0000011564 00000 n These plans include all your Part A and Part B coverage and often provide extra coverage for services not included in Original Medicare. 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. 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. Mon-Fri, 8:30am-5:00pm (ET), Texas office 1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. All health plan companies are required to provide an SBC for each of their different plans. Looser styling flatters while cleverly camouflaging around your middle. The time a mother and baby spend in the hospital after delivery is a medical decision. 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. Hearing & balance exams, Medicare.gov, last accessed June 10, 2022. %%EOF Thats because its basically a document that outlines whats covered and not covered under a health plan. Locations Directory Only travel arrangements made through your Care Advocate are eligible for coverage under the SurgeryPlus benefit. Your copays and deductibles will still apply. 2 If you have Medicare Part B primary, your costs for prescription drugs may be lower. "L @Zd X$9RAC~yGz3)fjaPk !e E57 Hln8 ``:w0@6Cfmu ] 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. 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. Your medical insurance may also pick up the cost in full or part for medically-related . The sharing of health information between these companies is permitted by regulation. This website is not intended as a contract of employment or a guarantee of current or future employment. *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. The service categories and plan limitations shown below represent an overview of the plan benefits. For procedures requiring inpatient admission or overnight recovery, the travel benefit covers the patient and one companion for a limited amount of time. Franchise Tax Help Center 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. (Portal access Code: surgeryplus). If it contains a form, you can print it and fill it out. such as Spine, General Surgery, Genitourinary, Orthopedic, Ear, Nose & Throat, Cardiac, GI, and Pain Management. It is not to be used for medical advice, diagnosis or treatment. Most plans cover the entire cost of preventive care, plus a portion of the cost after you meet your deductible for other procedures. This exclusion will apply whether or not the person receiving the services is enrolled for the government plan. 0000000016 00000 n 285 0 obj <>stream "Original Medicare may cover 80% of a traditional cataract surgery. SurgeryPlus is a supplemental benefit for non-emergency surgeries that provides high-quality care, Consult your healthcare provider if you have questions or concerns. Hospital Care. Procedures can cost from $700 to $2,000 per eye, depending on . Coverage is provided under a group insurance policy (Policy form GPNP99) issued by MetLife. The effective date of coverage for newly added dependent(s) will depend on when we receive notice and required premium. Delaware Marketplace 0000377893 00000 n Read your certificate of insurance for details on plan benefits, limitations, and exclusions. 0000001609 00000 n You are always free to select the dentist of your choice. Your SurgeryPlus Care Advocate will provide you one-on-one, personalized help each step of the way. Your SurgeryPlus benefit will also help pay for necessary travel associated with the covered procedure. What is Medicare Part C? U.S. Department of Health & Human Services, last accessed June 10, 2022. Some general conditions to receive coverage from United Healthcare requires that you meet the following criteria: Have a body mass index over 40 OR. . Through the planning process, you will work with the same Care Advocate. 0 Will Medicare Cover LASIK Eye Surgery? Medicare.org, last accessed June 10, 2022. A class is a group of people defined in the group policy. 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. 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. So you may be responsible for any difference in cost between the dentists fee and your plans benefit payment. The primary result of . Facilitate and consolidate your payments. This symbol denotes a PDF Document. 0000019224 00000 n This Coverage Policy addresses bariatric surgery and procedures for the treatment of morbid obesity. This benefit is available to those enrolled in one of the CEBT EPO, PPO or HDHP medical plans. This guide will explain the different types of . Its also possible to get an SBC in another language. You can also go through the SurgeryPlus member portal. 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. Take your bill (s) to your State Farm agent's office. Eleesha Lockett, Does Medicare Cover Plastic Surgery? Healthline, last accessed June 10, 2022. This symbol denotes a Web Page. 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. Please use this access code on website: surgeryplus. Malini Ghoshal, What You Need to Know About Medicare Prescription Drug Plans (Part D), Healthline, last accessed June 10, 2022. You can ask for a pretreatment estimate. Learn more about the ABN. 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. Prescription drug planscalled Medicare Part Dare only available through private companies like Humana. Coverage Policies are not recommendations for treatment and should never be used as treatment guidelines. 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. About SurgeryPlus SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. A prime example is breast implants done during or after breast cancer surgery. The State Employee Benefits Committee (SEBC) believes in providing high quality care to members at an affordable cost. However, some UnitedHealthcare policies charge lower deductibles . endobj Please Note: Additional information about this benefit change will be posted as it becomes available and before the July 1, 2023 effective date. Medically necessary services diagnose and treat health problems. Many offer affordable or even $0 monthly plan premiums, but you must continue to pay the Medicare Part B premium. 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. 0000001036 00000 n EXA!YA?fqLv1bd::M&a54g#A010p]p 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. However, Medicare doesnt cover routine hearing exams, hearing aids or fittings.7. Licensed Humana sales agents are available daily, 8a.m. 8 p.m. The surgery and any facility costs will be 100% covered under your SurgeryPlus benefit. 866-855-1212 to request a claim form. This program utilizes the MetLife PDP Plus Network of participating dentists. 9l J'X:50e0l`} }U,,Q`lam[5-0f`MVe` You sign a consent form to receive hospice care instead of other Medicare-covered treatments for your terminal condition. Negotiated fees for non-covered services may not apply in all states.). How can we make this page better for you? This is because you won't know what services you need until you meet with your provider. startxref 0000015806 00000 n 0000005180 00000 n Dependent age may vary by state. Yes. To connect with SurgeryPlus today, call 833-709-2445. 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. Assign you a personal care coordinator to offer one-on-one guidance and support as you prepare for, undergo and recover from surgery. 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. Always err on the side of caution! This information is provided for educational purposes only. It does not cover bariatric surgery or jaw care (TMJ). Coverage includes access to our network of excellent surgeons, consults and appointments with your SurgeryPlus provider, anesthesia, the procedure and facility (hospital) fees. Original Medicare generally covers most pre-existing conditions. Metlife will not pay Dental Insurance benefits for charges incurred for: Alternate Benefits Gross Receipts Tax 6 Original Medicare may even pay for corrective lenses if you have surgery to implant an intraocular lens (IOL). You may choose to share the information with your doctor and other medical professionals. What's not covered by Part A & Part B? Medicare.gov, last accessed June 10, 2022. Rest easy knowing you can afford the surgery you need, HDHP Plans will require a reduced deductible to be met first. 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. 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. Individuals enrolled in a State of Delaware Aetna or Highmark Delaware non-Medicare health plan are automatically enrolled in this FREE benefit. Mobile Apps By receiving services through SurgeryPlus, you and your dependents can earn financial rewards. Premiums and the list of covered drugscalled a formularywill vary by plan.6. 0000001266 00000 n Privacy Policy You'll also pay a deductible of $233. You may enroll for membership in the ABN directly through the ABN website or during your dental enrollment. 989 0 obj Or Reach Us at. To assist, American Airlines has business relationships with third-party vendors, for example, BCBS, UHC, and WebMD Health Services. Negotiated fees are subject to change. , begin to type the name of your employer in the space below. Group dental insurance policies featuring the Preferred Dentist Program are underwritten by Metropolitan Life Insurance Company, New York, NY 10166. However, this depends on the specific type of surgery you need, your dental plan, and your level of coverage. 125 0 obj <>stream But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary. Delaware State Code Filing a health insurance claim is simple and can be done in one of two ways. Policy number 5343606-1-G (Low plan), Metropolitan Life Insurance Company, 200 Park Avenue, New York, NY 10166 E-mail / Text Alerts Some types of surgery also change the connection between your stomach and intestines. Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment. (Negotiated fees are subject to change.). %PDF-1.6 % SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. Durable medical equipment (DME) coverage, Medicare.gov, last accessed June 10, 2022. Policy form GPNP99. Guided Support 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. 0000025231 00000 n %PDF-1.4 % It requires doctors and facilities to meet strict credential guidelines leading to the highest quality care possible. References to UnitedHealthcare pertain to each individual company or other UnitedHealthcare affiliated companies. 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. You consent to receiving palliative care to make you comfortable versus care to try to cure your illness. This Coverage Policy addresses breast reduction for symptomatic macromastia and breast reduction surgery on cost of cataract surgery with medicare. Each company is a separate entity and is not responsible for another's financial or contractual obligations. Benefits are subject to change upon agreement between Metropolitan Life Insurance Company and the participating organization. 0000004536 00000 n Mastectomy surgery is a significant life event for many people. We cover the most expensive costs associated with your surgery so youll pay less for your procedure. A mastectomy bra can provide comfort, support, and security to an individual as they become accustomed to their new normal. Yes. In . Remember that Medicare Advantage plans are required by law to offer all the benefits of Original Medicare, but most plans offer much more. Most common oral surgeries are covered, at least in part, by your dental insurance provider. Refer to the customer's benefit plan document for coverage details. Wearing a Suit After a Body-Altering Surgery. The State of Delaware is an Equal Opportunity employer and values a diverse workforce. 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. 250 0 obj <> endobj You and your dentist will receive a benefit estimate for most procedures while you are still in the office. Does Medicare Cover Pre-existing Conditions? Medicare.com, last accessed June 10, 2022. At time of enrollment, you will choose how you want to pay. There are no simple answers, but you can start here to find general answers to some of the most common questions about Medicare coverage. Outpatient facility care: 35% of our allowance . Child(ren)s eligibility for dental coverage is from birth up to age 26. Medicare Part B contributes 80% of the cost of one pair of eyeglasses or set of contact lenses after cataract surgery after. %%EOF 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. 0000004000 00000 n Home health services, Medicare.gov, last accessed June 10, 2022. Austin, TX 78735 The estimate helps you prepare for the cost of dental services. Yes. Know your options. Voting & Elections RSS Feeds, Make 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. 0000378718 00000 n In certain markets, delegated vendor guidelines may be used to support medical necessity and other coverage determinations. <>stream Policy form GPNP99 0000024943 00000 n 0000016018 00000 n 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. 0000014887 00000 n (Due to contractual requirements, MetLife is prevented from soliciting certain providers.) Delaware's Governor Because its all in the same format, its easier to make apples-to-apples comparisons when youre deciding which plan is best for you. For example, rather than paying separately for the surgeon, facility, anesthesiologist, and radiologist, SurgeryPlus negotiates one bundled rate. Jacksonville, FL 32256 Find out which Humana plans include your doctors and cover the medications you take now to help you estimate your costs. State Employees 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. ii AF! This group plan is made available to through membership in the American Association of Business Networking (ABN). 1026 0 obj Bigger. Please fill out the contact form so the right person can be in touch quickly. 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. The choice is yours. 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. 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. 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. This may include surgery to remove cataracts or after an eye injury. This communication does not guarantee benefits and does not indicate all services received will be covered by your plan. This is a voluntary benefit available to you if you're enrolled in the Core, Standard, Plus or High Cost Coverage medical option. Medicare Part B may cover diagnostic hearing and balance examstests your doctor requires if you need medical treatment. If it contains a form, you can fill it out online and submit it. Inpatient hospital: $450 per admission copay for unlimited days, plus 35% of our allowance. Alternatively, a Medicare Advantage plan often provides comprehensive vision coverage, plus cataract surgery without out-of-pocket coinsurance costs." Medicare pays 80% of the cost of traditional cataract surgery, which would be covered by Medicare Part B. To provide and maintain this valuable membership benefit, MetLife reimburses the association and/or the plan administrator for these costs. Coverage will be considered under your out-of-network benefits. Members will pay nothing out of pocket for bariatric surgery; however, financial incentives do not apply. Personal Income Tax Before undergoing surgery, youll want to be connected with the highest-quality providers and facilities. If the information online is inconsistent with the Plan Documents, the Plan Documents will govern. We recommend that you request a pre-treatment estimate for services in excess of $300. Please review the plan summaries for summarized information and your certificate of insurance for detailed information about your plan benefits. Information about where to go online to review and print copies of complete health plan documents, Where to find a list of network providers, Where to find prescription drug coverage information, Where to find a Glossary of Health Coverage and Medical Terms (also called a Uniform Glossary), A statement on whether the plan meets minimum essential coverage (MEC) for the, A statement that it meets minimum value (plan covers at least 60 percent of medical costs of benefits for a population on average), When changes happen within your health plan, Individual & Family ACA Marketplace plans, Heres what a sample SBC looks like (pdf), Glossary of Health Coverage and Medical Terms, Explore the benefits of UnitedHealthcare plans through work, Dual Special Needs Plans (D-SNP) from UnitedHealthcare, When you make a change or are added to a health plan for example if you get married, have a child, or experience another. Corporations Your costs in Original Medicare For surgeries or procedures, it's hard to know the exact costs in advance. Alternatively, a Medicare Advantage plan often provides comprehensive vision coverage, plus cataract surgery without out-of-pocket coinsurance costs.". Medicare Advantage plans may offer coverage for vision, hearing, dental and wellness services. hbbd```b``+@$}D You or your dependent use SurgeryPlus to receive a preoperative to post-operative bundled surgical service; SurgeryPlus validates that you or your dependent received the service; and. Text Size Smaler, Make Text Size