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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. Before undergoing surgery, youll want to be connected with the highest-quality providers and facilities. 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 Your medical insurance may also pick up the cost in full or part for medically-related . To get one, contact us. Medicare Part B may cover diagnostic hearing and balance examstests your doctor requires if you need medical treatment. You can also go through the SurgeryPlus member portal. <> 9l J'X:50e0l`} }U,,Q`lam[5-0f`MVe` Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment. hb```b``Nf`c`Wcd@ AV(G 2?X%c6g+S@|dHA[&@VS&-,&W\\f9v| **s)S\Ol%5T7A(F 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. Medicare Advantage plans may offer coverage for vision, hearing, dental and wellness services. (Based on internal analysis by MetLife. Consult your doctor before beginning any new diet or exercise regimen. At time of enrollment, you will choose how you want to pay. 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. Your costs in Original Medicare For surgeries or procedures, it's hard to know the exact costs in advance. 89 37 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. 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. Please review the plan summaries for summarized information and your certificate of insurance for detailed information about your plan benefits. 250 0 obj <> endobj A reminder that the SBC is only a summary. 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. Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. %PDF-1.4 % Negotiated fees are subject to change. 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. SurgeryPlus is a supplemental benefit for non-emergency surgeries that provides high-quality care, hb``P```e```5c@L@q EP0 This is because you won't know what services you need until you meet with your provider. Call a Care Advocate at 833.709.2444 for more information. 0 Even though its meant to make the information easier to understand, it can seem like a lot at first. For specific LCDs/LCAs, refer to the table for 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. Home health services, Medicare.gov, last accessed June 10, 2022. Assign you a personal care coordinator to offer one-on-one guidance and support as you prepare for, undergo and recover from surgery. Withholding Tax Administrative services provided by United HealthCare Services, Inc. or their affiliates. 0000001436 00000 n 0000006640 00000 n A prime example is breast implants done during or after breast cancer surgery. It is not to be used for medical advice, diagnosis or treatment. }4Q2L_L 0fI\l!AN7za|*_)2:lU2_kciTX*R:N%` c8B=3 Delaware State Code Expand your practice We route you incremental cases outside the typical radius of your practice. SurgeryPlus negotiates a single cost (bundled rate) for the entire surgical procedure, resulting in savings to the State of Delaware. You'll also pay a deductible of $233. 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. For the Plus Size Queens. 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 sharing of health information between these companies is permitted by regulation. Thats what SurgeryPlus does. 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. Negotiated fees are subject to change. You can also go through the SurgeryPlus member portal. Medicare pays $781, and your cost is $195. About SurgeryPlus SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. Connect you with a top-ranked, board-certified and fellowship-trained surgeon near you. Mobile Apps HIP Plus is the plan for the best value.HIP Plus provides health coverage for a low, predictable monthly cost. Through the planning process, you will work with the same Care Advocate. SurgeryPlus is included in your medical benefits at no additional cost to you. What is Medicare Part C? U.S. Department of Health & Human Services, last accessed June 10, 2022. Public Meetings endstream This information is provided for educational purposes only. You'll be more confident on the beach with an extensive selection of plus-size swimwear. 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. Preventive & screening services, Medicare.gov, last accessed June 10, 2022. 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. Procedures can cost from $700 to $2,000 per eye, depending on . You can ask for a pretreatment estimate. Inpatient (Precertification is required): $350 per admission. Pre-/postnatal professional care: 35% of our allowance . Coverage includes access to our network of excellent surgeons, consults and appointments with your SurgeryPlus provider, anesthesia, the procedure and facility (hospital) fees. h`06NH+500 866-855-1212. You pay 20% of the Medicare Part B copay plus any out-of-pocket costs such as your deductible, medication costs and physician fees. We recommend that you request a pre-treatment estimate for services in excess of $300. Facilitate and consolidate your payments. These partners are required to comply with all laws protecting privacy. The State Employee Benefits Committee (SEBC) believes in providing high quality care to members at an affordable cost. What's not covered by Part A & Part B? Medicare.gov, last accessed June 10, 2022. Gross Receipts Tax What Part A covers, Medicare.gov, last accessed June 10, 2022. This communication does not guarantee benefits and does not indicate all services received will be covered by your plan. Your SurgeryPlus Care Advocate will provide you one-on-one, personalized help each step of the way. 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. 0000001036 00000 n 0000009101 00000 n 89 0 obj <> endobj This symbol denotes a Web Page. Delaware's Governor 0000015930 00000 n 0000418667 00000 n SurgeryPlus provides an alternative to using your health plan for a planned surgical procedure that is not an emergency. You can choose whether or not to use SurgeryPlus for your surgical procedures. Prescription drug planscalled Medicare Part Dare only available through private companies like Humana. These savings are shared with the member through financial incentives and members will not be required to pay a copay, deductible, or coinsurance for services provided through SurgeryPlus. Please contact Member Benefits your plan administrator at 1-800-282-8626 for more information. Overview . Adjusting to the physical changes post-surgery can be difficult, and finding the right mastectomy bra is one of the most important steps in the process. 6 Original Medicare may even pay for corrective lenses if you have surgery to implant an intraocular lens (IOL). Privacy Policy Do your homework. cost of cataract surgery with medicare. Does Medicare Cover Pre-existing Conditions? Medicare.com, last accessed June 10, 2022. What Part B covers, Medicare.gov, last accessed June 10, 2022. By packaging surgical expenses into one simple, bundled rate, SurgeryPlus is able save money for you and the State of Florida. 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. Eleesha Lockett, Does Medicare Cover Plastic Surgery? Healthline, last accessed June 10, 2022. 3 You must be the contract holder or spouse, 18 or older, on a Standard or Basic Option Plan to earn incentive rewards. State Regulations Policy number 5343606-1-G (Low plan), Metropolitan Life Insurance Company, 200 Park Avenue, New York, NY 10166 %%EOF 0000024865 00000 n SurgeryPlus is a voluntary benefit that provides pre-planned, non-emergency surgical services. POWER Up to HIP Plus! Cancellation/Termination of Benefits %%EOF An estimated cost of cataract surgery may be*: In a surgery center or clinic, the average total cost is $977. 10739 Deerwood Park Blvd, Suite 200-B Some links on this page may take you to Humana non-Medicare product or service pages or to a different website. Franchise Tax Please use this access code on website: surgeryplus. Always err on the side of caution! 2 If you have Medicare Part B primary, your costs for prescription drugs may be lower. SurgeryPlus Frequently Asked Questions General Questions . 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. Yes. Fair and simple terms We pay a fair, transparent rate for cases and streamline reimbursement, decreasing your administrative burden. <<7C167570AC52504DB41418C8CABC0A04>]/Prev 422895/XRefStm 1266>> What is the SurgeryPlus benefit? 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. 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. 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. Alternatively, a Medicare Advantage plan often provides comprehensive vision coverage, plus cataract surgery without out-of-pocket coinsurance costs.". Help Center Weather & Travel, Contact Us Blue Distinction Centers for Substance Use Treatment and Recovery aims to improve patient outcomes and value by focusing on providers across the full continuum of care who deliver and facilitate treatment for substance use disorder, including opioid use disorder. 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. This symbol denotes a PDF Document. 0000023776 00000 n He or she hasnt agreed to accept negotiated fees. The effective date of coverage for newly added dependent(s) will depend on when we receive notice and required premium. 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. Examples of procedures covered are hernia repair, hysterectomy, colonoscopy, tendon release, spine injections and fusions, knee replacements, and many more. SurgeryPlus Care Advocates are your connection to the SurgeryPlus benefit. 0000019705 00000 n Coverage Policies are not recommendations for treatment and should never be used as treatment guidelines. Where two or more professionally acceptable dental treatments for a dental condition exist, reimbursement is based on the least costly treatment alternative. 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. A mastectomy bra can provide comfort, support, and security to an individual as they become accustomed to their new normal. Whats a Summary of Benefits and Coverage? hbbd```b``+@$}D Find out which Humana plans include your doctors and cover the medications you take now to help you estimate your costs. startxref Locations Directory We cover the most expensive costs associated with your surgery so youll pay less for your procedure. Theres a lot of information in an SBC. All services defined in your group dental benefits plan certificate are covered. The amount of benefits payable by MetLife may be reduced due to the benefits paid under the primary plan. You and your dentist will receive a benefit estimate for most procedures while you are still in the office. coinsurance and/or deductible on PPO plans, or copay on EPO plans). 0 The SurgeryPlus Difference We allow you to focus on practicing medicine and caring for patients. 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. 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. lbSy Voting & Elections Weight-Loss (Bariatric) Surgery. But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary. Many Medicare Advantage plans include prescription drug coverage, in addition to all the benefits provided by Original Medicare Part A and Part B. The inclusion of a code does not imply any right to . 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. 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. Enter your ZIP code below to see plans with their premiums, copays, and participating doctors and pharmacies. 0000015806 00000 n endstream Consult your healthcare provider if you have questions or concerns. Only travel arrangements made through your Care Advocate are eligible for coverage under the SurgeryPlus benefit. Information gathered by our partners will be used for your benefit to help guide you on your path to wellness. Negotiated fees typically range from 15-45% below the average fees charged in a dentists community for the same or substantially similar services. <>stream This program will be available on January 1, 2020. 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. Effective July 1, 2023, bariatric surgery coverage will be available exclusively through the SurgeryPlus benefit. The primary result of . (Due to contractual requirements, MetLife is prevented from soliciting certain providers.) You simply need to provide the plan administrator with advanced written notice along with any required premium. Will Medicare Cover LASIK Eye Surgery? Medicare.org, last accessed June 10, 2022. To check to see if you may already have SurgeryPlus, begin to type the name of your employer in the space below. Mastectomy surgery is a significant life event for many people. State Employees These plans include all your Part A and Part B coverage and often provide extra coverage for services not included in Original Medicare. The SBC was created to make it easier to compare and shop for health plans. Some types of surgery also change the connection between your stomach and intestines. 0000001266 00000 n If the MetLife dental benefit plan is primary, MetLife will pay the full amount of benefits that would normally be available under the plan. 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. Privacy Policy 0000004536 00000 n Take your bill (s) to your State Farm agent's office. It all depends on your policy. This document presents the majority of services within each category, but is not a complete description of the plan. The following services that are in progress while coverage is in effect will be paid after the coverage ends, if the applicable installment or the treatment is finished within 31 days after individual termination of coverage: Completion of a prosthetic device, crown or root canal therapy. However, this depends on the specific type of surgery you need, your dental plan, and your level of coverage. Coverage will be considered under your out-of-network benefits. 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. This surgery makes the stomach smaller. Some general conditions to receive coverage from United Healthcare requires that you meet the following criteria: Have a body mass index over 40 OR. Negotiated fees for non-covered services may not apply in all states.). This group plan is made available to through membership in the American Association of Business Networking (ABN). For procedures requiring inpatient admission or overnight recovery, the travel benefit covers the patient and one companion for a limited amount of time. 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. Coverage includes access to our network of excellent surgeons, consults and appointments with your SurgeryPlus provider, anesthesia, the procedure and facility (hospital) fees. 1. To get all the details, youll want to look at complete health plan documents. 0000392965 00000 n If permitted, you may only be responsible for the negotiated fee. In addition, it comes with a concierge service (Care Advocate) and travel benefits. Click Register Now to create your profile and start exploring this free service. "L @Zd X$9RAC~yGz3)fjaPk !e E57 Hln8 ``:w0@6Cfmu ] Delaware Courts endstream endobj 124 0 obj <>/Filter/FlateDecode/Index[5 84]/Length 22/Size 89/Type/XRef/W[1 1 1]>>stream Disclaimer "Original Medicare may cover 80% of a traditional cataract surgery. Actual payments may vary from the pretreatment estimate depending upon annual maximums, plan frequency limits, deductibles and other limits applicable at time of payment. Vision benefits are underwritten by Metropolitan Life Insurance Company, New York, NY (MetLife). 555 17th Street, Suite 2050 | Denver, CO 80202, 2023 CEBT :: CEBT is administered by WTW, When you use SurgeryPlus, CEBT will potentially waive your Out-of-Pocket costs (i.e. It has less visits to physical, speech and occupational therapies than HIP Plus. But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary.12. Most common oral surgeries are covered, at least in part, by your dental insurance provider. ic+C@nN`RYva@\}KRr>Wq8=Rw+{a .n!LF40d=DdcB42r7hRXyMQ"wDYfuwO se)D+jd7bLB,2}a'_UOaB:.bwRIQGp)` aHeO\@qPtn#u,{n{@|=V<^N}Ap2,+H>0$_ -C 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. You are always free to select the dentist of your choice. 0000011564 00000 n To provide and maintain this valuable membership benefit, MetLife reimburses the association and/or the plan administrator for these costs. 1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. 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. 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. 0000381088 00000 n 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. E-mail / Text Alerts Certain claim and network administration services are provided through Vision Service Plan (VSP), Rancho Cordova, CA. 1096 0 obj A dental plan may cover routine office visits, fillings, crowns, root canals, oral surgery, periodontics, orthodontics, or bridges and dentures. Continuous Glucose Monitors (CGMs)examples include Dexcom and Libre. Jacksonville, FL 32256 Your general dentist or specialist usually sends MetLife a plan for your care and requests an estimate of benefits. Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. The specific travel benefit depends on the procedure, the provider, and the distance between the provider and a member's residence. Your private health information is just that private. endobj Outpatient facility care: 35% of our allowance . Please Note: Additional information about this benefit change will be posted as it becomes available and before the July 1, 2023 effective date. Refer to the customer's benefit plan document for coverage details. RSS Feeds, Make By receiving services through SurgeryPlus, you and your dependents can earn financial rewards. Surgical Coverage Surgery Surgery Medicare covers many medically necessary surgical procedures.