Refer a dentist

If you are a member of a HumanaDental PPO or Traditional Preferred plan, you can save on your out-of-pocket costs by visiting a dentist who participates in the HumanaDental PPO Network.

Is your dentist missing from our network?
We don’t want you to have to choose between continuing to see your dentist and receiving the best possible value from your dental benefit plan. You can help us get your dentist on our participation list.

Simply complete the information below. We’ll invite your dentist to participate in the HumanaDental PPO Network. If your dentist joins, you’ll be sure to save!

Please note: If the dentist you would like to refer is in Georgia, please access the nomination form.

*Required information

Dentist information

*Dentist name:
*Dental specialty:
Dentist address:
*City:
*State:
Zip:

Your information

*Email Address:
*Patient name:
Employee name: (if different)
*Employer name:
*Employer’s city:
*Employer’s state:
My name can be used when contacting my dentist:
	Yes No