0000007939 00000 n 0000024865 00000 n SurgeryPlus provides an alternative to using your health plan for a planned surgical procedure that is not an emergency. 9l J'X:50e0l`} }U,,Q`lam[5-0f`MVe` <>stream At time of enrollment, you will choose how you want to pay. Whats a Summary of Benefits and Coverage? Hospital Care. <>/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 Every SBC is created with four double-sided pages and 12-point type. 866-855-1212 to request a claim form. Inpatient (Precertification is required): $350 per admission. You can make monthly payments by monthly bank draft (ACH) or pay for the entire year via credit card payment. endstream endobj 251 0 obj <. This symbol denotes a PDF Document. 0000005131 00000 n You can search a list of these participating dentists online or call 1-800-942-0854 to have a list faxed or mailed to you. 0000005180 00000 n Procedure charge schedules are subject to change each plan year. When will my medical insurance cover oral surgery? What Part A covers, Medicare.gov, last accessed June 10, 2022. Coverage Policy ; Coverage for bariatric surgery or revision of a bariatric surgical procedure varies across plans and may be governed by state mandates. 1. Pick the option that's best for you. TE 6Uz A$& &`5= X7"yH: wd`^+H(`q] DF9qt 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. All health plan companies are required to provide an SBC for each of their different plans. 0000001266 00000 n If the MetLife dental benefit plan is primary, MetLife will pay the full amount of benefits that would normally be available under the plan. 0000378718 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. 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. To check to see if you may already have SurgeryPlus, begin to type the name of your employer in the space below. Austin, TX 78735 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. 0000016018 00000 n To connect with SurgeryPlus today, call 833-709-2445. The effective date of coverage for newly added dependent(s) will depend on when we receive notice and required 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. Where two or more professionally acceptable dental treatments for a dental condition exist, reimbursement is based on the least costly treatment alternative. This benefit is available to those enrolled in one of the CEBT EPO, PPO or HDHP medical plans. Certain claim and network administration services are provided through Vision Service Plan (VSP), Rancho Cordova, CA. You consent to receiving palliative care to make you comfortable versus care to try to cure your illness. (Based on internal analysis by MetLife. %PDF-1.4 % SurgeryPlus is a voluntary benefit that provides pre-planned, non-emergency surgical services. Original Medicare generally covers most pre-existing conditions. 0000019705 00000 n HVn7}Wt)A87HPV$(YXF;3as=sfj'O&y>=zF_Gmlr:v1z5`:A1suhMFY}r0_&o^w]vw%'o':~u>)|]!6nRBki;L}h0y^'#cCmJJc hbbd```b``+@$}D Enter your ZIP code below to see plans with their premiums, copays, and participating doctors and pharmacies. 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. You can ask for a pretreatment estimate. 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. Yes. Withholding Tax It has less visits to physical, speech and occupational therapies than HIP Plus. <<7C167570AC52504DB41418C8CABC0A04>]/Prev 422895/XRefStm 1266>> This Coverage Policy addresses bariatric surgery and procedures for the treatment of morbid obesity. Negotiated fees for non-covered services may not apply in all states.). 6 Original Medicare may even pay for corrective lenses if you have surgery to implant an intraocular lens (IOL). (Due to contractual requirements, MetLife is prevented from soliciting certain providers.) Privacy Policy Some general conditions to receive coverage from United Healthcare requires that you meet the following criteria: Have a body mass index over 40 OR. This guide will explain the different types of . Facilitate and consolidate your payments. 0000001609 00000 n Bigger. 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. All rights reserved. Members will pay nothing out of pocket for bariatric surgery; however, financial incentives do not apply. Scuba Certification; Private Scuba Lessons; Scuba Refresher for Certified Divers; Try Scuba Diving; Enriched Air Diver (Nitrox) Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment. 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. 0000019224 00000 n RSS Feeds, Make 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. This document presents the majority of services within each category, but is not a complete description of the plan. SurgeryPlus is a supplemental benefit for non-emergency surgeries that provides high-quality care, Filing a health claim. Alternatively, a Medicare Advantage plan often provides comprehensive vision coverage, plus cataract surgery without out-of-pocket coinsurance costs.". Malini Ghoshal, What You Need to Know About Medicare Prescription Drug Plans (Part D), Healthline, last accessed June 10, 2022. For procedures requiring inpatient admission or overnight recovery, the travel benefit covers the patient and one companion for a limited amount of time. Your Care Advocate will provide you with personalized support, helping you to understand your benefit, find you excellent care, coordinate any consults and appointments with your SurgeryPlus surgeon and make sure you feel informed every step of the way. Jacksonville, FL 32256 Outpatient: 15% of our allowance . 285 0 obj <>stream Reconstructive Procedures include surgery or other procedures which are related to a health condition. 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. Please Note: Additional information about this benefit change will be posted as it becomes available and before the July 1, 2023 effective date. Thats because its basically a document that outlines whats covered and not covered under a health plan. However, Medicare doesnt cover routine hearing exams, hearing aids or fittings.7. 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. 0000015806 00000 n Coverage includes access to our network of excellent surgeons, consults and appointments with your SurgeryPlus provider, anesthesia, the procedure and facility (hospital) fees. Take some time to understand your Medicare plan. such as Spine, General Surgery, Genitourinary, Orthopedic, Ear, Nose & Throat, Cardiac, GI, and Pain Management. SurgeryPlus Frequently Asked Questions General Questions . This Coverage Policy addresses breast reduction for symptomatic macromastia and breast reduction surgery on Personal Income Tax Most common oral surgeries are covered, at least in part, by your dental insurance provider. Through the planning process, you will work with the same Care Advocate. If it contains a form, you can print it and fill it out. Copyright 2023 Member Benefits. Consult your doctor before beginning any new diet or exercise regimen. 1026 0 obj 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. 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. hb```b``Nf`c`Wcd@ AV(G 2?X%c6g+S@|dHA[&@VS&-,&W\\f9v| **s)S\Ol%5T7A(F State Regulations 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. 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. Before undergoing surgery, youll want to be connected with the highest-quality providers and facilities. 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. 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. 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. Or Reach Us at 855-200-2099 " *" indicates required fields lbSy All other HIP plans cover members ages 19 to 64. Coverage is provided under a group insurance policy (Policy form GPNP99) issued by MetLife. 1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. 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. Eleesha Lockett, Does Medicare Cover Plastic Surgery? Healthline, last accessed June 10, 2022. Click Register Now to create your profile and start exploring this free service. Public Meetings It all depends on your policy. Agent tip: "Original Medicare may cover 80% of a traditional cataract surgery. 0000392965 00000 n To connect with SurgeryPlus today, call 833-709-2445. State Agencies Confirm your coverage before you commit to a procedure you're unsure about. Delaware Topics To get one, contact us. All services defined in your group dental benefits plan certificate are covered. Policy number TS 05343606-G (High plan) endstream endobj 124 0 obj <>/Filter/FlateDecode/Index[5 84]/Length 22/Size 89/Type/XRef/W[1 1 1]>>stream 10 frequently asked questions about Medicare plans, Deductibles for Medicare Part A and Part B. 0 1XQg&.9mE#(Tq& 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. The SurgeryPlus Difference We allow you to focus on practicing medicine and caring for patients. 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). EXA!YA?fqLv1bd::M&a54g#A010p]p %PDF-1.6 % Yes. By receiving services through SurgeryPlus, you and your dependents can earn financial rewards. 89 0 obj <> endobj Learn more about the ABN. Inpatient hospital: $450 per admission copay for unlimited days, plus 35% of our allowance. Wearing a Suit After a Body-Altering Surgery. By packaging surgical expenses into one simple, bundled rate, SurgeryPlus is able save money for you and the State of Florida. Medicare Advantage plans are provided by private companies with approval from Medicare. Delaware Courts 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. Call a Care Advocate at 833.709.2444 for more information. It also includes more benefits like dental, vision, or chiropractic.With HIP Plus, you do not have copays when you visit the doctor, fill a prescription or go to the hospital for an emergency.On average, HIP Plus members spend less money on their health care . In addition, it comes with a concierge service (Care Advocate) and travel benefits. Transparency 0 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. xref Negotiated fees are subject to change. h`06NH+500 Individuals enrolled in a State of Delaware Aetna or Highmark Delaware non-Medicare health plan are automatically enrolled in this FREE benefit. A prime example is breast implants done during or after breast cancer surgery. 0000014887 00000 n Does Medicare Cover Pre-existing Conditions? Medicare.com, last accessed June 10, 2022. Many Medicare Advantage plans include prescription drug coverage, in addition to all the benefits provided by Original Medicare Part A and Part B. Administrative services provided by United HealthCare Services, Inc. or their affiliates. Medicare pays 80% of the cost of traditional cataract surgery, which would be covered by Medicare Part B. Text Size Smaler, Make Text Size 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.