This program utilizes the MetLife PDP Plus Network of participating dentists. Hospice care, Medicare.gov, last accessed June 10, 2022. If the MetLife dental benefit plan is primary, MetLife will pay the full amount of benefits that would normally be available under the plan. Wearing a swimsuit after a mastectomy can be a transition. To connect with SurgeryPlus today, call 833-709-2445. 7500 Rialto Blvd, Building 1 Suite 250 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. Medicare pays 80% of the treatment costs, and the beneficiary contributes 20%. 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. 0000004536 00000 n Withholding Tax 0000015806 00000 n What's not covered by Part A & Part B? Medicare.gov, last accessed June 10, 2022. 0000015692 00000 n 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 A dental plan may cover routine office visits, fillings, crowns, root canals, oral surgery, periodontics, orthodontics, or bridges and dentures. <> It all depends on your policy. 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. You may choose to share the information with your doctor and other medical professionals. 0000381088 00000 n Prescription drug planscalled Medicare Part Dare only available through private companies like Humana. 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. Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment. Delaware State Code Overview . Confirm your coverage before you commit to a procedure you're unsure about. startxref startxref The sharing of health information between these companies is permitted by regulation. Call our Health Response Center at. SurgeryPlus Frequently Asked Questions General Questions . To provide and maintain this valuable membership benefit, MetLife reimburses the association and/or the plan administrator for these costs. Cancellation/Termination of Benefits 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. Child(ren)s eligibility for dental coverage is from birth up to age 26. Plan benefits and rates are effective for group plan year January 1, 2023 through December 31, 2024, and subject to change thereafter. Hearing & balance exams, Medicare.gov, last accessed June 10, 2022. 10739 Deerwood Park Blvd, Suite 200-B Many offer affordable or even $0 monthly plan premiums, but you must continue to pay the Medicare Part B premium. You pay 20% of the Medicare Part B copay plus any out-of-pocket costs such as your deductible, medication costs and physician fees. This symbol denotes a PDF Document. Yes. Assign you a personal care coordinator to offer one-on-one guidance and support as you prepare for, undergo and recover from surgery. 0000015930 00000 n Out-of-pocket costs may be greater if you visit a dentist who does not participate in the network. 89 37 <>stream Your SurgeryPlus Care Advocate will provide you one-on-one, personalized help each step of the way. Actual payments may vary from the pretreatment estimate depending upon annual maximums, plan frequency limits, deductibles and other limits applicable at time of payment. Effective July 1, 2023, bariatric surgery coverage will be available exclusively through the SurgeryPlus benefit. About Us; Staff; Camps; Scuba. Delaware Courts When it comes to Medicare, the question we hear most often after What does it cost? is, What does it cover?. <>/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 Alternatively, a Medicare Advantage plan often provides comprehensive vision coverage, plus cataract surgery without out-of-pocket coinsurance costs.". Bigger. 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. The choice is yours. Please review the plan summaries for summarized information and your certificate of insurance for detailed information about your plan benefits. Negotiated fees are subject to change. For example, rather than paying separately for the surgeon, facility, anesthesiologist, and radiologist, SurgeryPlus negotiates one bundled rate. Disclaimer Policy form GPNP99 It is not to be used for medical advice, diagnosis or treatment. This communication does not guarantee benefits and does not indicate all services received will be covered by your plan. Fair and simple terms We pay a fair, transparent rate for cases and streamline reimbursement, decreasing your administrative burden. (Negotiated fees are subject to change.). At time of enrollment, you will choose how you want to pay. This document presents the majority of services within each category, but is not a complete description of the plan. You'll be more confident on the beach with an extensive selection of plus-size swimwear. hbbd```b``+@$}D Take some time to understand your Medicare plan. Knowing which types of common medical costs are not covered will be helpful when planning for your out-of-pocket medical costs. HIP Plus is the plan for the best value.HIP Plus provides health coverage for a low, predictable monthly cost. 0000001036 00000 n 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. Coverage is provided under a group insurance policy (Policy form GPNP99) issued by MetLife. Looser styling flatters while cleverly camouflaging around your middle. Facilitate and consolidate your payments. 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. 0000418667 00000 n Hospital Care. However, Medicare doesnt cover routine hearing exams, hearing aids or fittings.7. If permitted, you may only be responsible for the negotiated fee. 0000019224 00000 n Learn more about COVID-19 and the vaccine from the Division of Public Health, Learn about your benefits and resources for Behavioral Health & Emotional Wellbeing More Info. You earn the reward once the following occurs: The reward will then be credited to the savings and spending account of your choice. Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. HV[kH~GTfJ4C-lKM#si+4swzZ\|P/_^jji>W(W^"SZE~?xerLgibT}gyQtjSFGil2ZZb6#NWM[]uT{:Gk)0 >IZn,:-/855fOneI4nUGqK9G{-hb!E|VXM)65}`OLX|Tb)k``K}L@6%y+ba}f[#e5pr>i:r. These savings are shared with the member through financial incentives and members will not be required to pay a copay, deductible, or coinsurance for services provided through SurgeryPlus. 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. 0000007939 00000 n Your medical insurance may also pick up the cost in full or part for medically-related . 989 0 obj Always err on the side of caution! You can also go through the SurgeryPlus member portal. Privacy Policy %PDF-1.6 % All services defined in your group dental benefits plan certificate are covered. Many Medicare Advantage plans also provide prescription drug coverage (also known as Part D).5, Original Medicare does not include coverage for prescription drugs, but you can buy a stand-alone prescription drug plan to help manage your drug costs. Medicare won't cover Lasik surgery just to avoid the need for glasses. cost of cataract surgery with medicare. 0000000016 00000 n Take your bill (s) to your State Farm agent's office. American Airlines manages employee and retiree health benefits. Thats what SurgeryPlus does. Original Medicare generally covers most pre-existing conditions. 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. Surgical Coverage Surgery Surgery Medicare covers many medically necessary surgical procedures. Eleesha Lockett, Does Medicare Cover Plastic Surgery? Healthline, last accessed June 10, 2022. If the MetLife dental benefit plan is secondary, most coordination of benefits provisions require MetLife to determine benefits after benefits have been determined under the primary plan. He or she hasnt agreed to accept negotiated fees. If it contains a form, you can fill it out online and submit it. A class is a group of people defined in the group policy. Information about where to go online to review and print copies of complete health plan documents, Where to find a list of network providers, Where to find prescription drug coverage information, Where to find a Glossary of Health Coverage and Medical Terms (also called a Uniform Glossary), A statement on whether the plan meets minimum essential coverage (MEC) for the, A statement that it meets minimum value (plan covers at least 60 percent of medical costs of benefits for a population on average), When changes happen within your health plan, Individual & Family ACA Marketplace plans, Heres what a sample SBC looks like (pdf), Glossary of Health Coverage and Medical Terms, Explore the benefits of UnitedHealthcare plans through work, Dual Special Needs Plans (D-SNP) from UnitedHealthcare, When you make a change or are added to a health plan for example if you get married, have a child, or experience another. 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. You sign a consent form to receive hospice care instead of other Medicare-covered treatments for your terminal condition. endstream endobj 124 0 obj <>/Filter/FlateDecode/Index[5 84]/Length 22/Size 89/Type/XRef/W[1 1 1]>>stream These partners are required to comply with all laws protecting privacy. Original Medicare generally doesnt cover the cost of a nursing home, assisted living or long-term care facility. 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. Members will pay nothing out of pocket for bariatric surgery; however, financial incentives do not apply. 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. This program will be available on January 1, 2020. 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. Please use this access code on website: surgeryplus. Jacksonville, FL 32256 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. However, this depends on the specific type of surgery you need, your dental plan, and your level of coverage. 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. 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. 1096 0 obj 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. If it contains a form, you can print it and fill it out. 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. Inpatient (Precertification is required): $350 per admission. (Based on internal analysis by MetLife. What Part A covers, Medicare.gov, last accessed June 10, 2022. Preventive & screening services, Medicare.gov, last accessed June 10, 2022. Coverage Policies are not recommendations for treatment and should never be used as treatment guidelines. However, some UnitedHealthcare policies charge lower deductibles . An estimated cost of cataract surgery may be*: In a surgery center or clinic, the average total cost is $977. Coverage includes access to our network of excellent surgeons, consults and appointments with your SurgeryPlus provider, anesthesia, the procedure and facility (hospital) fees. Inpatient hospital: $450 per admission copay for unlimited days, plus 35% of our allowance. If you need cataract surgery in both eyes . 0000378718 00000 n Policy number 5343606-1-G (Low plan), Metropolitan Life Insurance Company, 200 Park Avenue, New York, NY 10166 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. Negotiated fees typically range from 15-45% below the average fees charged in a dentists community for the same or substantially similar services. Yes. L0920007743[exp0922][All States][DC,GU,MP,PR,VI] 2020 MSS, Florida office (headquarters) E-mail / Text Alerts Rest easy knowing you can afford the surgery you need, HDHP Plans will require a reduced deductible to be met first. Malini Ghoshal, What You Need to Know About Medicare Prescription Drug Plans (Part D), Healthline, last accessed June 10, 2022. An explanation of whats not covered and/or the limits on coverage, Information on costs you might have to pay like deductibles, coinsurance and copayments, Coverage examples, including how coverage works in the case of a pregnancy or a minor injury. Pre-/postnatal professional care: 35% of our allowance . 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. If the information online is inconsistent with the Plan Documents, the Plan Documents will govern. . hb```b``Nf`c`Wcd@ AV(G 2?X%c6g+S@|dHA[&@VS&-,&W\\f9v| **s)S\Ol%5T7A(F 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. It does not cover bariatric surgery or jaw care (TMJ). Local Coverage Determinations (LCDs)/Local Coverage Article (LCAs) exist and compliance with these policies is required where applicable. Generally, most vision, dental and hearing services are not covered by Medicare Parts A and B. The State Employee Benefits Committee (SEBC) believes in providing high quality care to members at an affordable cost. 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. Consult your healthcare provider if you have questions or concerns. Mon-Fri, 8:30am-5:00pm (CT). All rights reserved. You can make monthly payments by monthly bank draft (ACH) or pay for the entire year via credit card payment. The SBC was created to make it easier to compare and shop for health plans. xref Your SurgeryPlus benefit will also help pay for necessary travel associated with the covered procedure. You can use the SBC to compare prices, benefits and other health plan options and features that might be important to you. 0000004000 00000 n (Due to contractual requirements, MetLife is prevented from soliciting certain providers.) This webpage is provided for summary purposes only and is not a complete description of the plan benefits, limitations, and exclusions. Through the planning process, you will work with the same Care Advocate. 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. 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. SurgeryPlus Care Advocates are your connection to the SurgeryPlus benefit. , begin to type the name of your employer in the space below. Metlife will not pay Dental Insurance benefits for charges incurred for: Alternate Benefits Adjustable straps allow for a better, customized fit. local anesthesia, non-intravenous conscious sedation or analgesia such as nitrous oxide; Dental services arising out of accidental injury to the teeth and supporting structures, except for injuries to the teeth due to chewing or biting of food; Initial installation of a fixed and permanent Denture to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth; Other fixed Denture prosthetic services not described elsewhere in the certificate; Precision attachments, except when the precision attachment is related to implant prosthetics; Addition of teeth to a partial removable Denture to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth; Adjustment of a Denture made within 6 months after installation by the same Dentist who installed it; Implants supported prosthetics to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth; Fixed and removable appliances for correction of harmful habits; Appliances or treatment for bruxism (grinding teeth), including but not limited to occlusal guards and night guards; Diagnosis and treatment of temporomandibular joint (TMJ) disorders. hbbbd`b`` K All health plan companies are required to provide an SBC for each of their different plans. This may include surgery to remove cataracts or after an eye injury. Voting & Elections 0000005131 00000 n 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. You can choose whether or not to use SurgeryPlus for your surgical procedures. 0000001266 00000 n Elected Officials Read your certificate of insurance for details on plan benefits, limitations, and exclusions. So you may be responsible for any difference in cost between the dentists fee and your plans benefit payment. Yes. 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. 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 Scuba Certification; Private Scuba Lessons; Scuba Refresher for Certified Divers; Try Scuba Diving; Enriched Air Diver (Nitrox) This information is provided for educational purposes only. State Regulations The State of Delaware is an Equal Opportunity employer and values a diverse workforce. %%EOF 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. Gross Receipts Tax 0000016018 00000 n 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. In addition, it comes with a concierge service (Care Advocate) and travel benefits. 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. Some examples of comorbidities include high blood pressure, high cholesterol, obstructive sleep apnea, Type II Diabetes, angina or stroke. Home health services, Medicare.gov, last accessed June 10, 2022. Refer to the customer's benefit plan document for coverage details. Delaware's Governor This benefit is available to those enrolled in one of the CEBT EPO, PPO or HDHP medical plans. endstream endobj 97 0 obj <>stream For procedures requiring inpatient admission or overnight recovery, the travel benefit covers the patient and one companion for a limited amount of time. Examples of procedures covered are hernia repair, hysterectomy, colonoscopy, tendon release, spine injections and fusions, knee replacements, and many more. Yes. Policy form GPNP99. Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. We cover the most expensive costs associated with your surgery so youll pay less for your procedure. What is Medicare Part C? U.S. Department of Health & Human Services, last accessed June 10, 2022. 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. 89 0 obj <> endobj 0000019705 00000 n Continuous Glucose Monitors (CGMs)examples include Dexcom and Libre. SurgeryPlus is a supplemental benefit for non-emergency surgeries that provides high-quality care, 0000025231 00000 n hb``P```e```5c@L@q EP0 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. When enrolling you may choose to also cover your spouse, domestic partner, and/or children up to age 26. Mobile Apps %PDF-1.6 % Learn more about the ABN. The surgery and any facility costs will be 100% covered under your SurgeryPlus benefit. But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary.12. SurgeryPlus provides an alternative to using your health plan for a planned surgical procedure that is not an emergency. These plans include all your Part A and Part B coverage and often provide extra coverage for services not included in Original Medicare. SurgeryPlus is a voluntary benefit that provides pre-planned, non-emergency surgical services. 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. Please Note: Additional information about this benefit change will be posted as it becomes available and before the July 1, 2023 effective date. References to UnitedHealthcare pertain to each individual company or other UnitedHealthcare affiliated companies. What is the SurgeryPlus benefit? Licensed Humana sales agents are available daily, 8a.m. 8 p.m. This guide will explain the different types of . Simply have your dentist submit a request online at www.metdental.com or call 1-877-MET-DDS9. Complete and submit the form and well be in touch soon. Tax Center 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. Franchise Tax 0000392965 00000 n Premiums and the list of covered drugscalled a formularywill vary by plan.6. Rates are subject to change and depend on geographic area. Your copays and deductibles will still apply. Membership in the ABN in required to enroll in this plan. Delaware Topics However, if you choose a non-participating dentist, your out-of-pocket costs may be higher. You can also go through the SurgeryPlus member portal. Medicare Advantage plans may offer coverage for vision, hearing, dental and wellness services. Our licensed Humana sales agents are available to help you select the coverage that best meets your needs.

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