contact your PCP or refer to the Evidence of Coverage (EOC) for services that require aprior authorization from the 
plan .
c
10 Summary of Benefits H5216324000SB23 H5216324000 
Covered Medical and Hospital Benefits  (cont.) 
IN-NETWORK OUT-OF-NETWORK 
amount greater than the  
payment made by Humana to  
the provider.  
Use the HumanaDental Medicare  
network for the Mandatory  
Supplemental Dental. The  
provider locator can be found at  
Humana.com >Find aDoctor >  
from the Search Type drop down