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. A reminder that the SBC is only a summary. The inclusion of a code does not imply any right to . endobj Copyright 2022 Employer Direct HealthcareAll Rights Reserved. Hearing & balance exams, Medicare.gov, last accessed June 10, 2022. Cancellation/Termination of Benefits 1 Sturti / Getty Images Coverage Varies by Insurer Each health plan is different. Guided Support 0000023776 00000 n What's not covered by Part A & Part B? Medicare.gov, last accessed June 10, 2022. Medicare pays $781, and your cost is $195. 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. 0000001609 00000 n 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. Effective July 1, 2023, bariatric surgery coverage will be available exclusively through the SurgeryPlus benefit. Dentists may submit your claims for you which means you have little or no paperwork. endstream endobj 251 0 obj <. Austin, TX 78735 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. This exclusion will apply whether or not the person receiving the services is enrolled for the government plan. You can also go through the SurgeryPlus member portal. Confirm your coverage before you commit to a procedure youre unsure about. Because its all in the same format, its easier to make apples-to-apples comparisons when youre deciding which plan is best for you. Agent tip: "Original Medicare may cover 80% of a traditional cataract surgery. <>/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 h`06NH+500 If the information online is inconsistent with the Plan Documents, the Plan Documents will govern. 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. Group dental insurance policies featuring the Preferred Dentist Program are underwritten by Metropolitan Life Insurance Company, New York, NY 10166. (Refer to your dental benefits plan summary for your out-of-network dental coverage.) What is Medicare Part C? U.S. Department of Health & Human Services, last accessed June 10, 2022. 1026 0 obj Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. Premiums and the list of covered drugscalled a formularywill vary by plan.6. HVn7}Wt)A87HPV$(YXF;3as=sfj'O&y>=zF_Gmlr:v1z5`:A1suhMFY}r0_&o^w]vw%'o':~u>)|]!6nRBki;L}h0y^'#cCmJJc 10 frequently asked questions about Medicare plans, Deductibles for Medicare Part A and Part B. This benefit is available to those enrolled in one of the CEBT EPO, PPO or HDHP medical plans. 1XQg&.9mE#(Tq& It has less visits to physical, speech and occupational therapies than HIP Plus. This webpage is provided for summary purposes only and is not a complete description of the plan benefits, limitations, and exclusions. Dependent age may vary by state. 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. <<7C167570AC52504DB41418C8CABC0A04>]/Prev 422895/XRefStm 1266>> The complete provisions of the plans are set forth in the Plan Documents and Summary Plan Description. 0000379543 00000 n 0 Or Reach Us at 855-200-2099 " *" indicates required fields 0000007939 00000 n Yes. 0000000016 00000 n 0000015930 00000 n This is a voluntary benefit available to you if you're enrolled in the Core, Standard, Plus or High Cost Coverage medical option. Individuals enrolled in a State of Delaware Aetna or Highmark Delaware non-Medicare health plan are automatically enrolled in this FREE benefit. (Due to contractual requirements, MetLife is prevented from soliciting certain providers.) You can also go through the SurgeryPlus member portal. Durable medical equipment (DME) coverage, Medicare.gov, last accessed June 10, 2022. Thats because its basically a document that outlines whats covered and not covered under a health plan. 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. Certain claim and network administration services are provided through Vision Service Plan (VSP), Rancho Cordova, CA. . 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. Arrives by Mon, Mar 13 Buy Samickarr Clearance items!Wireless Support Bras For Women Full Coverage And Lift Plus Size Bras Post-Surgery Bra Wirefree Bralette Minimizer Bra For Everyday Comfort at Walmart.com 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. This document presents the majority of services within each category, but is not a complete description of the plan. Inpatient (Precertification is required): $350 per admission. Gross Receipts Tax Enter your ZIP code below to see plans with their premiums, copays, and participating doctors and pharmacies. Jacksonville, FL 32256 Adjustable straps allow for a better, customized fit. You'll also pay a deductible of $233. %PDF-1.4 % The State of Delaware is an Equal Opportunity employer and values a diverse workforce. General Assembly 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. Coverage is provided under a group insurance policy (Policy form GPNP99) issued by MetLife. 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. Trust in our network Please fill out the contact form so the right person can be in touch quickly. 89 0 obj <> endobj 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. 0000381088 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. <> Most plans cover the entire cost of preventive care, plus a portion of the cost after you meet your deductible for other procedures. If permitted, you may only be responsible for the negotiated fee. SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. Your private health information is just that private. 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. 0000011564 00000 n 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. hbbbd`b`` K The specific travel benefit depends on the procedure, the provider, and the distance between the provider and a member's residence. Copyright 2023 Member Benefits. You may need to exhaust your personal resources on medical care before you are eligible. This group plan is made available to through membership in the American Association of Business Networking (ABN). endstream State Agencies Consistent with federal law effective 1/1/98, the Cigna national maternity policy includes coverage for 48 hours of hospitalization following a normal vaginal delivery and 96 hours following an uncomplicated Caesarean section. 0 Delaware State Code 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. State Employees You may choose to share the information with your doctor and other medical professionals. The Plan Sponsor(s) reserve the right to amend or terminate each plan at any time. 0000018849 00000 n Procedures can cost from $700 to $2,000 per eye, depending on . Home. Delaware Marketplace To check to see if you may already have SurgeryPlus, begin to type the name of your employer in the space below. Filing a health insurance claim is simple and can be done in one of two ways. 0000012970 00000 n 1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. startxref 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. 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. Wearing a Suit After a Body-Altering Surgery. Your doctor certifies that you are terminally ill, meaning that your life expectancy is 6 months or less. You sign a consent form to receive hospice care instead of other Medicare-covered treatments for your terminal condition. 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. (Portal access Code: surgeryplus). Even though its meant to make the information easier to understand, it can seem like a lot at first. Whats a Summary of Benefits and Coverage? Information gathered by our partners will be used for your benefit to help guide you on your path to wellness. Medicare will not pay for 24-hour in-home care or meals delivered to you at home. startxref 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. Membership in the ABN in required to enroll in this plan. Generally, most vision, dental and hearing services are not covered by Medicare Parts A and B. Only travel arrangements made through your Care Advocate are eligible for coverage under the SurgeryPlus benefit. Yes. Thats what SurgeryPlus does. %%EOF 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. You simply need to provide the plan administrator with advanced written notice along with any required premium. Child(ren)s eligibility for dental coverage is from birth up to age 26. Overview . The time a mother and baby spend in the hospital after delivery is a medical decision. Outpatient facility care: 35% of our allowance . Learn more about a Summary of Benefits and Coverage, also commonly referred to as an SBC. 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. If it contains a form, you can fill it out online and submit it. Through the planning process, you will work with the same Care Advocate. 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. All health plan companies are required to provide an SBC for each of their different plans. Locations Directory Other services not covered by Medicare Parts A and B include:4, Medicare Part C is also known as Medicare Advantage. "L @Zd X$9RAC~yGz3)fjaPk !e E57 Hln8 ``:w0@6Cfmu ] Yes. An estimated cost of cataract surgery may be*: In a surgery center or clinic, the average total cost is $977. You can track your claims online and even receive e-mail alerts when a claim has been processed. Rest easy knowing you can afford the surgery you need, HDHP Plans will require a reduced deductible to be met first. This website is not intended as a contract of employment or a guarantee of current or future employment. This benefit is available to those enrolled in one of the CEBT EPO, PPO or HDHP medical plans. This may include surgery to remove cataracts or after an eye injury. Transparency It does not cover bariatric surgery or jaw care (TMJ). Medicare pays 80% of the treatment costs, and the beneficiary contributes 20%. A prime example is breast implants done during or after breast cancer surgery. Remember that Medicare Advantage plans are required by law to offer all the benefits of Original Medicare, but most plans offer much more. Negotiated fees typically range from 15-45% below the average fees charged in a dentists community for the same or substantially similar services. You or your dependent use SurgeryPlus to receive a preoperative to post-operative bundled surgical service; SurgeryPlus validates that you or your dependent received the service; and. "_P^)J^:+&!nI-eMNYrVY;QU&+,SUdTVvSN(GTDS o5q_H\%lqbF$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 Withholding Tax Simply have your dentist submit a request online at www.metdental.com or call 1-877-MET-DDS9. The SurgeryPlus Difference We allow you to focus on practicing medicine and caring for patients. Wearing a swimsuit after a mastectomy can be a transition. Coverage includes access to our network of excellent surgeons, consults and appointments with your SurgeryPlus provider, anesthesia, the procedure and facility (hospital) fees. This surgery makes the stomach smaller. But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary. 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. 0000015692 00000 n What Part A covers, Medicare.gov, 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. We cover the most expensive costs associated with your surgery so youll pay less for your procedure. 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. He or she hasnt agreed to accept negotiated fees. Negotiated fees are subject to change. 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. 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. %%EOF You earn the reward once the following occurs: The reward will then be credited to the savings and spending account of your choice. About SurgeryPlus SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. Franchise Tax Medicare Advantage plans may offer coverage for vision, hearing, dental and wellness services. Privacy Policy Please fill out the contact form so the right person can be in touch quickly. Text Size Smaler, Make Text Size 10739 Deerwood Park Blvd, Suite 200-B 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. 0000401803 00000 n Hospice care, Medicare.gov, last accessed June 10, 2022. This assures State of Delaware Aetna and Highmark Delaware members will have access to surgeons and facilities that meet strict SurgeryPlus credentialing guidelines, leading to the highest quality care possible. Consult your doctor before beginning any new diet or exercise regimen. endobj 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. Coverage will be considered under your out-of-network benefits. Out-of-pocket costs may be greater if you visit a dentist who does not participate in the network. To see if your procedure is covered, contact us. 0000005131 00000 n Prescription drug planscalled Medicare Part Dare only available through private companies like Humana. 0000006640 00000 n 6 Original Medicare may even pay for corrective lenses if you have surgery to implant an intraocular lens (IOL). You'll be more confident on the beach with an extensive selection of plus-size swimwear. Will Medicare Cover LASIK Eye Surgery? Medicare.org, last accessed June 10, 2022. RSS Feeds, Make 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. Tax Center 0000010311 00000 n These rules determine the order in which the plans will pay benefits. 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. Policy number 5343606-1-G (Low plan), Metropolitan Life Insurance Company, 200 Park Avenue, New York, NY 10166 Call our Health Response Center at. Reconstructive Procedures include surgery or other procedures which are related to a health condition. Mon-Fri, 8:30am-5:00pm (CT). Personal Income Tax It requires doctors and facilities to meet strict credential guidelines leading to the highest quality care possible. SurgeryPlus is separate from your health plan and has its own network of high-quality providers. Yes. The service categories and plan limitations shown below represent an overview of the plan benefits. E-mail / Text Alerts Plan benefits and rates are effective for group plan year January 1, 2023 through December 31, 2024, and subject to change thereafter. Administrative services provided by United HealthCare Services, Inc. or their affiliates. Delaware Courts Updated 08/29/2019 . , begin to type the name of your employer in the space below. Connect you with a top-ranked, board-certified and fellowship-trained surgeon near you. 285 0 obj <>stream 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. Elected Officials 0 Or Reach Us at. However, Medicare doesnt cover routine hearing exams, hearing aids or fittings.7. L0920007743[exp0922][All States][DC,GU,MP,PR,VI] 2020 MSS, Florida office (headquarters) What Part B covers, Medicare.gov, last accessed June 10, 2022. Corporations 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 Pick the option that's best for you. The SBC was created to make it easier to compare and shop for health plans.

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