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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. 0000011564 00000 n Many Medicare Advantage plans include prescription drug coverage, in addition to all the benefits provided by Original Medicare Part A and Part B. 0000379543 00000 n 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. xref %%EOF Negotiated fees are subject to change. 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. SurgeryPlus Care Advocates are your connection to the SurgeryPlus benefit. Group dental insurance policies featuring the Preferred Dentist Program are underwritten by Metropolitan Life Insurance Company, New York, NY 10166. 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. Or Reach Us at 855-200-2099 " *" indicates required fields Delaware's Governor Theres a lot of information in an SBC. References to UnitedHealthcare pertain to each individual company or other UnitedHealthcare affiliated companies. Click Register Now to create your profile and start exploring this free service. Simply have your dentist submit a request online at www.metdental.com or call 1-877-MET-DDS9. Consult your healthcare provider if you have questions or concerns. Mon-Fri, 8:30am-5:00pm (ET), Texas office Will Medicare Cover LASIK Eye Surgery? Medicare.org, last accessed June 10, 2022. Coverage is provided under a group insurance policy (Policy form GPNP99) issued by MetLife. 0000377893 00000 n Or Reach Us at. Delaware State Code Membership in the ABN in required to enroll in this plan. Dependent age may vary by state. To check to see if you may already have SurgeryPlus, begin to type the name of your employer in the space below. To get one, contact us. 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. 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. <>/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 A mastectomy bra can provide comfort, support, and security to an individual as they become accustomed to their new normal. This website provides an overview of your benefit options. 0000024943 00000 n 0000010311 00000 n Some examples of comorbidities include high blood pressure, high cholesterol, obstructive sleep apnea, Type II Diabetes, angina or stroke. Your medical insurance may also pick up the cost in full or part for medically-related . What is Medicare Part C? U.S. Department of Health & Human Services, last accessed June 10, 2022. Policy number TS 05343606-G (High plan) Learn more about COVID-19 and the vaccine from the Division of Public Health, Learn about your benefits and resources for Behavioral Health & Emotional Wellbeing More Info. 89 37 Every SBC is created with four double-sided pages and 12-point type. <>stream Heres a step-by-step look at what information is in an SBC: You can request a copy of an SBC anytime. This symbol denotes a PDF Document. The specific travel benefit depends on the procedure, the provider, and the distance between the provider and a member's residence. 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. However, this depends on the specific type of surgery you need, your dental plan, and your level of coverage. Each company is a separate entity and is not responsible for another's financial or contractual obligations. Gross Receipts Tax Where two or more professionally acceptable dental treatments for a dental condition exist, reimbursement is based on the least costly treatment alternative. Outpatient facility care: 35% of our allowance . It has less visits to physical, speech and occupational therapies than HIP Plus. 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. Many offer affordable or even $0 monthly plan premiums, but you must continue to pay the Medicare Part B premium. Agent tip: "Original Medicare may cover 80% of a traditional cataract surgery. endstream endobj 97 0 obj <>stream 1 Sturti / Getty Images Coverage Varies by Insurer Each health plan is different. 10739 Deerwood Park Blvd, Suite 200-B 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. 1026 0 obj You can choose whether or not to use SurgeryPlus for your surgical procedures. Home health services, Medicare.gov, last accessed June 10, 2022. Even though its meant to make the information easier to understand, it can seem like a lot at first. If you need cataract surgery in both eyes . 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. 0000015692 00000 n 89 0 obj <> endobj 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. The time a mother and baby spend in the hospital after delivery is a medical decision. coinsurance and/or deductible on PPO plans, or copay on EPO plans). By packaging surgical expenses into one simple, bundled rate, SurgeryPlus is able save money for you and the State of Florida. 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. The sharing of health information between these companies is permitted by regulation. To see if your procedure is covered, contact us. State Agencies If it contains a form, you can fill it out online and submit it. Take some time to understand your Medicare plan. You may enroll for membership in the ABN directly through the ABN website or during your dental enrollment. 0000381088 00000 n The SurgeryPlus Difference We allow you to focus on practicing medicine and caring for patients. He or she hasnt agreed to accept negotiated fees. (Portal access Code: surgeryplus). 0000015806 00000 n Weather & Travel, Contact Us 3 You must be the contract holder or spouse, 18 or older, on a Standard or Basic Option Plan to earn incentive rewards. 0000012970 00000 n General Assembly What happens with my health information? Reconstructive Procedures include surgery or other procedures which are related to a health condition. This program utilizes the MetLife PDP Plus Network of participating dentists. Whats a Summary of Benefits and Coverage? Bigger. You earn the reward once the following occurs: The reward will then be credited to the savings and spending account of your choice. Vision benefits are underwritten by Metropolitan Life Insurance Company, New York, NY (MetLife). This group plan is made available to through membership in the American Association of Business Networking (ABN). 0000401803 00000 n You and your dentist will receive a benefit estimate for most procedures while you are still in the office. For example, rather than paying separately for the surgeon, facility, anesthesiologist, and radiologist, SurgeryPlus negotiates one bundled rate. 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. The State Employee Benefits Committee (SEBC) believes in providing high quality care to members at an affordable cost. hbbd```b``+@$}D 0000001266 00000 n 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. Metlife will not pay Dental Insurance benefits for charges incurred for: Alternate Benefits About SurgeryPlus SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. Only travel arrangements made through your Care Advocate are eligible for coverage under the SurgeryPlus benefit. 0000018849 00000 n SurgeryPlus is included in your medical benefits at no additional cost to you. Most common oral surgeries are covered, at least in part, by your dental insurance provider. Yes. Facilitate and consolidate your payments. 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. Alternatively, a Medicare Advantage plan often provides comprehensive vision coverage, plus cataract surgery without out-of-pocket coinsurance costs.". 7500 Rialto Blvd, Building 1 Suite 250 State Employees 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. Hearing & balance exams, Medicare.gov, last accessed June 10, 2022. Scuba Certification; Private Scuba Lessons; Scuba Refresher for Certified Divers; Try Scuba Diving; Enriched Air Diver (Nitrox) Coverage will be considered under your out-of-network benefits. To provide and maintain this valuable membership benefit, MetLife reimburses the association and/or the plan administrator for these costs. Wearing a swimsuit after a mastectomy can be a transition. Trust in our network 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. 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. In . 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. On average, cataract surgery costs about $5,000 per eye; however, in some places, this price can move up to over $10,000. 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. Learn more about a Summary of Benefits and Coverage, also commonly referred to as an SBC. Medicare Advantage plans may offer coverage for vision, hearing, dental and wellness services. <> 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. This symbol denotes a PDF Document. Effective July 1, 2023, bariatric surgery coverage will be available exclusively through the SurgeryPlus benefit. Administrative services provided by United HealthCare Services, Inc. or their affiliates. The Plan Sponsor(s) reserve the right to amend or terminate each plan at any time. 0000023776 00000 n You'll also pay a deductible of $233. All health plan companies are required to provide an SBC for each of their different plans. Examples of procedures covered are hernia repair, hysterectomy, colonoscopy, tendon release, spine injections and fusions, knee replacements, and many more. Assign you a personal care coordinator to offer one-on-one guidance and support as you prepare for, undergo and recover from surgery. What's not covered by Part A & Part B? Medicare.gov, last accessed June 10, 2022. Before undergoing surgery, youll want to be connected with the highest-quality providers and facilities. TE 6Uz A$& &`5= X7"yH: wd`^+H(`q] DF9qt RSS Feeds, Make startxref You can ask for a pretreatment estimate. The State of Delaware is an Equal Opportunity employer and values a diverse workforce. 0000001651 00000 n Pick the option that's best for you. 12 Always err on the side of caution! endstream endobj startxref This webpage is provided for summary purposes only and is not a complete description of the plan benefits, limitations, and exclusions. When will my medical insurance cover oral surgery? 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. Yes. Benefits are subject to change upon agreement between Metropolitan Life Insurance Company and the participating organization. 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 Medicare pays 80% of the cost of traditional cataract surgery, which would be covered by Medicare Part B. 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. Delaware Topics Licensed Humana sales agents are available daily, 8a.m. 8 p.m. 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. Our licensed Humana sales agents are available to help you select the coverage that best meets your needs. 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. Mastectomy surgery is a significant life event for many people. <<7C167570AC52504DB41418C8CABC0A04>]/Prev 422895/XRefStm 1266>> 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. The SBC was created to make it easier to compare and shop for health plans. When enrolling you may choose to also cover your spouse, domestic partner, and/or children up to age 26. A prime example is breast implants done during or after breast cancer surgery. For specific LCDs/LCAs, refer to the table for This surgery makes the stomach smaller. . 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. 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. 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. The inclusion of a code does not imply any right to . Disclaimer You can also go through the SurgeryPlus member portal. Locations Directory (Refer to your dental benefits plan summary for your out-of-network dental coverage.) 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). Yes. HIP Plus is the plan for the best value.HIP Plus provides health coverage for a low, predictable monthly cost. At time of enrollment, you will choose how you want to pay. 0000024865 00000 n 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. 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. What Part A covers, Medicare.gov, last accessed June 10, 2022. VSP is not affiliated with Metropolitan Life Insurance Company or its affiliates. Looser styling flatters while cleverly camouflaging around your middle. Yes. endstream endobj 251 0 obj <. Out-of-pocket costs may be greater if you visit a dentist who does not participate in the network. It requires doctors and facilities to meet strict credential guidelines leading to the highest quality care possible. 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. Medicare won't cover Lasik surgery just to avoid the need for glasses. When it comes to Medicare, the question we hear most often after What does it cost? is, What does it cover?. Thats because its basically a document that outlines whats covered and not covered under a health plan. This benefit is available to those enrolled in one of the CEBT EPO, PPO or HDHP medical plans. 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. Medicare Part B contributes 80% of the cost of one pair of eyeglasses or set of contact lenses after cataract surgery after. 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 The amount of benefits payable by MetLife may be reduced due to the benefits paid under the primary plan. We cover the most expensive costs associated with your surgery so you'll pay less for your procedure. Connect you with a top-ranked, board-certified and fellowship-trained surgeon near you. 250 0 obj <> endobj Other services not covered by Medicare Parts A and B include:4, Medicare Part C is also known as Medicare Advantage. 2 If you have Medicare Part B primary, your costs for prescription drugs may be lower. You sign a consent form to receive hospice care instead of other Medicare-covered treatments for your terminal condition. The service categories and plan limitations shown below represent an overview of the plan benefits. endstream 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. This is a voluntary benefit available to you if you're enrolled in the Core, Standard, Plus or High Cost Coverage medical option. 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. Your private health information is just that private. 125 0 obj <>stream 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. The complete provisions of the plans are set forth in the Plan Documents and Summary Plan Description. You are always free to select the dentist of your choice. Mobile Apps Please fill out the contact form so the right person can be in touch quickly. 9l J'X:50e0l`} }U,,Q`lam[5-0f`MVe` Wearing a Suit After a Body-Altering 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. 0000014887 00000 n Business First Steps, Phone Directory Delaware Marketplace Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. 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. 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. 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 0000000016 00000 n hbbd```b``f+A$S$d@$&},L`1]`*z3`] rO o bHHj@&{:.a`$ S For the Plus Size Queens. Medicare Part A does cover care provided in a skilled nursing facility with certain conditions and time limitations. Consult your doctor before beginning any new diet or exercise regimen. Hospital Care. To connect with SurgeryPlus today, call 833-709-2445. Home. hbbbd`b`` K Negotiated fees for non-covered services may not apply in all states.). Individuals enrolled in a State of Delaware Aetna or Highmark Delaware non-Medicare health plan are automatically enrolled in this FREE benefit. Negotiated fees are subject to change. Bariatric surgery is surgery to help you lose weight. 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. You simply need to provide the plan administrator with advanced written notice along with any required premium. Voting & Elections Surgical Coverage Surgery Surgery Medicare covers many medically necessary surgical procedures. You'll be more confident on the beach with an extensive selection of plus-size swimwear. endobj Knowing which types of common medical costs are not covered will be helpful when planning for your out-of-pocket medical costs. 0000004536 00000 n 1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. Your costs in Original Medicare For surgeries or procedures, it's hard to know the exact costs in advance. 00k` !" 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. Some types of surgery also change the connection between your stomach and intestines. hb```b``Nf`c`Wcd@ AV(G 2?X%c6g+S@|dHA[&@VS&-,&W\\f9v| **s)S\Ol%5T7A(F Your SurgeryPlus benefit will also help pay for necessary travel associated with the covered procedure.

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