What Part A covers, Medicare.gov, last accessed June 10, 2022. How can we make this page better for you? Every SBC is created with four double-sided pages and 12-point type. To check to see if you may already have SurgeryPlus, begin to type the name of your employer in the space below. Learn more about the ABN. 0000015930 00000 n So you may be responsible for any difference in cost between the dentists fee and your plans benefit payment. There are no simple answers, but you can start here to find general answers to some of the most common questions about Medicare coverage. You consent to receiving palliative care to make you comfortable versus care to try to cure your illness. You'll be more confident on the beach with an extensive selection of plus-size swimwear. Negotiated fees are subject to change. For procedures requiring inpatient admission or overnight recovery, the travel benefit covers the patient and one companion for a limited amount of time. Your copays and deductibles will still apply. 0000015692 00000 n (Negotiated fees are subject to change.). 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. You can also go through the SurgeryPlus member portal. Fair and simple terms We pay a fair, transparent rate for cases and streamline reimbursement, decreasing your administrative burden. 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. Group dental insurance policies featuring the Preferred Dentist Program are underwritten by Metropolitan Life Insurance Company, New York, NY 10166. 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. Most plans cover the entire cost of preventive care, plus a portion of the cost after you meet your deductible for other procedures. Home. Plan benefits and rates are effective for group plan year January 1, 2023 through December 31, 2024, and subject to change thereafter. You sign a consent form to receive hospice care instead of other Medicare-covered treatments for your terminal condition. 12 Always err on the side of caution! Rates are subject to change and depend on geographic area. Policy number TS 05343606-G (High plan) Policy number 5343606-1-G (Low plan) Metropolitan Life Insurance Company, 200 Park Avenue, New York, NY 10166. Your private health information is just that private. All rights reserved. 1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. 866-855-1212. Remember that Medicare Advantage plans are required by law to offer all the benefits of Original Medicare, but most plans offer much more. Please use this access code on website: surgeryplus. Delaware Marketplace hbbd```b``+@$}D Arrives by Mon, Mar 13 Buy Samickarr Clearance items!Wireless Support Bras For Women Full Coverage And Lift Plus Size Bras Post-Surgery Bra Wirefree Bralette Minimizer Bra For Everyday Comfort at Walmart.com To provide and maintain this valuable membership benefit, MetLife reimburses the association and/or the plan administrator for these costs. If the MetLife dental benefit plan is primary, MetLife will pay the full amount of benefits that would normally be available under the plan. Visit ESPN for the game videos of the Brooklyn Nets vs. Boston Celtics NBA basketball game on March 3, 2023 Enter your ZIP code below to see plans with their premiums, copays, and participating doctors and pharmacies. Will Medicare Cover LASIK Eye Surgery? Medicare.org, last accessed June 10, 2022. However, this depends on the specific type of surgery you need, your dental plan, and your level of coverage. Connect you with a top-ranked, board-certified and fellowship-trained surgeon near you. It is not to be used for medical advice, diagnosis or treatment. Outpatient facility care: 35% of our allowance . You can search a list of these participating dentists online or call 1-800-942-0854 to have a list faxed or mailed to you. This symbol denotes a PDF Document. ic+C@nN`RYva@\}KRr>Wq8=Rw+{a .n!LF40d=DdcB42r7hRXyMQ"wDYfuwO se)D+jd7bLB,2}a'_UOaB:.bwRIQGp)` aHeO\@qPtn#u,{n{@|=V<^N}Ap2,+H>0$_ -C Effective July 1, 2023, bariatric surgery coverage will be available exclusively through the SurgeryPlus benefit. Inpatient hospital: $450 per admission copay for unlimited days, plus 35% of our allowance. The inclusion of a code does not imply any right to . Medicare will only provide coverage through suppliers who participate in the Medicare program.10, Services that are not considered medically necessary are generally not covered by Medicare Part A or Part B. Coverage is provided under a group insurance policy (Policy form GPNP99) issued by MetLife. Privacy Policy Rest easy knowing you can afford the surgery you need, HDHP Plans will require a reduced deductible to be met first. All health plan companies are required to provide an SBC for each of their different plans. Filing a health insurance claim is simple and can be done in one of two ways. All services defined in your group dental benefits plan certificate are covered. You earn the reward once the following occurs: The reward will then be credited to the savings and spending account of your choice. You are always free to select the dentist of your choice. Mobile Apps It does not cover bariatric surgery or jaw care (TMJ). Individuals enrolled in a State of Delaware Aetna or Highmark Delaware non-Medicare health plan are automatically enrolled in this FREE benefit. 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. This symbol denotes a Web Page. The following services that are in progress while coverage is in effect will be paid after the coverage ends, if the applicable installment or the treatment is finished within 31 days after individual termination of coverage: Completion of a prosthetic device, crown or root canal therapy. This website and phone number are for use by dental professionals only. But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary. hbbbd`b`` K 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. Members will pay nothing out of pocket for bariatric surgery; however, financial incentives do not apply. You can also go through the SurgeryPlus member portal. 10739 Deerwood Park Blvd, Suite 200-B 0000014251 00000 n Outpatient: 15% of our allowance . 7500 Rialto Blvd, Building 1 Suite 250 Each company is a separate entity and is not responsible for another's financial or contractual obligations. Delaware State Code Yes. 1. TE 6Uz A$& &`5= X7"yH: wd`^+H(`q] DF9qt 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. 1 Sturti / Getty Images Coverage Varies by Insurer Each health plan is different. SurgeryPlus is included in your medical benefits at no additional cost to you. When it comes to Medicare, the question we hear most often after What does it cost? is, What does it cover?. You and your dentist will each receive an Explanation of Benefits (EOB) outlining the services provided, your plans reimbursement for those services, and your out-of-pocket expense. 0000377893 00000 n Generally, Medicare Part B covers cataract surgery because it's usually performed in an outpatient clinic, and most people won't require a hospital stay afterward. If your current dentist does not participate in the network and you would like to encourage him or her to apply, ask your dentist to visit www.metdental.com, or call 1-866-PDP-NTWK for an application. These rules determine the order in which the plans will pay benefits. Confirm your coverage before you commit to a procedure youre unsure about. When you already have a health plan, youll get an SBC automatically at certain times: Even though an SBC is made to make it easier to understand health plan information, sometimes the terms in them can be confusing. Weight-Loss (Bariatric) Surgery. Facilitate and consolidate your payments. You may enroll for membership in the ABN directly through the ABN website or during your dental enrollment. 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. endstream endobj 90 0 obj <>/Metadata 3 0 R/OpenAction 91 0 R/Pages 2 0 R/StructTreeRoot 5 0 R/Type/Catalog/ViewerPreferences<>>> endobj 91 0 obj <> endobj 92 0 obj >/PageTransformationMatrixList<0[1.0 0.0 0.0 1.0 0.0 -396.0]>>/PageUIDList<0 878>>/PageWidthList<0 612.0>>>>>>/Resources<>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 93 0 obj <> endobj 94 0 obj <> endobj 95 0 obj [/Indexed/DeviceRGB 250 104 0 R] endobj 96 0 obj <>stream Benefits are subject to change upon agreement between Metropolitan Life Insurance Company and the participating organization. Your medical insurance may also pick up the cost in full or part for medically-related . Prescription drug planscalled Medicare Part Dare only available through private companies like Humana. To see if your procedure is covered, contact us. Dentists may submit your claims for you which means you have little or no paperwork. A prime example is breast implants done during or after breast cancer surgery. <> For specific LCDs/LCAs, refer to the table for L0920007743[exp0922][All States][DC,GU,MP,PR,VI] 2020 MSS, Florida office (headquarters) Other services not covered by Medicare Parts A and B include:4, Medicare Part C is also known as Medicare Advantage. Take some time to understand your Medicare plan. 1096 0 obj %PDF-1.4 % Complete and submit the form and well be in touch soon. The State of Delaware is an Equal Opportunity employer and values a diverse workforce. A dental plan may cover routine office visits, fillings, crowns, root canals, oral surgery, periodontics, orthodontics, or bridges and dentures. You may choose to share the information with your doctor and other medical professionals. Updated 08/29/2019 . 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. (Due to contractual requirements, MetLife is prevented from soliciting certain providers.) "Original Medicare may cover 80% of a traditional cataract surgery. SurgeryPlus negotiates a single cost (bundled rate) for the entire surgical procedure, resulting in savings to the State of Delaware. %PDF-1.6 % Surgical Coverage Surgery Surgery Medicare covers many medically necessary surgical procedures. 2 If you have Medicare Part B primary, your costs for prescription drugs may be lower. Medicare covers hospice care if the following conditions are met: Medicare does help cover some in-home health services, including: To be eligible, you must be under the care of a doctor and treated under a plan of care that is monitored and reviewed by your doctor. "L @Zd X$9RAC~yGz3)fjaPk !e E57 Hln8 ``:w0@6Cfmu ] If permitted, you may only be responsible for the negotiated fee. %%EOF 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. Always err on the side of caution! Your costs in Original Medicare For surgeries or procedures, it's hard to know the exact costs in advance. By packaging surgical expenses into one simple, bundled rate, SurgeryPlus is able save money for you and the State of Florida. These plans include all your Part A and Part B coverage and often provide extra coverage for services not included in Original Medicare. Some links on this page may take you to Humana non-Medicare product or service pages or to a different website. Even though its meant to make the information easier to understand, it can seem like a lot at first. such as Spine, General Surgery, Genitourinary, Orthopedic, Ear, Nose & Throat, Cardiac, GI, and Pain Management. 0000023776 00000 n Medicare Part B may cover diagnostic hearing and balance examstests your doctor requires if you need medical treatment. A reminder that the SBC is only a summary. %%EOF Pre-/postnatal professional care: 35% of our allowance . Find out which Humana plans include your doctors and cover the medications you take now to help you estimate your costs. Some types of surgery also change the connection between your stomach and intestines. 989 0 obj endstream endobj 97 0 obj <>stream To get all the details, youll want to look at complete health plan documents. The group policy terminates for non-payment of premium and may terminate if participation requirements are not met or if the Policyholder fails to perform any obligations under the policy. The effective date of coverage for newly added dependent(s) will depend on when we receive notice and required premium. Copyright 2023 Member Benefits. 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. Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. endstream Thats because its basically a document that outlines whats covered and not covered under a health plan. 0 The complete provisions of the plans are set forth in the Plan Documents and Summary Plan Description. Procedures can cost from $700 to $2,000 per eye, depending on . %PDF-1.6 % The documentation requirements outlined below are used to assess whether the member meets the clinical criteria for coverage but do not guarantee coverage of the service requested. 125 0 obj <>stream Procedure charge schedules are subject to change each plan year. Members of HumanaVision can receive deeper discounts on LASIK services, especially when using a specific in-network provider. It can include Durable Medical Equipment (DME), mental healthcare or ambulance services.2 Preventive care services are health treatments that prevent illness or detect problems at an early stage, like flu shots or cancer screenings.3, There are some things Original Medicare wont cover. Hospice care, Medicare.gov, last accessed June 10, 2022. <>/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 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. What happens with my health information? Only travel arrangements made through your Care Advocate are eligible for coverage under the SurgeryPlus benefit. 0000018849 00000 n Please refer to your Evidence of Coverage or call Customer Service at the number on the back of your Humana ID card to confirm that the service will be covered by your plan. About Us; Staff; Camps; Scuba. h`06NH+500 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. Also, your doctor will need to certify that you need certain eligible in-home services. lbSy We cover the most expensive costs associated with your surgery so youll pay less for your procedure. Negotiated fees for non-covered services may not apply in all states.). It requires doctors and facilities to meet strict credential guidelines leading to the highest quality care possible. Take your bill (s) to your State Farm agent's office. 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. 0000016018 00000 n They help you find a great doctor for your procedure, schedule your procedure appointments, make travel reservations (if travel is required), transfer your medical records, and coordinate all your surgery bills. You can ask for a pretreatment estimate. 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. 273 0 obj <>/Filter/FlateDecode/ID[<0FC6C6833B2C26439F46B854E028A8C8>]/Index[250 36]/Info 249 0 R/Length 110/Prev 207371/Root 251 0 R/Size 286/Type/XRef/W[1 3 1]>>stream Its also possible to get an SBC in another language. Call a Care Advocate at 833.709.2444 for more information. 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. Please contact Member Benefits your plan administrator at 1-800-282-8626 for more information. Some examples of comorbidities include high blood pressure, high cholesterol, obstructive sleep apnea, Type II Diabetes, angina or stroke. This program utilizes the MetLife PDP Plus Network of participating dentists. <. 0000418667 00000 n This Coverage Policy addresses breast reduction for symptomatic macromastia and breast reduction surgery on Medicare Part B benefits cover 80% of the Medicare-approved amount for cataract surgery. Heres a step-by-step look at what information is in an SBC: You can request a copy of an SBC anytime. SurgeryPlus notifies that you or your dependent earned the reward. 0000024943 00000 n HVn7}Wt)A87HPV$(YXF;3as=sfj'O&y>=zF_Gmlr:v1z5`:A1suhMFY}r0_&o^w]vw%'o':~u>)|]!6nRBki;L}h0y^'#cCmJJc 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. coinsurance and/or deductible on PPO plans, or copay on EPO plans). We recommend that you request a pre-treatment estimate for services in excess of $300. 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. Certain claim and network administration services are provided through Vision Service Plan (VSP), Rancho Cordova, CA. To assist, American Airlines has business relationships with third-party vendors, for example, BCBS, UHC, and WebMD Health Services. Weather & Travel, Contact Us 0000005180 00000 n 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. *Negotiated Fee refers to the fees that participating dentists have agreed to accept as payment in full, subject to any co-payments, deductibles, cost sharing and benefits maximums. Or Reach Us at 855-200-2099 " *" indicates required fields Some general conditions to receive coverage from United Healthcare requires that you meet the following criteria: Have a body mass index over 40 OR. 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. SurgeryPlus is a supplemental benefit for non-emergency surgeries that provides high-quality care, Privacy Policy Learn more aboutsavings and spending accounts. 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. Wearing a Suit After a Body-Altering Surgery. Malini Ghoshal, What You Need to Know About Medicare Prescription Drug Plans (Part D), Healthline, last accessed June 10, 2022. Franchise Tax Benefit coverage for health services is determined by the member specific benefit plan document and applic able laws that may require coverage for a specific service. The sharing of health information between these companies is permitted by regulation. 9l J'X:50e0l`} }U,,Q`lam[5-0f`MVe` Pre-authorization will still need to be submitted by your provider to SurgeryPlus before the surgery is scheduled. 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. Yes. 0000004536 00000 n Does Medicare Cover Pre-existing Conditions? Medicare.com, last accessed June 10, 2022. Mon-Fri, 8:30am-5:00pm (CT). Please Note: Additional information about this benefit change will be posted as it becomes available and before the July 1, 2023 effective date. Membership in the ABN in required to enroll in this plan. It all depends on your policy. This Coverage Policy addresses bariatric surgery and procedures for the treatment of morbid obesity. Please remember to hold on to all receipts to submit a dental claim. 0000000016 00000 n (Based on internal analysis by MetLife. Please fill out the contact form so the right person can be in touch quickly. 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. These partners are required to comply with all laws protecting privacy. Medicare Advantage plans are provided by private companies with approval from Medicare. You can choose whether or not to use SurgeryPlus for your surgical procedures. You can use the SBC to compare prices, benefits and other health plan options and features that might be important to you. Your doctor certifies that you are terminally ill, meaning that your life expectancy is 6 months or less. E-mail / Text Alerts Through the planning process, you will work with the same Care Advocate. 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. Policy number TS 05343606-G (High plan) To get one, contact us. 0000014887 00000 n Overview . Where two or more professionally acceptable dental treatments for a dental condition exist, reimbursement is based on the least costly treatment alternative. Policy form GPNP99 Vision benefits are underwritten by Metropolitan Life Insurance Company, New York, NY (MetLife). You simply need to provide the plan administrator with advanced written notice along with any required premium. The estimate helps you prepare for the cost of dental services. Refer to the customer's benefit plan document for coverage details. Elected Officials This website provides an overview of your benefit options. Withholding Tax The State Employee Benefits Committee (SEBC) believes in providing high quality care to members at an affordable cost. 0000015806 00000 n Text Size Smaler, Make Text Size SurgeryPlus Care Advocates are your connection to the SurgeryPlus benefit. SurgeryPlus Frequently Asked Questions General Questions . 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. endstream endobj 124 0 obj <>/Filter/FlateDecode/Index[5 84]/Length 22/Size 89/Type/XRef/W[1 1 1]>>stream The amount of benefits payable by MetLife may be reduced due to the benefits paid under the primary plan. 0000011564 00000 n To connect with SurgeryPlus today, call 833-709-2445. endobj In . Original Medicare generally covers most pre-existing conditions. 0 SurgeryPlus is separate from your health plan and has its own network of high-quality providers. 1XQg&.9mE#(Tq& 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. Home health services, Medicare.gov, last accessed June 10, 2022. Whats a Summary of Benefits and Coverage? For some conditions, such as end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS), you could be eligible for Medicare before you turn 65.13. We suggest you discuss treatment options with your dentist before services are rendered, and obtain a pre-treatment estimate of benefits prior to receiving certain high cost services such as crowns, bridges or dentures. 0000379543 00000 n 0000019705 00000 n 0000001651 00000 n Coverage will be considered under your out-of-network benefits. Premiums and the list of covered drugscalled a formularywill vary by plan.6. Mastectomy surgery is a significant life event for many people. What is Medicare Part C? U.S. Department of Health & Human Services, last accessed June 10, 2022. Wearing a swimsuit after a mastectomy can be a transition. It has less visits to physical, speech and occupational therapies than HIP Plus. 0000001609 00000 n 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. 0000005131 00000 n For example, rather than paying separately for the surgeon, facility, anesthesiologist, and radiologist, SurgeryPlus negotiates one bundled rate. Knowing which types of common medical costs are not covered will be helpful when planning for your out-of-pocket medical costs. 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. Expand your practice We route you incremental cases outside the typical radius of your practice. Child(ren)s eligibility for dental coverage is from birth up to age 26. , begin to type the name of your employer in the space below. 10 frequently asked questions about Medicare plans, Deductibles for Medicare Part A and Part B. Policy number 5343606-1-G (Low plan), Metropolitan Life Insurance Company, 200 Park Avenue, New York, NY 10166 This is because you won't know what services you need until you meet with your provider. Disclaimer A class is a group of people defined in the group policy. hb```f`` vAX,Xf000Z\ q1=nIc /( Medicare Part A does cover care provided in a skilled nursing facility with certain conditions and time limitations. When enrolling you may choose to also cover your spouse, domestic partner, and/or children up to age 26. State Agencies Savings from enrolling in the MetLife Dental Plan will depend on various factors, including how often participants visit the dentist and the costs for services rendered. hbbd```b``f+A$S$d@$&},L`1]`*z3`] rO o bHHj@&{:.a`$ S Adjustable straps allow for a better, customized fit.
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