The time a mother and baby spend in the hospital after delivery is a medical decision. 0000010311 00000 n 0000014251 00000 n Click Register Now to create your profile and start exploring this free service. You can use the SBC to compare prices, benefits and other health plan options and features that might be important to you. 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. Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, reductions, limitations, waiting periods and terms for keeping them in force. Prescription drug planscalled Medicare Part Dare only available through private companies like Humana. 0000379543 00000 n Hospital Care. Medically necessary services diagnose and treat health problems. For the Plus Size Queens. To see if your procedure is covered, contact us. ii AF! Hospice care, Medicare.gov, last accessed June 10, 2022. 0000377893 00000 n Help Center Procedure charge schedules are subject to change each plan year. Certain claim and network administration services are provided through Vision Service Plan (VSP), Rancho Cordova, CA. Yes. 10 frequently asked questions about Medicare plans, Deductibles for Medicare Part A and Part B. (Based on internal analysis by MetLife. Cities & Towns Always err on the side of caution! Austin, TX 78735 xref 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. However, if you choose a non-participating dentist, your out-of-pocket costs may be higher. trailer Jacksonville, FL 32256 Policy number TS 05343606-G (High plan) About SurgeryPlus SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. 989 0 obj 0000009101 00000 n All health plan companies are required to provide an SBC for each of their different plans. Delaware State Code In addition, it comes with a concierge service (Care Advocate) and travel benefits. SurgeryPlus is included in your medical benefits at no additional cost to you. Medicare pays 80% of the cost of traditional cataract surgery, which would be covered by Medicare Part B. VSP is not affiliated with Metropolitan Life Insurance Company or its affiliates. Looser styling flatters while cleverly camouflaging around your middle. Transparency A prime example is breast implants done during or after breast cancer surgery. These plans include all your Part A and Part B coverage and often provide extra coverage for services not included in Original Medicare. HIP Plus is the plan for the best value.HIP Plus provides health coverage for a low, predictable monthly cost. SurgeryPlus Care Advocates are your connection to the SurgeryPlus benefit. Your general dentist or specialist usually sends MetLife a plan for your care and requests an estimate of benefits. If the MetLife dental benefit plan is primary, MetLife will pay the full amount of benefits that would normally be available under the plan. 988 0 obj 0000019705 00000 n 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). Complete and submit the form and well be in touch soon. If the information online is inconsistent with the Plan Documents, the Plan Documents will govern. Original Medicare generally covers most pre-existing conditions. (Portal access Code: surgeryplus). SurgeryPlus notifies that you or your dependent earned the reward. hb```b``Nf`c`Wcd@ AV(G 2?X%c6g+S@|dHA[&@VS&-,&W\\f9v| **s)S\Ol%5T7A(F Medicare pays 80% of the treatment costs, and the beneficiary contributes 20%. startxref Or Reach Us at. This benefit is available to those enrolled in one of the CEBT EPO, PPO or HDHP medical plans. endstream What is Medicare Part C? U.S. Department of Health & Human Services, last accessed June 10, 2022. 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. 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. What Part B covers, Medicare.gov, last accessed June 10, 2022. We cover the most expensive costs associated with your surgery so you'll pay less for your procedure. Locations Directory We recommend that you request a pre-treatment estimate for services in excess of $300. 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. Tax Center 12 Always err on the side of caution! Personal Income Tax 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. Your SurgeryPlus benefit will also help pay for necessary travel associated with the covered procedure. Actual payments may vary from the pretreatment estimate depending upon annual maximums, plan frequency limits, deductibles and other limits applicable at time of payment. 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. hbbbd`b`` K If you need cataract surgery in both eyes . For specific LCDs/LCAs, refer to the table for All rights reserved. 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. Out-of-pocket costs may be greater if you visit a dentist who does not participate in the network. 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. These partners are required to comply with all laws protecting privacy. Do your homework. SurgeryPlus is a voluntary benefit that provides pre-planned, non-emergency surgical services. Even though its meant to make the information easier to understand, it can seem like a lot at first. 0000024262 00000 n 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. Consult your doctor before beginning any new diet or exercise regimen. Inpatient hospital: $450 per admission copay for unlimited days, plus 35% of our allowance. You are always free to select the dentist of your choice. The effective date of coverage for newly added dependent(s) will depend on when we receive notice and required premium. Mobile Apps 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 Coverage Policy addresses breast reduction for symptomatic macromastia and breast reduction surgery on Policy number 5343606-1-G (Low plan), Metropolitan Life Insurance Company, 200 Park Avenue, New York, NY 10166 Simply have your dentist submit a request online at www.metdental.com or call 1-877-MET-DDS9. This communication does not guarantee benefits and does not indicate all services received will be covered by your plan. 0000015806 00000 n It all depends on your policy. To connect with SurgeryPlus today, call 833-709-2445. POWER Up to HIP Plus! Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. Original Medicare generally doesnt cover the cost of a nursing home, assisted living or long-term care facility. 0000014887 00000 n 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. 0000001436 00000 n endobj Negotiated fees are subject to change. Copyright 2023 Member Benefits. . For procedures requiring inpatient admission or overnight recovery, the travel benefit covers the patient and one companion for a limited amount of time. 0000024943 00000 n This symbol denotes a PDF Document. By packaging surgical expenses into one simple, bundled rate, SurgeryPlus is able save money for you and the State of Florida. Thats because its basically a document that outlines whats covered and not covered under a health plan. 0000005180 00000 n Please use this access code on website: surgeryplus. You sign a consent form to receive hospice care instead of other Medicare-covered treatments for your terminal condition. 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. This website provides an overview of your benefit options. Your costs in Original Medicare For surgeries or procedures, it's hard to know the exact costs in advance. To provide and maintain this valuable membership benefit, MetLife reimburses the association and/or the plan administrator for these costs. "_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 Call our Health Response Center at. 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. The complete provisions of the plans are set forth in the Plan Documents and Summary Plan Description. Administrative services provided by United HealthCare Services, Inc. or their affiliates. 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. Metlife will not pay Dental Insurance benefits for charges incurred for: Alternate Benefits 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. <> Filing a health insurance claim is simple and can be done in one of two ways. <. Mastectomy surgery is a significant life event for many people. Learn more about a Summary of Benefits and Coverage, also commonly referred to as an SBC. 0000011564 00000 n 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. You simply need to provide the plan administrator with advanced written notice along with any required premium. Please Note: Additional information about this benefit change will be posted as it becomes available and before the July 1, 2023 effective date. An estimated cost of cataract surgery may be*: In a surgery center or clinic, the average total cost is $977. The sharing of health information between these companies is permitted by regulation. How can we make this page better for you? Learn more aboutsavings and spending accounts. Inpatient (Precertification is required): $350 per admission. Whats a Summary of Benefits and Coverage? Learn more about COVID-19 and the vaccine from the Division of Public Health, Learn about your benefits and resources for Behavioral Health & Emotional Wellbeing More Info. Before undergoing surgery, youll want to be connected with the highest-quality providers and facilities. Have a body mass index over 35 with severe comorbidity. 0000001651 00000 n What Part A covers, Medicare.gov, last accessed June 10, 2022. This assures State of Delaware Aetna and Highmark Delaware members will have access to surgeons and facilities that meet strict SurgeryPlus credentialing guidelines, leading to the highest quality care possible. endstream endobj startxref hbbd```b``+@$}D State Regulations Thats what SurgeryPlus does. To connect with SurgeryPlus today, call 833-709-2445. hb```f`` vAX,Xf000Z\ q1=nIc /( 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 doctor certifies that you are terminally ill, meaning that your life expectancy is 6 months or less. 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. Policy form GPNP99 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. 1. 0 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. 1 Sturti / Getty Images Coverage Varies by Insurer Each health plan is different. However, some UnitedHealthcare policies charge lower deductibles . 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. Many Medicare Advantage plans include prescription drug coverage, in addition to all the benefits provided by Original Medicare Part A and Part B. Policy form GPNP99. In . 1096 0 obj Effective July 1, 2023, bariatric surgery coverage will be available exclusively through the SurgeryPlus benefit. State Employees If you qualify for it, Medicaid, which is administered by states under federal guidelines, may cover nursing home care. Does Medicare Cover Pre-existing Conditions? Medicare.com, last accessed June 10, 2022. Please remember to hold on to all receipts to submit a dental claim. "Original Medicare may cover 80% of a traditional cataract surgery. This exclusion will apply whether or not the person receiving the services is enrolled for the government plan. 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. Where two or more professionally acceptable dental treatments for a dental condition exist, reimbursement is based on the least costly treatment alternative. You pay 20% of the Medicare Part B copay plus any out-of-pocket costs such as your deductible, medication costs and physician fees. cost of cataract surgery with medicare. 250 0 obj <> endobj This program will be available on January 1, 2020. 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. hbbd```b``f+A$S$d@$&},L`1]`*z3`] rO o bHHj@&{:.a`$ S 0000381088 00000 n You can choose whether or not to use SurgeryPlus for your surgical procedures. Its also possible to get an SBC in another language. Withholding Tax Voting & Elections 0000378718 00000 n 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. Weight-Loss (Bariatric) Surgery. Weather & Travel, Contact Us Corporations Generally, Medicare Part A (also known as hospital insurance) can cover inpatient hospital care, nursing facility care, nursing home care, hospice care and home healthcare.1, Medicare Part B (also known as medical insurance) offers coverage for medically necessary and preventive care services. Learn more about the ABN. The Plan Sponsor(s) reserve the right to amend or terminate each plan at any time. Yes. Public Meetings <<7C167570AC52504DB41418C8CABC0A04>]/Prev 422895/XRefStm 1266>> (Refer to your dental benefits plan summary for your out-of-network dental coverage.) This group plan is made available to through membership in the American Association of Business Networking (ABN). 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. 0000001266 00000 n You can also go through the SurgeryPlus member portal. Medicare Advantage plans are provided by private companies with approval from Medicare. Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment. Child(ren)s eligibility for dental coverage is from birth up to age 26. Agent tip: "Original Medicare may cover 80% of a traditional cataract surgery. , begin to type the name of your employer in the space below. EXA!YA?fqLv1bd::M&a54g#A010p]p 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. Please fill out the contact form so the right person can be in touch quickly. (Negotiated fees are subject to change.). For example, if youre still working and covered by your employer or your spouses employer sponsored health coverage, you may be able to wait. This website and phone number are for use by dental professionals only. To check to see if you may already have SurgeryPlus, begin to type the name of your employer in the space below. 0000023776 00000 n Eleesha Lockett, Does Medicare Cover Plastic Surgery? Healthline, last accessed June 10, 2022. Because its all in the same format, its easier to make apples-to-apples comparisons when youre deciding which plan is best for you. 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. This information is provided for educational purposes only. 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. 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 program utilizes the MetLife PDP Plus Network of participating dentists. coinsurance and/or deductible on PPO plans, or copay on EPO plans). Your SurgeryPlus Care Advocate will provide you one-on-one, personalized help each step of the way. To assist, American Airlines has business relationships with third-party vendors, for example, BCBS, UHC, and WebMD Health Services. These rules determine the order in which the plans will pay benefits. endstream endobj 97 0 obj <>stream 0000007939 00000 n Wearing a Suit After a Body-Altering Surgery. 0000006640 00000 n Will Medicare Cover LASIK Eye Surgery? Medicare.org, last accessed June 10, 2022. Vision benefits are underwritten by Metropolitan Life Insurance Company, New York, NY (MetLife). 0000418667 00000 n %%EOF 0000024865 00000 n TE 6Uz A$& &`5= X7"yH: wd`^+H(`q] DF9qt This symbol denotes a Web Page. Members of HumanaVision can receive deeper discounts on LASIK services, especially when using a specific in-network provider. 0000392965 00000 n Gross Receipts Tax 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. 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. 0000001036 00000 n 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 can ask for a pretreatment estimate. . Heres a step-by-step look at what information is in an SBC: You can request a copy of an SBC anytime. Updated 08/29/2019 . 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. Know your options. 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. This webpage is provided for summary purposes only and is not a complete description of the plan benefits, limitations, and exclusions. 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. For example, rather than paying separately for the surgeon, facility, anesthesiologist, and radiologist, SurgeryPlus negotiates one bundled rate. 10739 Deerwood Park Blvd, Suite 200-B Examples of procedures covered are hernia repair, hysterectomy, colonoscopy, tendon release, spine injections and fusions, knee replacements, and many more. Every SBC is created with four double-sided pages and 12-point type. This benefit is available to those enrolled in one of the CEBT EPO, PPO or HDHP medical plans. 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. 0 References to UnitedHealthcare pertain to each individual company or other UnitedHealthcare affiliated companies. The State of Delaware is an Equal Opportunity employer and values a diverse workforce. Medicare Advantage plans may offer coverage for vision, hearing, dental and wellness services. Each company is a separate entity and is not responsible for another's financial or contractual obligations. The amount of benefits payable by MetLife may be reduced due to the benefits paid under the primary plan. RSS Feeds, Make Membership in the ABN in required to enroll in this plan. You can also go through the SurgeryPlus member portal. 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. But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary. 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. SurgeryPlus Frequently Asked Questions General Questions . L0920007743[exp0922][All States][DC,GU,MP,PR,VI] 2020 MSS, Florida office (headquarters) Copyright 2022 Employer Direct HealthcareAll Rights Reserved. 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. He or she hasnt agreed to accept negotiated fees. This document presents the majority of services within each category, but is not a complete description of the plan.

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