth every 5 years), D6064 Abutment supported cast metal crown noble metal (limited to 1per tooth every 5 years), D6065 Implant supported porcelain/ceramic crown (limited to 1per tooth every 5 years), D6066 Implant supported porcelain, high noble alloys (limited to 1 per tooth every 5 years), D6067 Implant supported crown, high noblealloys (limited to 1 per tooth every 5 years), D6068 Abutment supported retainer for porcelain/ceramic FPD (limited to 1 per tooth every 5 years), D6069 Abutment supported retainer for porcelain fused to metal FPD high noble metal (limited to 1per tooth every 5 years), D6070 Abutment supported retainer for porcelain fused to metal FPD predominantly base metal (limited to 1 per toothevery 5 years), D6071 Abutment supported retainer for porcelain fused to metal FPD noble metal (limited to 1 per tooth every 5 years), D6072 Abutment supported retainer for cast metal FPD high noble metal (limited to 1per tooth every 5 years), D6073 Abutment supported retainer for cast metal FPD predominantly base metal (limited to 1per tooth every 5 years), D6074 Abutment supported retainer for cast metal FPD noble metal (limited to 1per tooth every 5 years), D6075 Implant supported retainer for ceramic FPD (limited to 1 per toothevery 5 years), D6076 Implant supported retainer FPDhigh noblealloys (limited to 1per tooth every 5 years), D6077 Implant supported retainer for FPD high noblealloys (limited to 1per tooth every 5 years), D6080 Implant maintenance procedures, including removal of prosthesis, cleansing of prosthesis and abutments and reinsertion of prosthesis (limited to 1per tooth every 5 years), D6081 Scaling and debridement in the presence of inflammation or mucositis of a single implant, including cleaning of the implant surface, without flap entry and closure (limited to 1 per tooth every 3 years), D6082 Implant supported crown porcelain fused to predominantly base alloys (limited to 1 per tooth every 5 years), D6084 Implant supported crown porcelain fused to titanium and titanium alloys (limited to 1 per tooth every 5 years), D6083 Implant supported crown porcelain fused to predominantly base alloys (limited to 1 per tooth every 5 years), D6086 Implant supported crown predominantly base alloys (limited to 1 per tooth every 5 years), D6087 Implant supported crown noble alloys (limited to 1 per tooth every 5 years), D6088 Implant supported crown titanium and titanium alloys (limited to 1 per tooth every 5 years), D6090 Repair implant supported prosthesis, by report (limited to 1per toothevery 5 years), D6091 Replacement of semi-precision or precision attachment (male or female component) of implant/abutment supported prosthesis, per attachment (limited to 1per tooth every 5 years), D6094 Abutment supported crown titanium (limited to 1per tooth every 5 years), D6095 Repair Implant Abutment (limited to 1per tooth every 5 years), D6097 Abutment supported crown porcelain fused to titanium and titanium alloys (limited to 1 per tooth every 5 years), D6098 Implant supported retainer - porcelain fused to predominantly base alloys (limited to 1 per tooth every 5 years), D6099 Implant supported retainer FPD - porcelain fused to noble alloys (limited to 1 per tooth every 5 years), D6100 Implant Removal (limited to 1per tooth every 5 years), D6102 Debridement of peri-implant defect (limited to 1 per tooth every 5 years), D6105 - removal of implant body not requiring bone removal or flap elevation, D6110 implant /abutment supported removable denture for edentulous arch Maxillary (limited to 1per tooth every 5 years), D6111 implant /abutment supported removable denture for edentulous arch mandibular (limited to 1per tooth every 5 years), D6112 implant /abutment supported removable denture for partially edentulous arch maxillary (limited to 1per tooth every 5 years), D6113 implant /abutment supported removable denture for partially edentulous arch mandibular (limited to 1per tooth every 5 years), D6114 implant /abutment supported fixed denture for edentulous arch maxillary (limited to1 per tooth every 5 years), D6115 implant /abutment supported fixed denture for edentulous arch mandibular (limited to1 per tooth every 5 years), D6116 implant /abutment supported fixed denture for partially edentulous arch maxillary (limited to1 per tooth every 5 years), D6117 implant /abutment supported fixed denture for partially edentulous arch mandibular (limited to1 per tooth every 5 years), D6120 Implant supported retainer - porcelain fused to titanium and titanium alloys (limited to 1 per tooth every 5 years), D6121 Implant supported retainer for metal FPD - predominantly base alloys (limited to 1 per tooth every 5 years), D6122 Implant supported retainer for metal FPD - noble alloys (limited to 1 per tooth every 5 years), D6123 Implant supported retainer for metal FPD - titanium and titanium alloys (limited to 1 per tooth every 5 years), D6194 Abutment supported retainer crown for FPD titanium and titanium alloys (limited to 1per year every 5 years), D6195 Abutment supported retainer - porcelain fused to titanium and titanium alloys (limited to 1 per tooth every 5 years), D6197 - replacement of restorative material used to close an access opening of a screw-retained implant supported prosthesis, per implant, D6214 Pontic titanium and titanium alloys (limited to 1 per tooth every 5 years), D6243 Pontic - porcelain fused to titanium and titanium alloys (limited to 1 per tooth every 5 years), D6753 Retainer crown - porcelain fused to titanium and titanium alloys (limited to 1 per tooth every 5 years), D6784 Retainer crown - titanium and titanium alloys (limited to 1 per tooth every 5 years), D9941 Fabrication of athletic mouth guard, D9944 Occlusal guard hard appliance, full arch (limited to 1 arch-maxillary or mandibular every 5 years), D9945 Occlusal guard soft appliance, full arch (limited to 1 arch-maxillary or mandibular every 5 years), D9946 Occlusal guard hard appliance, partial arch (limited to 1 arch-maxillary or mandibular every 5 years), D8010 Limited orthodontic treatment of the primary dentition (limited to 1 treatment per lifetime), D8020 Limited orthodontic treatment of the transitional dentition (limited to 1 treatment per lifetime), D8030 Limited orthodontic treatment of the adolescent dentition (limited to 1 treatment per lifetime), D8040 Limited orthodontic treatment of adult dentition (limited to 1 treatment per lifetime, D8070 Comprehensive orthodontic treatment of the transitional dentition (Limited to 1 treatment per lifetime), D8080 Comprehensive orthodontic treatment of the adolescent dentition (limited to 1 treatment per lifetime), D8090 Comprehensive orthodontic treatment of the adult dentition (limited to 1 treatment per lifetime), D8210 Removable appliance therapy (limited to 1 treatment per lifetime), D8220 Fixed appliance therapy (limited to 1 treatment per lifetime), D8660 Pre-orthodontic treatment visit (limited to 1 treatment per lifetime), D8670 Periodic orthodontic treatment visit (as part of contract), D8680 Orthodontic retention (removal of appliances, construction and placement of retainer(s)) - (limited to 1 treatment per lifetime), D9222 Deep sedation/general anesthesia first 15 minutes, D9223 Deep sedation/general anesthesia each subsequent 15 minute increment, D9239 Intravenous moderate (conscious) sedation/analgesia first 15 minutes, D9243 Intravenous moderate (conscious) sedation/analgesia each subsequent 15 minute increment. all 50 states: varies: vision, dental, or hearing benefit coverage; prescription drug coverage, and fitness discounts, all depending on the plan . Dental insurance helps manage the costs of preventive care and also helps lower costs for an unexpected event, like a broken tooth or a cavity. The Humana vision insurance plans are full of benefits with affordable monthly premiums. These articles help break down the costs and give you an idea of what to expect. The Humana Dental Value HI215 is a dental HMO plan that covers preventive, basic and major dental services provided by the primary care dentist of your choice from our dental network. Call a licensed insurance agent6 at 1-855-298-6309 TTY Users: 711 24 hours a day, 7 days a week to get help reviewing your Medicare coverage options and find a plan with vision coverage. Because of the tax benefits an FSA provides, the IRS requires that you forfeit any money for which you did not incur an eligible expense and file a claim in the time period permitted. Enter your ZIP code below to see plans with their premiums, copays, and participating doctors and pharmacies. See our full accessibility rights information and language options. Box 15949 Tallahassee, FL 32317 | 800.780.3100, with over 70 retail locations throughout Florida. You can obtain care from any licensed dentist you choose. Humana Vision Care Plan - Capital Insurance Agency What is a Medicare Part D Formulary? | Humana Whether you're already a Humana member or shopping for a vision plan, we can help you find in-network optometrists or ophthalmologists in your area. Looking for an optometrist or ophthalmologist? You can find in-network providers by visiting our website at http://feds.humana.com. We do not cover services that generally are considered to be medical services except those specifically noted as covered in this plan. See www.fsafeds.com or call 1-877-FSAFEDS (372-3337) or TTY: 1-866-353-8058. email@example.com. For additional information contact us at, 877-692-2468 or visit the website at, Humanas Lifestyle Discount Program is designed to help you achieve lifelong well-being with valuable discounts and exclusive deals on popular health and wellness services. ), D3352 Apexification/recalcification - interim medication replacement (apical closure/calcific repair of perforations, root resorption, etc. Here are some details to explain what a Medicare Part D formulary is and how it works. Some documents are presented in Portable Document Format (PDF). You may choose a Self Plus One enrollment even though you have additional eligible family members, but the additional family members will not be covered under FEDVIP. Most TRICARE health plans meet the requirements for minimum essential coverage under the Affordable Care Act. This year, Open Season runs from November 14, 2022 through midnight EST December 12, 2022. Plan Tools to maximize your value Register for online access each additional contiguous tooth, implant or edentulous tooth position in same graft site, D6211 Pontic cast predominately base metal (, D6240 Pontic porcelain fused to high noble metal (, D6241 Pontic porcelain fused to predominately base metal (, D6242 Pontic porcelain fused to noble metal (, D6545 Retainer cast metal for resin bonded fixed prosthesis, D6548 Retainer porcelain/ceramic for resin bonded fixed prosthesis, D6600 Retainer inlay porcelain/ceramic,2 surfaces (, D6601 Retainer inlay porcelain/ceramic,3 or more surfaces (, D6602 Retainer inlay cast high noble metal,2 surfaces (, D6603 Retainer inlay cast high noble metal,3 or more surfaces (, D6604 Retainer inlay cast predominantly base metal,2 surfaces (, D6605 Retainer inlay cast predominantly base metal,3 or more surfaces (, D6606 Retainer inlay cast noble metal,2 surfaces (, D6607 Retainer inlay cast noble metal,3 or more surfaces (, D6608 Retainer onlay porcelain/ceramic,2 surfaces (, D6609 Retainer onlay porcelain/ceramic,3 or more surfaces (, D6610 Retainer onlay cast noble metal,2 surfaces (, D6611 Retainer onlay cast noble metal,3 or more surfaces (, D6612 Retainer onlay cast predominantly base metal,2 surfaces (, D6613 Retainer onlay cast predominantly base metal,3 or more surfaces (, D6614 Retainer onlay cast noble metal,2 surfaces (, D6615 Retainer onlay cast noble metal,3 or more surfaces (, D6740 Retainer crown porcelain/ceramic (, D6750 Retainer crown porcelain fused to high noble metal (, D6751 Retainer crown porcelain fused to predominantly base metal (, D6752 Retainer crown porcelain fused to noble metal (, D6780 Retainer crown 3/4 cast high noble metal (, D6781 Retainer crown 3/4 cast predominantly base metal (, D6782 Retainer crown 3/4 cast noble metal (, D6783 Retainer crown 3/4 porcelain/ceramic (, D6790 Retainer crown full cast high noble metal (, D6791 Retainer crown full cast predominately base metal (, D6792 Retainer crown full cast noble metal (, D0160 Detailed and extensive oral evaluation problem focused, by report(, D9215 Local anesthesia in conjunction with operative or surgical procedures, D9610 Therapeutic drug injection, single administration, D9612 Therapeutic parenteral drugs, two or more administrations, different medications.

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