State Regulations Medicare Advantage plans are provided by private companies with approval from Medicare. General Assembly E-mail / Text Alerts This website provides an overview of your benefit options. Your doctor certifies that you are terminally ill, meaning that your life expectancy is 6 months or less. Privacy Policy This group plan is made available to through membership in the American Association of Business Networking (ABN). Rest easy knowing you can afford the surgery you need, HDHP Plans will require a reduced deductible to be met first. This information is provided for educational purposes only. The choice is yours. American Airlines manages employee and retiree health benefits. Mobile Apps 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. Voting & Elections Individuals enrolled in a State of Delaware Aetna or Highmark Delaware non-Medicare health plan are automatically enrolled in this FREE benefit. 1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. Yes. 0000007939 00000 n A class is a group of people defined in the group policy. For example, rather than paying separately for the surgeon, facility, anesthesiologist, and radiologist, SurgeryPlus negotiates one bundled rate. Find out which Humana plans include your doctors and cover the medications you take now to help you estimate your costs. lbSy Information gathered by our partners will be used for your benefit to help guide you on your path to wellness. Filing a health claim. xref 7500 Rialto Blvd, Building 1 Suite 250 89 0 obj <> endobj Your medical insurance may also pick up the cost in full or part for medically-related . Policy number TS 05343606-G (High plan) (Due to contractual requirements, MetLife is prevented from soliciting certain providers.) Outpatient facility care: 35% of our allowance . Coverage may not be available in all states. Coverage Policy ; Coverage for bariatric surgery or revision of a bariatric surgical procedure varies across plans and may be governed by state mandates. Dependent age may vary by state. 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. We suggest you discuss treatment options with your dentist before services are rendered, and obtain a pre-treatment estimate of benefits prior to receiving certain high cost services such as crowns, bridges or dentures. Or Reach Us at. Will Medicare Cover LASIK Eye Surgery? Medicare.org, last accessed June 10, 2022. 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. 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. 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. Effective July 1, 2023, bariatric surgery coverage will be available exclusively through the SurgeryPlus benefit. 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. 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 You can choose whether or not to use SurgeryPlus for your surgical procedures. Consult your doctor before beginning any new diet or exercise regimen. Your private health information is just that private. 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. Home health services, Medicare.gov, last accessed June 10, 2022. endstream endobj startxref Even though its meant to make the information easier to understand, it can seem like a lot at first. 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. To check to see if you may already have SurgeryPlus, begin to type the name of your employer in the space below. The specific travel benefit depends on the procedure, the provider, and the distance between the provider and a member's residence. Delaware Courts Enter your ZIP code below to see plans with their premiums, copays, and participating doctors and pharmacies. For specific LCDs/LCAs, refer to the table for Learn more aboutsavings and spending accounts. This program will be available on January 1, 2020. Know your options. 989 0 obj startxref This communication does not guarantee benefits and does not indicate all services received will be covered by your plan. By receiving services through SurgeryPlus, you and your dependents can earn financial rewards. %%EOF This benefit is available to those enrolled in one of the CEBT EPO, PPO or HDHP medical plans. SurgeryPlus is a supplemental benefit for non-emergency surgeries that provides high-quality care, Medicare Part B contributes 80% of the cost of one pair of eyeglasses or set of contact lenses after cataract surgery after. Effective July 1, 2023, bariatric surgery coverage will be available exclusively through the SurgeryPlus benefit. You sign a consent form to receive hospice care instead of other Medicare-covered treatments for your terminal condition. SurgeryPlus negotiates a single cost (bundled rate) for the entire surgical procedure, resulting in savings to the State of Delaware. You can ask for a pretreatment estimate. "_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 Most plans cover the entire cost of preventive care, plus a portion of the cost after you meet your deductible for other procedures. Overview . Bariatric surgery is surgery to help you lose weight. Metlife will not pay Dental Insurance benefits for charges incurred for: Alternate Benefits 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. Coverage includes access to our network of excellent surgeons, consults and appointments with your SurgeryPlus provider, anesthesia, the procedure and facility (hospital) fees. 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. The sharing of health information between these companies is permitted by regulation. The complete provisions of the plans are set forth in the Plan Documents and Summary Plan Description. Please remember to hold on to all receipts to submit a dental claim. State Agencies 10 frequently asked questions about Medicare plans, Deductibles for Medicare Part A and Part B. SurgeryPlus is separate from your health plan and has its own network of high-quality providers. 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. Learn more about the ABN. Locations Directory SurgeryPlus notifies that you or your dependent earned the reward. Negotiated fees are subject to change. This webpage is provided for summary purposes only and is not a complete description of the plan benefits, limitations, and exclusions. But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary. You may choose to share the information with your doctor and other medical professionals. Many Medicare Advantage plans include prescription drug coverage, in addition to all the benefits provided by Original Medicare Part A and Part B. 0000000016 00000 n Visit ESPN for the game videos of the Brooklyn Nets vs. Boston Celtics NBA basketball game on March 3, 2023 0000005180 00000 n In certain markets, delegated vendor guidelines may be used to support medical necessity and other coverage determinations. Licensed Humana sales agents are available daily, 8a.m. 8 p.m. <. This website and phone number are for use by dental professionals only. Many Medicare Advantage plans, however, do include coverage for routine dental, vision and hearing care, including glasses and hearing aids. 250 0 obj <> endobj This symbol denotes a Web Page. endobj Thats what SurgeryPlus does. This program utilizes the MetLife PDP Plus Network of participating dentists. All rights reserved. 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. 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. You'll be more confident on the beach with an extensive selection of plus-size swimwear. Generally, most vision, dental and hearing services are not covered by Medicare Parts A and B. Please Note: Additional information about this benefit change will be posted as it becomes available and before the July 1, 2023 effective date. You can also go through the SurgeryPlus member portal. Vision benefits are underwritten by Metropolitan Life Insurance Company, New York, NY (MetLife). 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. 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. (Portal access Code: surgeryplus). 1026 0 obj Medicare will not pay for 24-hour in-home care or meals delivered to you at home. 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. It does not cover bariatric surgery or jaw care (TMJ). Medicare pays 80% of the treatment costs, and the beneficiary contributes 20%. POWER Up to HIP Plus! 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. Copyright 2023 Member Benefits. In . Certain claim and network administration services are provided through Vision Service Plan (VSP), Rancho Cordova, CA. Other services not covered by Medicare Parts A and B include:4, Medicare Part C is also known as Medicare Advantage. Coverage is provided under a group insurance policy (Policy form GPNP99) issued by MetLife. Inpatient hospital: $450 per admission copay for unlimited days, plus 35% of our allowance. endstream endobj 97 0 obj <>stream The primary result of . Medicare Advantage plans may offer coverage for vision, hearing, dental and wellness services. 125 0 obj <>stream To connect with SurgeryPlus today, call 833-709-2445. 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. Medicare Part A does cover care provided in a skilled nursing facility with certain conditions and time limitations. For example, if youre still working and covered by your employer or your spouses employer sponsored health coverage, you may be able to wait. Does Medicare Cover Pre-existing Conditions? Medicare.com, last accessed June 10, 2022. You earn the reward once the following occurs: The reward will then be credited to the savings and spending account of your choice. On average, cataract surgery costs about $5,000 per eye; however, in some places, this price can move up to over $10,000. What's not covered by Part A & Part B? Medicare.gov, last accessed June 10, 2022. 0000019705 00000 n 0000015692 00000 n Text Size Smaler, Make Text Size ic+C@nN`RYva@\}KRr>Wq8=Rw+{a .n!LF40d=DdcB42r7hRXyMQ"wDYfuwO se)D+jd7bLB,2}a'_UOaB:.bwRIQGp)` aHeO\@qPtn#u,{n{@|=V<^N}Ap2,+H>0$_ -C "L @Zd X$9RAC~yGz3)fjaPk !e E57 Hln8 ``:w0@6Cfmu ] Negotiated fees typically range from 15-45% below the average fees charged in a dentists community for the same or substantially similar services. hb``P```e```5c@L@q EP0 Procedures can cost from $700 to $2,000 per eye, depending on . The estimate helps you prepare for the cost of dental services. Expand your practice We route you incremental cases outside the typical radius of your practice. Consult your healthcare provider if you have questions or concerns. Delaware's Governor Call a Care Advocate at 833.709.2444 for more information. 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. 866-855-1212 to request a claim form. What Part A covers, Medicare.gov, last accessed June 10, 2022. About SurgeryPlus SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. The service categories and plan limitations shown below represent an overview of the plan benefits. 0000019224 00000 n Procedure charge schedules are subject to change each plan year. SurgeryPlus Frequently Asked Questions General Questions . Gross Receipts Tax Tax Center 0000014887 00000 n Your costs in Original Medicare For surgeries or procedures, it's hard to know the exact costs in advance. You are always free to select the dentist of your choice. 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. 0000005131 00000 n 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. 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. h`06NH+500 Medicare Part B may cover diagnostic hearing and balance examstests your doctor requires if you need medical treatment. SurgeryPlus is included in your medical benefits at no additional cost to you. He or she hasnt agreed to accept negotiated fees. Medicare pays 80% of the cost of traditional cataract surgery, which would be covered by Medicare Part B. Coverage Policies are not recommendations for treatment and should never be used as treatment guidelines. HVn7}Wt)A87HPV$(YXF;3as=sfj'O&y>=zF_Gmlr:v1z5`:A1suhMFY}r0_&o^w]vw%'o':~u>)|]!6nRBki;L}h0y^'#cCmJJc 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. 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. Malini Ghoshal, What You Need to Know About Medicare Prescription Drug Plans (Part D), Healthline, last accessed June 10, 2022. 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. Negotiated fees for non-covered services may not apply in all states.). endstream endobj 251 0 obj <. Many offer affordable or even $0 monthly plan premiums, but you must continue to pay the Medicare Part B premium. Pre-authorization will still need to be submitted by your provider to SurgeryPlus before the surgery is scheduled. Where two or more professionally acceptable dental treatments for a dental condition exist, reimbursement is based on the least costly treatment alternative. Please contact Member Benefits your plan administrator at 1-800-282-8626 for more information. Do your homework. You consent to receiving palliative care to make you comfortable versus care to try to cure your illness. 988 0 obj Members of HumanaVision can receive deeper discounts on LASIK services, especially when using a specific in-network provider. SurgeryPlus is a voluntary benefit that provides pre-planned, non-emergency surgical services. . The SBC was created to make it easier to compare and shop for health plans. This document presents the majority of services within each category, but is not a complete description of the plan. Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. 12 Always err on the side of caution! Every SBC is created with four double-sided pages and 12-point type. But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary.12. Benefit coverage for health services is determined by the member specific benefit plan document and applic able laws that may require coverage for a specific service. 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. 0000012970 00000 n Yes. 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. *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. Guided Support You pay 20% of the Medicare Part B copay plus any out-of-pocket costs such as your deductible, medication costs and physician fees. Looser styling flatters while cleverly camouflaging around your middle. What happens with my health information? Mon-Fri, 8:30am-5:00pm (ET), Texas office There is a long list of items covered, including: Before renting or purchasing any medical equipment, be sure to ask if the retailer or supplier participates in Medicare. This guide will explain the different types of . You can use the SBC to compare prices, benefits and other health plan options and features that might be important to you. Eleesha Lockett, Does Medicare Cover Plastic Surgery? Healthline, last accessed June 10, 2022. Coverage will be considered under your out-of-network benefits. hbbd```b``f+A$S$d@$&},L`1]`*z3`] rO o bHHj@&{:.a`$ S 0000015930 00000 n 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 When will my medical insurance cover oral surgery? About Us; Staff; Camps; Scuba. If permitted, you may only be responsible for the negotiated fee. 00k` !" 0000023776 00000 n Before undergoing surgery, youll want to be connected with the highest-quality providers and facilities. 0000401803 00000 n 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. To see if your procedure is covered, contact us. 9l J'X:50e0l`} }U,,Q`lam[5-0f`MVe` The State Employee Benefits Committee (SEBC) believes in providing high quality care to members at an affordable cost. This Coverage Policy addresses breast reduction for symptomatic macromastia and breast reduction surgery on If you and your dentist have agreed on a treatment that is more costly than the treatment upon which the plan benefit is based, you will be responsible for any additional payment responsibility. To get you to the right place, click the link below to indicate whether you are a member of Surgery Direct or Cancer Care Direct. Some examples of comorbidities include high blood pressure, high cholesterol, obstructive sleep apnea, Type II Diabetes, angina or stroke. 2 If you have Medicare Part B primary, your costs for prescription drugs may be lower. Have a body mass index over 35 with severe comorbidity. 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. To assist, American Airlines has business relationships with third-party vendors, for example, BCBS, UHC, and WebMD Health Services. Reconstructive Procedures include surgery or other procedures which are related to a health condition. Also, your doctor will need to certify that you need certain eligible in-home services. Click Register Now to create your profile and start exploring this free service. A participating dentist is a general dentist or specialist who has agreed to accept negotiated fees as payment in full for services provided to plan members. Jacksonville, FL 32256 Privacy Policy However, some UnitedHealthcare policies charge lower deductibles . Elected Officials Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment. 0000001036 00000 n 0000024262 00000 n Examples of procedures covered are hernia repair, hysterectomy, colonoscopy, tendon release, spine injections and fusions, knee replacements, and many more. Always err on the side of caution! 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. However, Medicare doesnt cover routine hearing exams, hearing aids or fittings.7. SurgeryPlus provides an alternative to using your health plan for a planned surgical procedure that is not an emergency. endstream endobj 124 0 obj <>/Filter/FlateDecode/Index[5 84]/Length 22/Size 89/Type/XRef/W[1 1 1]>>stream Read your certificate of insurance for details on plan benefits, limitations, and exclusions. Dentists may submit your claims for you which means you have little or no paperwork. startxref It has less visits to physical, speech and occupational therapies than HIP Plus. Through the planning process, you will work with the same Care Advocate. 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. An estimated cost of cataract surgery may be*: In a surgery center or clinic, the average total cost is $977. Weight-Loss (Bariatric) Surgery. 1XQg&.9mE#(Tq& For the Plus Size Queens. Your SurgeryPlus benefit will also help pay for necessary travel associated with the covered procedure. Austin, TX 78735 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. You can also go through the SurgeryPlus member portal. If it contains a form, you can print it and fill it out. Yes. To provide and maintain this valuable membership benefit, MetLife reimburses the association and/or the plan administrator for these costs. These plans include all your Part A and Part B coverage and often provide extra coverage for services not included in Original Medicare. 0 Hospital Care. ii AF! 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. 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. %%EOF . 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.
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