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Humana Dental PPO Limitations, Frequencies, Exclusions and Missing Tooth Clause

Humana Dental PPO Limitations, Frequencies, Exclusions and Missing Tooth Clause

Do you struggle to understand your dental insurance policy? If so you are not alone. The many rules and regulations regarding coverage can be confusing. Sunnyvale Dentist Dr. Bhawna Gupta and the staff at Sunnyvale Dental Care have over 22 years of experience reading coverage information and explanations of benefits for multiple insurance policies including those administered by Humana Dental PPO insurance. Many patients at Sunnyvale Dental Care have this type of coverage.

Humana Dental PPO insurance will cover its members up to their annual maximum dollar amount. This amount will differ amongst individual policies. Most insurance companies including Humana Dental PPO have rules of how this money can be spent. These rules can be referred to as limitations, frequencies, exclusions and missing tooth clause. Sunnyvale Dentist Dr. Bhawna Gupta wants to make sure his patients understand these rules.


Some people really enjoy the feeling of teeth that have been professionally cleaned. Can they use all of their annual dental insurance benefits on frequent cleanings? No. Humana Dental PPO insurance plans limit how often cleanings can be done. The frequency limit is normally twice per year or every six months. Most dental procedures have frequency limitations that apply.


Many dentists would agree that dental implants are an ideal way to replace missing teeth. Not all, but some insurance companies exclude this type of treatment. Why? This may be because there are other less expensive options available. Occlusal guards or night guards are also commonly excluded from some dental insurance policies.

Missing Tooth Clause

Options to replace missing teeth include full dentures, partial dentures, fixed bridges, and implants. If an insurance policy has a missing tooth clause, the replacement of a tooth or teeth lost prior to the policy start date would not be a covered expense. Not every insurance policy has this clause, but it is important to know if it does.

The only way to know the rules and regulations of your insurance policy is to request eligibility information and a breakdown of benefits directly from Humana Dental PPO insurance. Sunnyvale Dentist Dr. Bhawna Gupta will have his staff request this information for you. Please contact Sunnyvale Dental Care to learn more about your insurance coverage and to schedule your appointment.

Learn more when you visit Sunnyvale Dental Care. Call Sunnyvale Dentist Dr. Bhawna Gupta at 408-720-0900 to schedule a consultation today!

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