Also, your doctor will need to certify that you need certain eligible in-home services. Your copays and deductibles will still apply. Click Register Now to create your profile and start exploring this free service. However, Medicare doesnt cover routine hearing exams, hearing aids or fittings.7. 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. 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. All services defined in your group dental benefits plan certificate are covered. You earn the reward once the following occurs: The reward will then be credited to the savings and spending account of your choice. received at a facility maintained by the Policyholder, labor union, mutual benefit association, or VA hospital; Services covered under other coverage provided by the Policyholder; Services for which the submitted documentation indicates a poor prognosis; The following when charged by the Dentist on a separate basis: infection control such as gloves, masks, and sterilization of supplies; or. 0000016018 00000 n The service categories and plan limitations shown below represent an overview of the plan benefits. Home health services, Medicare.gov, last accessed June 10, 2022. 10 frequently asked questions about Medicare plans, Deductibles for Medicare Part A and Part B. Your doctor certifies that you are terminally ill, meaning that your life expectancy is 6 months or less. <. The estimate helps you prepare for the cost of dental services. What is Medicare Part C? U.S. Department of Health & Human Services, last accessed June 10, 2022. Call our Health Response Center at. This website provides an overview of your benefit options. Public Meetings 89 0 obj <> endobj 0 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). The SBC was created to make it easier to compare and shop for health plans. These partners are required to comply with all laws protecting privacy. 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. 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. SurgeryPlus notifies that you or your dependent earned the reward. hb```f`` vAX,Xf000Z\ q1=nIc /( 125 0 obj <>stream For example, if youre still working and covered by your employer or your spouses employer sponsored health coverage, you may be able to wait. General Assembly It is not to be used for medical advice, diagnosis or treatment. Learn more aboutsavings and spending accounts. For procedures requiring inpatient admission or overnight recovery, the travel benefit covers the patient and one companion for a limited amount of time. Its also possible to get an SBC in another language. Bigger. Mastectomy surgery is a significant life event for many people. About SurgeryPlus SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. Please remember to hold on to all receipts to submit a dental claim. Coverage Policies are not recommendations for treatment and should never be used as treatment guidelines. Know your options. Original Medicare generally doesnt cover the cost of a nursing home, assisted living or long-term care facility. <>/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 Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. Pre-/postnatal professional care: 35% of our allowance . Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. You consent to receiving palliative care to make you comfortable versus care to try to cure your illness. SurgeryPlus is separate from your health plan and has its own network of high-quality providers. Coverage includes access to our network of excellent surgeons, consults and appointments with your SurgeryPlus provider, anesthesia, the procedure and facility (hospital) fees. By receiving services through SurgeryPlus, you and your dependents can earn financial rewards. To connect with SurgeryPlus today, call 833-709-2445. Examples of procedures covered are hernia repair, hysterectomy, colonoscopy, tendon release, spine injections and fusions, knee replacements, and many more. 00k` !" Only travel arrangements made through your Care Advocate are eligible for coverage under the SurgeryPlus benefit. 0000006640 00000 n 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. HIP Plus is the plan for the best value.HIP Plus provides health coverage for a low, predictable monthly cost. hbbbd`b`` K You can also go through the SurgeryPlus member portal. The State of Delaware is an Equal Opportunity employer and values a diverse workforce. This group plan is made available to through membership in the American Association of Business Networking (ABN). Will Medicare Cover LASIK Eye Surgery? Medicare.org, last accessed June 10, 2022. Medicare Part A does cover care provided in a skilled nursing facility with certain conditions and time limitations. 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. Effective July 1, 2023, bariatric surgery coverage will be available exclusively through the SurgeryPlus benefit. 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. 1 Sturti / Getty Images Coverage Varies by Insurer Each health plan is different. 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. This website and phone number are for use by dental professionals only. Medicare pays 80% of the cost of traditional cataract surgery, which would be covered by Medicare Part B. <> 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. 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. Refer to the customer's benefit plan document for coverage details. 0000001651 00000 n For example, breast augmentation for cosmetic reasons isnt covered by Medicare, but reconstructive surgery after a mastectomy is covered.11, Medicare wont cover Lasik surgery just to avoid the need for glasses. Franchise Tax 0000381088 00000 n 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. 1. 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. Because its all in the same format, its easier to make apples-to-apples comparisons when youre deciding which plan is best for you. "_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 Medically necessary services diagnose and treat health problems. About Us; Staff; Camps; Scuba. Medicare pays $781, and your cost is $195. (Due to contractual requirements, MetLife is prevented from soliciting certain providers.) 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. You'll also pay a deductible of $233. Members of HumanaVision can receive deeper discounts on LASIK services, especially when using a specific in-network provider. 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. Delaware's Governor This program will be available on January 1, 2020. 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. The State Employee Benefits Committee (SEBC) believes in providing high quality care to members at an affordable cost. Heres a step-by-step look at what information is in an SBC: You can request a copy of an SBC anytime. However, if you choose a non-participating dentist, your out-of-pocket costs may be higher. 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. startxref Where two or more professionally acceptable dental treatments for a dental condition exist, reimbursement is based on the least costly treatment alternative. Yes. Pick the option that's best for you. NCD for Bariatric Surgery for Treatment of Co-Morbid Conditions Related to Morbid Obesity (100.1) and NCD for Surgery for Diabetes (100.14) for coverage guideline. Take some time to understand your Medicare plan. This webpage is provided for summary purposes only and is not a complete description of the plan benefits, limitations, and exclusions. Assign you a personal care coordinator to offer one-on-one guidance and support as you prepare for, undergo and recover from surgery. 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. Medicare pays 80% of the treatment costs, and the beneficiary contributes 20%. Delaware Courts Austin, TX 78735 What's not covered by Part A & Part B? Medicare.gov, last accessed June 10, 2022. Have a body mass index over 35 with severe comorbidity. You'll be more confident on the beach with an extensive selection of plus-size swimwear. 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. Adjustable straps allow for a better, customized fit. VSP is not affiliated with Metropolitan Life Insurance Company or its affiliates. The time a mother and baby spend in the hospital after delivery is a medical decision. You may choose to share the information with your doctor and other medical professionals. Many offer affordable or even $0 monthly plan premiums, but you must continue to pay the Medicare Part B premium. We cover the most expensive costs associated with your surgery so youll pay less for your procedure. 6 Original Medicare may even pay for corrective lenses if you have surgery to implant an intraocular lens (IOL). 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. Coverage Policy ; Coverage for bariatric surgery or revision of a bariatric surgical procedure varies across plans and may be governed by state mandates. xref (Negotiated fees are subject to change.). Benefits are subject to change upon agreement between Metropolitan Life Insurance Company and the participating organization. 0000024943 00000 n Fair and simple terms We pay a fair, transparent rate for cases and streamline reimbursement, decreasing your administrative burden. 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. Pre-authorization will still need to be submitted by your provider to SurgeryPlus before the surgery is scheduled. Business First Steps, Phone Directory Every SBC is created with four double-sided pages and 12-point type. 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. Policy number 5343606-1-G (Low plan), Metropolitan Life Insurance Company, 200 Park Avenue, New York, NY 10166 Do your homework. There are no simple answers, but you can start here to find general answers to some of the most common questions about Medicare coverage. 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. 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. Outpatient facility care: 35% of our allowance . Weight-Loss (Bariatric) Surgery. If it contains a form, you can print it and fill it out. This communication does not guarantee benefits and does not indicate all services received will be covered by your plan. Wearing a swimsuit after a mastectomy can be a transition. 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 Tax Center This information is provided for educational purposes only. What is the SurgeryPlus benefit? You can choose whether or not to use SurgeryPlus for your surgical procedures. Individuals enrolled in a State of Delaware Aetna or Highmark Delaware non-Medicare health plan are automatically enrolled in this FREE benefit. Group dental insurance policies featuring the Preferred Dentist Program are underwritten by Metropolitan Life Insurance Company, New York, NY 10166. Delaware Topics Other services not covered by Medicare Parts A and B include:4, Medicare Part C is also known as Medicare Advantage. All health plan companies are required to provide an SBC for each of their different plans. Alternatively, a Medicare Advantage plan often provides comprehensive vision coverage, plus cataract surgery without out-of-pocket coinsurance costs.". (Based on internal analysis by MetLife. 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. Coverage will be considered under your out-of-network benefits. . Generally, most vision, dental and hearing services are not covered by Medicare Parts A and B. Medicare won't cover Lasik surgery just to avoid the need for glasses. Disclaimer State Regulations Your SurgeryPlus benefit will also help pay for necessary travel associated with the covered procedure. Membership in the ABN in required to enroll in this plan. Medicare Part B benefits cover 80% of the Medicare-approved amount for cataract surgery. Guided Support Voting & Elections Privacy Policy The surgery and any facility costs will be 100% covered under your SurgeryPlus benefit. Preventive & screening services, Medicare.gov, last accessed June 10, 2022. 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. Filing a health insurance claim is simple and can be done in one of two ways. Read your certificate of insurance for details on plan benefits, limitations, and exclusions. Cities & Towns %PDF-1.6 % Remember that Medicare Advantage plans are required by law to offer all the benefits of Original Medicare, but most plans offer much more. 10739 Deerwood Park Blvd, Suite 200-B Learn more about a Summary of Benefits and Coverage, also commonly referred to as an SBC. endobj 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. Licensed Humana sales agents are available daily, 8a.m. 8 p.m. Elected Officials This is because you won't know what services you need until you meet with your provider. 0000001266 00000 n Whats a Summary of Benefits and Coverage? This exclusion will apply whether or not the person receiving the services is enrolled for the government plan. Your medical insurance may also pick up the cost in full or part for medically-related . Prescription drug planscalled Medicare Part Dare only available through private companies like Humana. hb``P```e```5c@L@q EP0 endstream endobj 124 0 obj <>/Filter/FlateDecode/Index[5 84]/Length 22/Size 89/Type/XRef/W[1 1 1]>>stream American Airlines manages employee and retiree health benefits. However, this depends on the specific type of surgery you need, your dental plan, and your level of coverage. Thats because its basically a document that outlines whats covered and not covered under a health plan. If you qualify for it, Medicaid, which is administered by states under federal guidelines, may cover nursing home care. 0 Copyright 2023 Member Benefits. 1096 0 obj Your SurgeryPlus Care Advocate will provide you one-on-one, personalized help each step of the way. Members will pay nothing out of pocket for bariatric surgery; however, financial incentives do not apply. If you need cataract surgery in both eyes . Facilitate and consolidate your payments. But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary. SurgeryPlus negotiates a single cost (bundled rate) for the entire surgical procedure, resulting in savings to the State of Delaware. EXA!YA?fqLv1bd::M&a54g#A010p]p 1XQg&.9mE#(Tq& Delaware Marketplace 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. SurgeryPlus Frequently Asked Questions General Questions . Malini Ghoshal, What You Need to Know About Medicare Prescription Drug Plans (Part D), Healthline, last accessed June 10, 2022. Expand your practice We route you incremental cases outside the typical radius of your practice. 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. This website is not intended as a contract of employment or a guarantee of current or future employment. Our licensed Humana sales agents are available to help you select the coverage that best meets your needs. A dental plan may cover routine office visits, fillings, crowns, root canals, oral surgery, periodontics, orthodontics, or bridges and dentures. All other HIP plans cover members ages 19 to 64. 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. 0000377893 00000 n Dependent age may vary by state. This symbol denotes a Web Page. %PDF-1.6 % Gross Receipts Tax 2 If you have Medicare Part B primary, your costs for prescription drugs may be lower. Administrative services provided by United HealthCare Services, Inc. or their affiliates. Procedure charge schedules are subject to change each plan year. 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. If it contains a form, you can fill it out online and submit it. (Portal access Code: surgeryplus). "Original Medicare may cover 80% of a traditional cataract surgery. 0000011564 00000 n Vision benefits are underwritten by Metropolitan Life Insurance Company, New York, NY (MetLife). 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. 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. Yes. All rights reserved. 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. 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. This program utilizes the MetLife PDP Plus Network of participating dentists. Coverage may not be available in all states. Medicare Part B may cover diagnostic hearing and balance examstests your doctor requires if you need medical treatment. Dentists may submit your claims for you which means you have little or no paperwork. 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. 3 You must be the contract holder or spouse, 18 or older, on a Standard or Basic Option Plan to earn incentive rewards. Each company is a separate entity and is not responsible for another's financial or contractual obligations. <<7C167570AC52504DB41418C8CABC0A04>]/Prev 422895/XRefStm 1266>> Procedures can cost from $700 to $2,000 per eye, depending on . Mon-Fri, 8:30am-5:00pm (ET), Texas office This symbol denotes a PDF Document. Some links on this page may take you to Humana non-Medicare product or service pages or to a different website. You and your dentist will receive a benefit estimate for most procedures while you are still in the office. When enrolling you may choose to also cover your spouse, domestic partner, and/or children up to age 26. The choice is yours.

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