It all depends on your policy. You'll also pay a deductible of $233. SurgeryPlus offers surgical procedures that are covered under the State Group Health Insurance Program, but is different from your health insurance plan because the healthcare services are bundled together. 273 0 obj
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The State Employee Benefits Committee (SEBC) believes in providing high quality care to members at an affordable cost. For example, if youre still working and covered by your employer or your spouses employer sponsored health coverage, you may be able to wait. It also doesnt cover help for whats called activities of daily living, like bathing, getting dressed, using the toilet, eating or moving from place to place within your home.9. This website and phone number are for use by dental professionals only. The amount of benefits payable by MetLife may be reduced due to the benefits paid under the primary plan. 0000006640 00000 n
Call a Care Advocate at 833.709.2444 for more information. 0000016018 00000 n
Coverage includes access to our network of excellent surgeons, consults and appointments with your SurgeryPlus provider, anesthesia, the procedure and facility (hospital) fees. Medicare pays 80% of the cost of traditional cataract surgery, which would be covered by Medicare Part B. If it contains a form, you can print it and fill it out. Contact us or connect with customer service by calling the number on your health plan ID card to ask for a copy in the language you need. You earn the reward once the following occurs: The reward will then be credited to the savings and spending account of your choice. The primary result of . 0000004536 00000 n
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Savings from enrolling in a dental benefits plan will depend on various factors, including how often members visit participating dentists and the cost for services rendered. Medicare won't cover Lasik surgery just to avoid the need for glasses. Wearing a Suit After a Body-Altering Surgery. 0000014251 00000 n
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Updated 08/29/2019 . Malini Ghoshal, What You Need to Know About Medicare Prescription Drug Plans (Part D), Healthline, last accessed June 10, 2022. Your costs in Original Medicare For surgeries or procedures, it's hard to know the exact costs in advance. xref
search a list of these participating dentists online, https://www.metlife.com/support-and-manage/forms-library/, One fluoride treatment per 12-month period for dependent children up to their 14th birthday, Total number of periodontal maintenance treatments and prophylaxis cannot exceed two treatments in a calendar year, For dependent children up to 14th birthday, once per lifetime per tooth area, One application of sealant material every 60 months for each non-restored, non-decayed 1st and 2nd molar of a dependent child up to their 16th birthday, Crown, Denture, and Bridge Repair / Recementations, Initial placement to replace one or more natural teeth, which are lost while covered by the plan, Root canal treatment limited to once per tooth per lifetime, When dentally necessary in connection with oral surgery, extractions or other covered dental services, Except as mentioned elsewhere in certificate, Periodontal scaling and root planning once per quadrant, every 24 months, Your Children, up to age 19, are covered while Dental Insurance is in effect. The requirements needed for surgery, including any pre-operative tests, screenings, evaluations, and post-operative care will continue to be covered under your Aetna or Highmark Delaware non-Medicare health plan. <>/Filter/FlateDecode/ID[<4A8EC73074B5B2110A00B0B8D090FC7F>]/Index[988 109]/Info 987 0 R/Length 162/Prev 206109/Root 989 0 R/Size 1097/Type/XRef/W[1 3 1]>>stream
endobj Looser styling flatters while cleverly camouflaging around your middle. This guide will explain the different types of . Continuous Glucose Monitors (CGMs)examples include Dexcom and Libre. Because its all in the same format, its easier to make apples-to-apples comparisons when youre deciding which plan is best for you. You consent to receiving palliative care to make you comfortable versus care to try to cure your illness. Pre-/postnatal professional care: 35% of our allowance . 0000018849 00000 n
Whats especially helpful is that every health plan has to use the same outline to show the costs and coverage for each of the plans they offer. For people 65+ or those under 65 who qualify due to a disability or special situation, For people who qualify for both Medicaid and Medicare, Individual & family plans short term, dental & more, Individual & family plans - Marketplace (ACA). Wearing a swimsuit after a mastectomy can be a transition. International dental travel assistance services are administered by AXA Assistance USA, Inc. AXA Assistance is not affiliated with MetLife or any of its affiliates, and the services they provide are separate from the benefits provided by MetLife. Yes. By receiving services through SurgeryPlus, you and your dependents can earn financial rewards. 0
Adjusting to the physical changes post-surgery can be difficult, and finding the right mastectomy bra is one of the most important steps in the process. If you need cataract surgery in both eyes . If the MetLife dental benefit plan is primary, MetLife will pay the full amount of benefits that would normally be available under the plan. Information gathered by our partners will be used for your benefit to help guide you on your path to wellness. Consult your healthcare provider if you have questions or concerns. Membership in the ABN in required to enroll in this plan. When enrolling you may choose to also cover your spouse, domestic partner, and/or children up to age 26. 0000381088 00000 n
Generally, most vision, dental and hearing services are not covered by Medicare Parts A and B. 0000001436 00000 n
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endstream What is Medicare Part C? U.S. Department of Health & Human Services, last accessed June 10, 2022. Only travel arrangements made through your Care Advocate are eligible for coverage under the SurgeryPlus benefit. Your SurgeryPlus benefit will also help pay for necessary travel associated with the covered procedure. Negotiated fees are subject to change. The complete provisions of the plans are set forth in the Plan Documents and Summary Plan Description. Policy number TS 05343606-G (High plan) Although most cosmetic surgery is not covered by insurance, certain operations are typically deemed medically necessary when they're done in conjunction with other medical treatments. Disclaimer SurgeryPlus is separate from your health plan and has its own network of high-quality providers. 866-855-1212 to request a claim form. If you qualify for it, Medicaid, which is administered by states under federal guidelines, may cover nursing home care. Hearing & balance exams, Medicare.gov, last accessed June 10, 2022. This assures State of Delaware Aetna and Highmark Delaware members will have access to surgeons and facilities that meet strict SurgeryPlus credentialing guidelines, leading to the highest quality care possible. Your private health information is just that private. Policy form GPNP99. 0000001036 00000 n
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To connect with SurgeryPlus today, call 833-709-2445. Inpatient (Precertification is required): $350 per admission. endstream
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such as Spine, General Surgery, Genitourinary, Orthopedic, Ear, Nose & Throat, Cardiac, GI, and Pain Management. 0000024943 00000 n
In some cases, your association and/or the plan administrator may incur costs in connection with providing oversight and administrative support for this sponsored plan. 12 Always err on the side of caution! The surgery and any facility costs will be 100% covered under your SurgeryPlus benefit. VSP is not affiliated with Metropolitan Life Insurance Company or its affiliates. To check to see if you may already have SurgeryPlus, begin to type the name of your employer in the space below. coinsurance and/or deductible on PPO plans, or copay on EPO plans). (Based on internal analysis by MetLife. 1. 1096 0 obj You may need to exhaust your personal resources on medical care before you are eligible. When youre making decisions about buying a plan or using your benefits, an SBC can be a useful tool to help you compare costs and understand coverage options. Do your homework. However, Medicare doesnt cover routine hearing exams, hearing aids or fittings.7. In addition, it comes with a concierge service (Care Advocate) and travel benefits. Adjustable straps allow for a better, customized fit. Weight-Loss (Bariatric) Surgery. Hospice care, Medicare.gov, last accessed June 10, 2022. (Portal access Code: surgeryplus). If you are enrolled in a medical option through American (except DFW ConnectedCare) and have a covered surgery coming up, SurgeryPlus will: This is a voluntary benefit available to you if youre enrolled in the Core, Standard, Plus, High Cost Coverage, PPO 80 or PPO 90 medical option. This assures State of Delaware Aetna and Highmark Delaware members will have access to surgeons and facilities that meet strict SurgeryPlus credentialing guidelines, leading to the highest quality care possible. 10739 Deerwood Park Blvd, Suite 200-B Click Register Now to create your profile and start exploring this free service.
0 This Coverage Policy addresses bariatric surgery and procedures for the treatment of morbid obesity. This type of surgery is only used for people who are very overweight and have not been able to lose weight with diet and exercise. These partners are required to comply with all laws protecting privacy. Medically necessary services diagnose and treat health problems. 00k` !" Coordination of benefits provisions in dental benefits plans are a set of rules that are followed when a patient is covered by more than one dental benefits plan. Your general dentist or specialist usually sends MetLife a plan for your care and requests an estimate of benefits. Please fill out the contact form so the right person can be in touch quickly. Text Size Smaler, Make Text Size
Complete and submit the form and well be in touch soon. Coverage will be considered under your out-of-network benefits. Licensed Humana sales agents are available daily, 8a.m. 8 p.m. Gross Receipts Tax
However, this depends on the specific type of surgery you need, your dental plan, and your level of coverage. Many Medicare Advantage plans, however, do include coverage for routine dental, vision and hearing care, including glasses and hearing aids. 2 If you have Medicare Part B primary, your costs for prescription drugs may be lower. You can use the SBC to compare prices, benefits and other health plan options and features that might be important to you. Before undergoing surgery, youll want to be connected with the highest-quality providers and facilities. L0920007743[exp0922][All States][DC,GU,MP,PR,VI] 2020 MSS, Florida office (headquarters) <. (Due to contractual requirements, MetLife is prevented from soliciting certain providers.) Negotiated fees are subject to change. 989 0 obj , begin to type the name of your employer in the space below. Board Certification, Specialty Training Requirements, Procedure Volume Requirements, State Sanctions Check, Medical Malpractice Claims Review, Criminal Background Checks, CMS Quality Requirements (Hospital Only), Monthly Network Monitoring. Outpatient facility care: 35% of our allowance . Yes. An important note: If you want coverage for prescription drugs, you must sign up as soon as youre eligible, unless you have whats called creditable prescription drug coverage elsewhere. Negotiated fees for non-covered services may not apply in all states.). SurgeryPlus negotiates all costs before the surgery, so youll pay a single rate for all associated surgical charges, and any bills will come directly from SurgeryPlus. This symbol denotes a PDF Document. Maybe youve heard the term, Summary of Benefits and Coverage also called SBC. Its often talked about when it comes to choosing health plans and learning about costs. About Us; Staff; Camps; Scuba. Theres a lot of information in an SBC. We cover the most expensive costs associated with your surgery so youll pay less for your procedure. %PDF-1.6
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Also, your doctor will need to certify that you need certain eligible in-home services. Your copays and deductibles will still apply. The Plan Sponsor(s) reserve the right to amend or terminate each plan at any time. You are always free to select the dentist of your choice. 0000019224 00000 n
Some general conditions to receive coverage from United Healthcare requires that you meet the following criteria: Have a body mass index over 40 OR. 1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. References to UnitedHealthcare pertain to each individual company or other UnitedHealthcare affiliated companies. Please fill out the contact form so the right person can be in touch quickly. Members of HumanaVision can receive deeper discounts on LASIK services, especially when using a specific in-network provider. Refer to the customer's benefit plan document for coverage details. At time of enrollment, you will choose how you want to pay. 285 0 obj
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Some links on this page may take you to Humana non-Medicare product or service pages or to a different website. Durable medical equipment (DME) coverage, Medicare.gov, last accessed June 10, 2022. 9l
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This benefit is available to those enrolled in one of the CEBT EPO, PPO or HDHP medical plans. Medicare Advantage plans are provided by private companies with approval from Medicare. The cost of cataract surgery not only depends on the equipment used and the IOL implanted, but on the skill of the surgeon, your overall health, and where you live in the country. 0000378718 00000 n
For the Plus Size Queens. This may include surgery to remove cataracts or after an eye injury. 10 frequently asked questions about Medicare plans, Deductibles for Medicare Part A and Part B. As a member of Humana, you can receive up to 15 percent off standard LASIK pricing (and 5 percent off promotional pricing) at specified in-network providers. We will not exclude payment of benefits for such services if the government plan requires that Dental Insurance under the group policy be paid first; Duplicate prosthetic devices or appliances; Replacement of a lost or stolen appliance, Cast Restoration, or Denture; and. Please note: If you are covered under the State of Delaware Group Health Insurance Plan as secondary, refer to the SurgeryPlus plan document for details on bariatric coverage. This program utilizes the MetLife PDP Plus Network of participating dentists. The effective date of coverage for newly added dependent(s) will depend on when we receive notice and required premium. Or Reach Us at. For procedures requiring inpatient admission or overnight recovery, the travel benefit covers the patient and one companion for a limited amount of time. 1 Sturti / Getty Images Coverage Varies by Insurer Each health plan is different. lbSy For example, breast augmentation for cosmetic reasons isnt covered by Medicare, but reconstructive surgery after a mastectomy is covered.11, Medicare wont cover Lasik surgery just to avoid the need for glasses. Most common oral surgeries are covered, at least in part, by your dental insurance provider. What Part A covers, Medicare.gov, last accessed June 10, 2022. You can obtain an updated procedure charge schedule for your area via fax by dialing 1-800-942-0854 and using the MetLife Dental Automated Information Service. This surgery makes the stomach smaller. Whats a Summary of Benefits and Coverage? The sharing of health information between these companies is permitted by regulation. State Agencies
Blue Distinction Centers for Substance Use Treatment and Recovery aims to improve patient outcomes and value by focusing on providers across the full continuum of care who deliver and facilitate treatment for substance use disorder, including opioid use disorder. This webpage is provided for summary purposes only and is not a complete description of the plan benefits, limitations, and exclusions. Connect you with a top-ranked, board-certified and fellowship-trained surgeon near you. ii AF! Knowing which types of common medical costs are not covered will be helpful when planning for your out-of-pocket medical costs. Medicare Part B (medical insurance) helps cover the cost of medically necessary durable medical equipment if your doctor prescribes it for use in your home. Our licensed Humana sales agents are available to help you select the coverage that best meets your needs. Remember that Medicare Advantage plans are required by law to offer all the benefits of Original Medicare, but most plans offer much more. Cancellation/Termination of Benefits Services which are not Dentally Necessary, those which do not meet generally accepted standards of care for treating the particular dental condition, or which We deem experimental in nature; Services for which covered person would not be required to pay in the absence of Dental Insurance; Services or supplies received by covered person before the Dental Insurance starts for that person; Services which are primarily cosmetic (for Texas residents, see notice page section in Certificate); Services which are neither performed nor prescribed by a Dentist except for those services of a licensed dental hygienist which are supervised and billed by a Dentist and which are for: Services or appliances which restore or alter occlusion or vertical dimension; Restoration of tooth structure damaged by attrition, abrasion or erosion, unless caused by disease; Restorations or appliances used for the purpose of periodontal splinting; Counseling or instruction about oral hygiene, plaque control, nutrition and tobacco; Personal supplies or devices including, but not limited to: water piks, toothbrushes, or dental floss; Decoration, personalization or inscription of any tooth, device, appliance, crown or other dental work; covered under any workers compensation or occupational disease law; covered under any employer liability law; for which the Policyholder of the person receiving such services is not required to pay; or. There are thousands of PDP Plus Network general dentists and specialists to choose from nationwide so you are sure to find one who meets your needs. Please Note: Additional information about this benefit change will be posted as it becomes available and before the July 1, 2023 effective date. Heres a step-by-step look at what information is in an SBC: You can request a copy of an SBC anytime. 125 0 obj
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Will Medicare Cover LASIK Eye Surgery? Medicare.org, last accessed June 10, 2022. Mon-Fri, 8:30am-5:00pm (CT). Consistent with federal law effective 1/1/98, the Cigna national maternity policy includes coverage for 48 hours of hospitalization following a normal vaginal delivery and 96 hours following an uncomplicated Caesarean section. Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. You can use the Glossary of Health Coverage and Medical Terms, also called a Uniform Glossary to get clear, simple answers about what terms mean. Examples of procedures covered are hernia repair, hysterectomy, colonoscopy, tendon release, spine injections and fusions, knee replacements, and many more. Reconstructive Procedures include surgery or other procedures which are related to a health condition. We strongly encourage and seek out a workforce representative of Delaware including race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression. <> By packaging surgical expenses into one simple, bundled rate, SurgeryPlus is able save money for you and the State of Florida. However, some UnitedHealthcare policies charge lower deductibles . 0000001609 00000 n
Out-of-pocket costs may be greater if you visit a dentist who does not participate in the network. hb``P```e```5c@L@q EP0 Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. Effective July 1, 2023, all bariatric surgeries will be required to be completed through the SurgeryPlus benefit and performed by a surgeon in the SurgeryPlus network. This exclusion does not apply to residents of New Mexico This exclusion does not apply to residents of Minnesota; Orthodontic services or appliances (APPLIES TO LOW PPO OPTION ONLY); Repair or replacement of an orthodontic device; Services, to the extent such services, or benefits for such services, are available under a government plan. With our nationwide network of top surgeons, our Care Advocates help you find an excellent provider as close to home as possible who is highly experienced in the specific procedure you need. This is because you won't know what services you need until you meet with your provider. . . There is a long list of items covered, including: Before renting or purchasing any medical equipment, be sure to ask if the retailer or supplier participates in Medicare. Rates are subject to change and depend on geographic area. Expand your practice We route you incremental cases outside the typical radius of your practice. There are no simple answers, but you can start here to find general answers to some of the most common questions about Medicare coverage. trailer
"_P^)J^:+&!nI-eMNYrVY;QU&+,SUdTVvSN(GTDS o5q_H\%lqbF$M2Q::=x?c}Efl 2"PwyOP# 3V&$b$E7TXI!"?k* NZOLizJT5A7a Xk56C*I~EOv {)Z` YFJ#i'O>4@6.\7=dBkwR)K@kJ^.|xs-v(\irQJhpQ-[":wwT%9KBU2hNU^ 6/En!`}#Yrud9,/R Yes. Once your policy takes effect, you can still add or remove dependents to your coverage once per year on the group plan anniversary date of Jan 1 or if you have a qualifying event such as marriage, divorce, birth of a child, and spouses termination of employment. Rest easy knowing you can afford the surgery you need, HDHP Plans will require a reduced deductible to be met first. You can search a list of these participating dentists online or call 1-800-942-0854 to have a list faxed or mailed to you. Consult your doctor before beginning any new diet or exercise regimen. Medicare pays $781, and your cost is $195. SurgeryPlus Care Advocates are your connection to the SurgeryPlus benefit. 0000009101 00000 n
Some examples of comorbidities include high blood pressure, high cholesterol, obstructive sleep apnea, Type II Diabetes, angina or stroke. Negotiated fees may extend to services not covered under your plan and services received after your plan maximum has been met, where permitted by applicable state law. Have a body mass index over 35 with severe comorbidity. startxref
Cities & Towns
Take some time to understand your Medicare plan. Learn more aboutsavings and spending accounts. Dentists may submit your claims for you which means you have little or no paperwork. SurgeryPlus offers a variety of medical procedures, including the following: Terms and Conditions | Privacy Statement | Accessibility Statement | Sitemap, Monthly Webinars / Educational YouTube Videos, Making plan changes with a Qualifying Status Change (QSC) Event. Through international dental travel assistance services* you can obtain a referral to a local dentist by calling +1-312-356-5970 (collect) when outside the U.S. to receive immediate care until you can see your dentist. Its also possible to get an SBC in another language. Benefits are subject to change upon agreement between Metropolitan Life Insurance Company and the participating organization. SurgeryPlus is a supplemental benefit for non-emergency surgeries that provides high-quality care, Business First Steps, Phone Directory
This benefit is available to those enrolled in one of the CEBT EPO, PPO or HDHP medical plans. What's not covered by Part A & Part B? Medicare.gov, last accessed June 10, 2022. h`06NH+500 Local Coverage Determinations (LCDs)/Local Coverage Article (LCAs) exist and compliance with these policies is required where applicable. Or Reach Us at 855-200-2099 " *" indicates required fields 555 17th Street, Suite 2050 | Denver, CO 80202, 2023 CEBT :: CEBT is administered by WTW, When you use SurgeryPlus, CEBT will potentially waive your Out-of-Pocket costs (i.e. Through the planning process, you will work with the same Care Advocate. You can also go through the SurgeryPlus member portal. endobj All health plan companies are required to provide an SBC for each of their different plans. Outpatient: 15% of our allowance . 0000015806 00000 n
If you and your dentist have agreed on a treatment that is more costly than the treatment upon which the plan benefit is based, you will be responsible for any additional payment responsibility. You sign a consent form to receive hospice care instead of other Medicare-covered treatments for your terminal condition. The inclusion of a code does not imply any right to . It has less visits to physical, speech and occupational therapies than HIP Plus. On average, cataract surgery costs about $5,000 per eye; however, in some places, this price can move up to over $10,000. The SurgeryPlus Difference We allow you to focus on practicing medicine and caring for patients. Assign you a personal care coordinator to offer one-on-one guidance and support as you prepare for, undergo and recover from surgery. Delaware Marketplace
POWER Up to HIP Plus! Medicare Part B may cover diagnostic hearing and balance examstests your doctor requires if you need medical treatment. But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary. Arrives by Mon, Mar 13 Buy Samickarr Clearance items!Wireless Support Bras For Women Full Coverage And Lift Plus Size Bras Post-Surgery Bra Wirefree Bralette Minimizer Bra For Everyday Comfort at Walmart.com Medicare Part A does cover care provided in a skilled nursing facility with certain conditions and time limitations. You pay 20% of the Medicare Part B copay plus any out-of-pocket costs such as your deductible, medication costs and physician fees. 0000010311 00000 n
The State of Delaware is an Equal Opportunity employer and values a diverse workforce. Know your options. What happens with my health information? 0000023776 00000 n
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Receiving care and earning rewards through SurgeryPlus, Contact a SurgeryPlus Care Advocate at 844-752-6170 to start the conversation about what services you need and let them guide you through the process or visit Florida.SurgeryPlus.com to learn more. SurgeryPlus is included in your medical benefits at no additional cost to you. %%EOF Franchise Tax
Individuals enrolled in a State of Delaware Aetna or Highmark Delaware non-Medicare health plan are automatically enrolled in this FREE benefit. If you need a claim form, visit https://www.metlife.com/support-and-manage/forms-library/ or request one by calling 1-800-942-0854. 250 0 obj
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You can track your claims online and even receive e-mail alerts when a claim has been processed. Coverage terminates when your membership ceases, insurance ceases for your class, when your dental contributions cease or upon termination of the group policy by the Policyholder or MetLife. NCD for Bariatric Surgery for Treatment of Co-Morbid Conditions Related to Morbid Obesity (100.1) and NCD for Surgery for Diabetes (100.14) for coverage guideline. Thats because its basically a document that outlines whats covered and not covered under a health plan. Medicare will not pay for 24-hour in-home care or meals delivered to you at home. You can ask for a pretreatment estimate. Group dental insurance policies featuring the Preferred Dentist Program are underwritten by Metropolitan Life Insurance Company, New York, NY 10166. Coverage may not be available in all states. Trust in our network 0
SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. We cover the most expensive costs associated with your surgery so you'll pay less for your procedure. 7500 Rialto Blvd, Building 1 Suite 250 Actual payments may vary from the pretreatment estimate depending upon annual maximums, plan frequency limits, deductibles and other limits applicable at time of payment. "L
@Zd X$9RAC~yGz3)fjaPk !e E57 Hln8 ``:w0@6Cfmu ] This website provides an overview of your benefit options. Privacy Policy
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