Do your homework. Many offer affordable or even $0 monthly plan premiums, but you must continue to pay the Medicare Part B premium. Inpatient (Precertification is required): $350 per admission. Take your bill (s) to your State Farm agent's office. The surgery and any facility costs will be 100% covered under your SurgeryPlus benefit. Medicare Advantage plans are provided by private companies with approval from Medicare. Remember that Medicare Advantage plans are required by law to offer all the benefits of Original Medicare, but most plans offer much more. startxref 0000023776 00000 n Scuba Certification; Private Scuba Lessons; Scuba Refresher for Certified Divers; Try Scuba Diving; Enriched Air Diver (Nitrox) SurgeryPlus Frequently Asked Questions General Questions . Policy number 5343606-1-G (Low plan), Metropolitan Life Insurance Company, 200 Park Avenue, New York, NY 10166 In . (Portal access Code: surgeryplus). Many Medicare Advantage plans, however, do include coverage for routine dental, vision and hearing care, including glasses and hearing aids. 1 Sturti / Getty Images Coverage Varies by Insurer Each health plan is different. 10 frequently asked questions about Medicare plans, Deductibles for Medicare Part A and Part B. Connect you with a top-ranked, board-certified and fellowship-trained surgeon near you. 0000000016 00000 n Looser styling flatters while cleverly camouflaging around your middle. Medicare Part B may cover diagnostic hearing and balance examstests your doctor requires if you need medical treatment. To see if your procedure is covered, contact us. 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 Call a Care Advocate at 833.709.2444 for more information. About SurgeryPlus SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. %PDF-1.6 % The amount of benefits payable by MetLife may be reduced due to the benefits paid under the primary plan. Please fill out the contact form so the right person can be in touch quickly. 0000007939 00000 n 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. 1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. 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 Elected Officials 0000019705 00000 n endstream endobj 124 0 obj <>/Filter/FlateDecode/Index[5 84]/Length 22/Size 89/Type/XRef/W[1 1 1]>>stream Please remember to hold on to all receipts to submit a dental claim. Yes. Dentists may submit your claims for you which means you have little or no paperwork. Learn more about the ABN. 0000015692 00000 n 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. 9l J'X:50e0l`} }U,,Q`lam[5-0f`MVe` On average, cataract surgery costs about $5,000 per eye; however, in some places, this price can move up to over $10,000. This is a voluntary benefit available to you if you're enrolled in the Core, Standard, Plus or High Cost Coverage medical option. You can make monthly payments by monthly bank draft (ACH) or pay for the entire year via credit card payment. We recommend that you request a pre-treatment estimate for services in excess of $300. Also, your doctor will need to certify that you need certain eligible in-home services. 0000001036 00000 n Heres a step-by-step look at what information is in an SBC: You can request a copy of an SBC anytime. HIP Plus is the plan for the best value.HIP Plus provides health coverage for a low, predictable monthly cost. Your private health information is just that private. Your copays and deductibles will still apply. Updated 08/29/2019 . 0000006640 00000 n "_P^)J^:+&!nI-eMNYrVY;QU&+,SUdTVvSN(GTDS o5q_H\%lqbF$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 0000014251 00000 n Medicare pays 80% of the cost of traditional cataract surgery, which would be covered by Medicare Part B. 0000016018 00000 n Yes. 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. SurgeryPlus negotiates a single cost (bundled rate) for the entire surgical procedure, resulting in savings to the State of Delaware. Will Medicare Cover LASIK Eye Surgery? Medicare.org, last accessed June 10, 2022. *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. endobj Thats what SurgeryPlus does. Home. Delaware Marketplace %%EOF If you are enrolled in a medical option through American (except DFW ConnectedCare) and have a covered surgery coming up, SurgeryPlus will: This is a voluntary benefit available to you if youre enrolled in the Core, Standard, Plus, High Cost Coverage, PPO 80 or PPO 90 medical option. 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 SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. <>stream Please Note: Additional information about this benefit change will be posted as it becomes available and before the July 1, 2023 effective date. <<7C167570AC52504DB41418C8CABC0A04>]/Prev 422895/XRefStm 1266>> There are no simple answers, but you can start here to find general answers to some of the most common questions about Medicare coverage. If it contains a form, you can print it and fill it out. 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. 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. You can also go through the SurgeryPlus member portal. Refer to the customer's benefit plan document for coverage details. It has less visits to physical, speech and occupational therapies than HIP Plus. 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. Licensed Humana sales agents are available daily, 8a.m. 8 p.m. Durable medical equipment (DME) coverage, Medicare.gov, last accessed June 10, 2022. At time of enrollment, you will choose how you want to pay. 12 Always err on the side of caution! When it comes to Medicare, the question we hear most often after What does it cost? is, What does it cover?. 89 37 To get one, contact us. 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. 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. 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. By receiving services through SurgeryPlus, you and your dependents can earn financial rewards. 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. Your medical insurance may also pick up the cost in full or part for medically-related . Copyright 2023 Member Benefits. SurgeryPlus is included in your medical benefits at no additional cost to you. 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. Voting & Elections SurgeryPlus is a supplemental benefit for non-emergency surgeries that provides high-quality care, 0000018849 00000 n endobj Actual payments may vary from the pretreatment estimate depending upon annual maximums, plan frequency limits, deductibles and other limits applicable at time of payment. This information is provided for educational purposes only. Dependent age may vary by state. 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. Delaware Topics Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. 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. 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. 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. SurgeryPlus Care Advocates are your connection to the SurgeryPlus benefit. Withholding Tax 0000019224 00000 n Metlife will not pay Dental Insurance benefits for charges incurred for: Alternate Benefits You earn the reward once the following occurs: The reward will then be credited to the savings and spending account of your choice. "Original Medicare may cover 80% of a traditional cataract surgery. Original Medicare generally doesnt cover the cost of a nursing home, assisted living or long-term care facility. To check to see if you may already have SurgeryPlus, begin to type the name of your employer in the space below. 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. Medically necessary services diagnose and treat health problems. 988 0 obj %PDF-1.4 % A prime example is breast implants done during or after breast cancer surgery. Coverage Policies are not recommendations for treatment and should never be used as treatment guidelines. To connect with SurgeryPlus today, call 833-709-2445. Effective July 1, 2023, bariatric surgery coverage will be available exclusively through the SurgeryPlus benefit. 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. 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. To assist, American Airlines has business relationships with third-party vendors, for example, BCBS, UHC, and WebMD Health Services. Public Meetings 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. This program will be available on January 1, 2020. The complete provisions of the plans are set forth in the Plan Documents and Summary Plan Description. This website and phone number are for use by dental professionals only. Where two or more professionally acceptable dental treatments for a dental condition exist, reimbursement is based on the least costly treatment alternative. This may include surgery to remove cataracts or after an eye injury. This group plan is made available to through membership in the American Association of Business Networking (ABN). Policy number TS 05343606-G (High plan) The State of Delaware is an Equal Opportunity employer and values a diverse workforce. We cover the most expensive costs associated with your surgery so you'll pay less for your procedure. 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. %PDF-1.6 % endstream endobj startxref Delaware Courts To provide and maintain this valuable membership benefit, MetLife reimburses the association and/or the plan administrator for these costs. When enrolling you may choose to also cover your spouse, domestic partner, and/or children up to age 26. 89 0 obj <> endobj (Refer to your dental benefits plan summary for your out-of-network dental coverage.) 2 If you have Medicare Part B primary, your costs for prescription drugs may be lower. 125 0 obj <>stream Effective July 1, 2023, bariatric surgery coverage will be available exclusively through the SurgeryPlus benefit. 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. Some links on this page may take you to Humana non-Medicare product or service pages or to a different website. Preventive & screening services, Medicare.gov, last accessed June 10, 2022. SurgeryPlus is separate from your health plan and has its own network of high-quality providers. 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. 1XQg&.9mE#(Tq& 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. 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. A mastectomy bra can provide comfort, support, and security to an individual as they become accustomed to their new normal. 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 pay 20% of the Medicare Part B copay plus any out-of-pocket costs such as your deductible, medication costs and physician fees. Disclaimer 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. Policy form GPNP99 If you need cataract surgery in both eyes . 285 0 obj <>stream SurgeryPlus notifies that you or your dependent earned the reward. This program utilizes the MetLife PDP Plus Network of participating dentists. Business First Steps, Phone Directory 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. Guided Support SurgeryPlus provides an alternative to using your health plan for a planned surgical procedure that is not an emergency. 00k` !" hbbbd`b`` K endobj L0920007743[exp0922][All States][DC,GU,MP,PR,VI] 2020 MSS, Florida office (headquarters) If the information online is inconsistent with the Plan Documents, the Plan Documents will govern. "L @Zd X$9RAC~yGz3)fjaPk !e E57 Hln8 ``:w0@6Cfmu ] Medicare will not pay for 24-hour in-home care or meals delivered to you at home. Wearing a swimsuit after a mastectomy can be a transition. What is Medicare Part C? U.S. Department of Health & Human Services, last accessed June 10, 2022. . 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. Hospice care, Medicare.gov, last accessed June 10, 2022. Visit ESPN for the game videos of the Brooklyn Nets vs. Boston Celtics NBA basketball game on March 3, 2023 We cover the most expensive costs associated with your surgery so youll pay less for your procedure. This guide will explain the different types of . Hospital Care. 866-855-1212. 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. Learn more about a Summary of Benefits and Coverage, also commonly referred to as an SBC. 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. Bariatric surgery is surgery to help you lose weight. Delaware State Code 1. Coverage includes access to our network of excellent surgeons, consults and appointments with your SurgeryPlus provider, anesthesia, the procedure and facility (hospital) fees. Vision benefits are underwritten by Metropolitan Life Insurance Company, New York, NY (MetLife). What Part A covers, Medicare.gov, last accessed June 10, 2022. The service categories and plan limitations shown below represent an overview of the plan benefits. Rest easy knowing you can afford the surgery you need, HDHP Plans will require a reduced deductible to be met first. Find out which Humana plans include your doctors and cover the medications you take now to help you estimate your costs. endstream endobj 251 0 obj <. 0000392965 00000 n Your general dentist or specialist usually sends MetLife a plan for your care and requests an estimate of benefits. A class is a group of people defined in the group policy. 0000401803 00000 n Your costs in Original Medicare For surgeries or procedures, it's hard to know the exact costs in advance. 0000004536 00000 n 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. 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. This benefit is available to those enrolled in one of the CEBT EPO, PPO or HDHP medical plans. However, if you choose a non-participating dentist, your out-of-pocket costs may be higher. You and your dentist will receive a benefit estimate for most procedures while you are still in the office. However, Medicare doesnt cover routine hearing exams, hearing aids or fittings.7. Generally, most vision, dental and hearing services are not covered by Medicare Parts A and B. hbbd```b``f+A$S$d@$&},L`1]`*z3`] rO o bHHj@&{:.a`$ S TE 6Uz A$& &`5= X7"yH: wd`^+H(`q] DF9qt This symbol denotes a Web Page. 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 partners are required to comply with all laws protecting privacy. 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. Knowing which types of common medical costs are not covered will be helpful when planning for your out-of-pocket medical costs. Theres a lot of information in an SBC. Consult your healthcare provider if you have questions or concerns. You may choose to share the information with your doctor and other medical professionals. What Part B covers, Medicare.gov, last accessed June 10, 2022. 0000001609 00000 n Enter your ZIP code below to see plans with their premiums, copays, and participating doctors and pharmacies. 0000012970 00000 n If you qualify for it, Medicaid, which is administered by states under federal guidelines, may cover nursing home care. Every SBC is created with four double-sided pages and 12-point type. , begin to type the name of your employer in the space below. 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. Does Medicare Cover Pre-existing Conditions? Medicare.com, last accessed June 10, 2022. %%EOF You are always free to select the dentist of your choice. Coverage will be considered under your out-of-network benefits. Wearing a Suit After a Body-Altering Surgery. For the Plus Size Queens. 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. 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). 0000005180 00000 n 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. 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. Locations Directory Medicare pays $781, and your cost is $195. The SBC was created to make it easier to compare and shop for health plans. Before undergoing surgery, youll want to be connected with the highest-quality providers and facilities. Eleesha Lockett, Does Medicare Cover Plastic Surgery? Healthline, last accessed June 10, 2022. Mon-Fri, 8:30am-5:00pm (CT). xref Members will pay nothing out of pocket for bariatric surgery; however, financial incentives do not apply. 250 0 obj <> endobj Adjustable straps allow for a better, customized fit. When will my medical insurance cover oral surgery? coinsurance and/or deductible on PPO plans, or copay on EPO plans). Read your certificate of insurance for details on plan benefits, limitations, and exclusions. Gross Receipts Tax A reminder that the SBC is only a summary. Bigger. Please contact Member Benefits your plan administrator at 1-800-282-8626 for more information. All other HIP plans cover members ages 19 to 64. The inclusion of a code does not imply any right to . This document presents the majority of services within each category, but is not a complete description of the plan. Many Medicare Advantage plans include prescription drug coverage, in addition to all the benefits provided by Original Medicare Part A and Part B. 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. Weight-Loss (Bariatric) Surgery. You'll also pay a deductible of $233. 0000001266 00000 n Group dental insurance policies featuring the Preferred Dentist Program are underwritten by Metropolitan Life Insurance Company, New York, NY 10166.
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