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ii AF! When enrolling you may choose to also cover your spouse, domestic partner, and/or children up to age 26. Other services not covered by Medicare Parts A and B include:4, Medicare Part C is also known as Medicare Advantage. Pre-authorization will still need to be submitted by your provider to SurgeryPlus before the surgery is scheduled. 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. 0000004536 00000 n It has less visits to physical, speech and occupational therapies than HIP Plus. The inclusion of a code does not imply any right to . Medicare Part A does cover care provided in a skilled nursing facility with certain conditions and time limitations. Continuous Glucose Monitors (CGMs)examples include Dexcom and Libre. Surgical Coverage Surgery Surgery Medicare covers many medically necessary surgical procedures. If you need cataract surgery in both eyes . Policy number 5343606-1-G (Low plan), Metropolitan Life Insurance Company, 200 Park Avenue, New York, NY 10166 Withholding Tax RSS Feeds, Make We cover the most expensive costs associated with your surgery so youll pay less for your procedure. Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. "Original Medicare may cover 80% of a traditional cataract surgery. The State Employee Benefits Committee (SEBC) believes in providing high quality care to members at an affordable cost. 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 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. Confirm your coverage before you commit to a procedure you're unsure about. You can also go through the SurgeryPlus member portal. To get one, contact us. 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. 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. This is a voluntary benefit available to you if you're enrolled in the Core, Standard, Plus or High Cost Coverage medical option. Actual payments may vary from the pretreatment estimate depending upon annual maximums, plan frequency limits, deductibles and other limits applicable at time of payment. 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. This information is provided for educational purposes only. 989 0 obj Privacy Policy <>/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 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. Call our Health Response Center at. Home. Mon-Fri, 8:30am-5:00pm (CT). Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. You can also go through the SurgeryPlus member portal. If it contains a form, you can print it and fill it out. Medicare pays 80% of the treatment costs, and the beneficiary contributes 20%. The Plan Sponsor(s) reserve the right to amend or terminate each plan at any time. 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. The State of Delaware is an Equal Opportunity employer and values a diverse workforce. Many Medicare Advantage plans include prescription drug coverage, in addition to all the benefits provided by Original Medicare Part A and Part B. "L @Zd X$9RAC~yGz3)fjaPk !e E57 Hln8 ``:w0@6Cfmu ] Licensed Humana sales agents are available daily, 8a.m. 8 p.m. Agent tip: "Original Medicare may cover 80% of a traditional cataract surgery. Some general conditions to receive coverage from United Healthcare requires that you meet the following criteria: Have a body mass index over 40 OR. Although most cosmetic surgery is not covered by insurance, certain operations are typically deemed medically necessary when they're done in conjunction with other medical treatments. xref These plans include all your Part A and Part B coverage and often provide extra coverage for services not included in Original Medicare. You sign a consent form to receive hospice care instead of other Medicare-covered treatments for your terminal condition. By receiving services through SurgeryPlus, you and your dependents can earn financial rewards. 3 You must be the contract holder or spouse, 18 or older, on a Standard or Basic Option Plan to earn incentive rewards. State Agencies All rights reserved. The service categories and plan limitations shown below represent an overview of the plan benefits. A reminder that the SBC is only a summary. 0000014251 00000 n 6 Original Medicare may even pay for corrective lenses if you have surgery to implant an intraocular lens (IOL). Hearing & balance exams, Medicare.gov, last accessed June 10, 2022. You may choose to share the information with your doctor and other medical professionals. Assign you a personal care coordinator to offer one-on-one guidance and support as you prepare for, undergo and recover from surgery. Delaware's Governor Coordination of benefits provisions in dental benefits plans are a set of rules that are followed when a patient is covered by more than one dental benefits plan. Premiums and the list of covered drugscalled a formularywill vary by plan.6. endstream You may need to exhaust your personal resources on medical care before you are eligible. Please contact Member Benefits your plan administrator at 1-800-282-8626 for more information. 0000392965 00000 n 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. %PDF-1.6 % VSP is not affiliated with Metropolitan Life Insurance Company or its affiliates. Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment. 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. Medicare pays 80% of the cost of traditional cataract surgery, which would be covered by Medicare Part B. 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. Policy form GPNP99. 0000401803 00000 n It all depends on your policy. 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. Gross Receipts Tax 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. Weather & Travel, Contact Us Most common oral surgeries are covered, at least in part, by your dental insurance provider. Adjustable straps allow for a better, customized fit. 866-855-1212. 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. 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. 250 0 obj <> endobj Home health services, Medicare.gov, last accessed June 10, 2022. Or Reach Us at. Because its all in the same format, its easier to make apples-to-apples comparisons when youre deciding which plan is best for you. Each company is a separate entity and is not responsible for another's financial or contractual obligations. 0000000016 00000 n SurgeryPlus notifies that you or your dependent earned the reward. startxref When will my medical insurance cover oral surgery? Your costs in Original Medicare For surgeries or procedures, it's hard to know the exact costs in advance. Out-of-pocket costs may be greater if you visit a dentist who does not participate in the network. This surgery makes the stomach smaller. You and your dentist will receive a benefit estimate for most procedures while you are still in the office. 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 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. 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. The surgery and any facility costs will be 100% covered under your SurgeryPlus benefit. 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. On average, cataract surgery costs about $5,000 per eye; however, in some places, this price can move up to over $10,000. For the Plus Size Queens. Procedure charge schedules are subject to change each plan year. This communication does not guarantee benefits and does not indicate all services received will be covered by your plan. (Due to contractual requirements, MetLife is prevented from soliciting certain providers.) 0 Medicare Part B (medical insurance) helps cover the cost of medically necessary durable medical equipment if your doctor prescribes it for use in your home. 555 17th Street, Suite 2050 | Denver, CO 80202, 2023 CEBT :: CEBT is administered by WTW, When you use SurgeryPlus, CEBT will potentially waive your Out-of-Pocket costs (i.e. Only travel arrangements made through your Care Advocate are eligible for coverage under the SurgeryPlus benefit. 0000015692 00000 n It is not to be used for medical advice, diagnosis or treatment. We cover the most expensive costs associated with your surgery so you'll pay less for your procedure. Plan benefits and rates are effective for group plan year January 1, 2023 through December 31, 2024, and subject to change thereafter. Please remember to hold on to all receipts to submit a dental claim. endobj "_P^)J^:+&!nI-eMNYrVY;QU&+,SUdTVvSN(GTDS o5q_H\%lqbF$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 State Regulations What's not covered by Part A & Part B? Medicare.gov, last accessed June 10, 2022. Remember that Medicare Advantage plans are required by law to offer all the benefits of Original Medicare, but most plans offer much more. You earn the reward once the following occurs: The reward will then be credited to the savings and spending account of your choice. 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. 285 0 obj <>stream 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 Also, your doctor will need to certify that you need certain eligible in-home services. These rules determine the order in which the plans will pay benefits. %PDF-1.4 % 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. Visit ESPN for the game videos of the Brooklyn Nets vs. Boston Celtics NBA basketball game on March 3, 2023 This may include surgery to remove cataracts or after an eye injury. Certain claim and network administration services are provided through Vision Service Plan (VSP), Rancho Cordova, CA. (Based on internal analysis by MetLife. A class is a group of people defined in the group policy. In addition, it comes with a concierge service (Care Advocate) and travel benefits. Pre-/postnatal professional care: 35% of our allowance . Find out which Humana plans include your doctors and cover the medications you take now to help you estimate your costs. Public Meetings These partners are required to comply with all laws protecting privacy. 0000001651 00000 n Trust in our network 1 Sturti / Getty Images Coverage Varies by Insurer Each health plan is different. The amount of benefits payable by MetLife may be reduced due to the benefits paid under the primary plan. 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. (Portal access Code: surgeryplus). If the MetLife dental benefit plan is secondary, most coordination of benefits provisions require MetLife to determine benefits after benefits have been determined under the primary plan. 0000001436 00000 n General Assembly But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary.12. L0920007743[exp0922][All States][DC,GU,MP,PR,VI] 2020 MSS, Florida office (headquarters) Cities & Towns endstream 00k` !" Medicare covers hospice care if the following conditions are met: Medicare does help cover some in-home health services, including: To be eligible, you must be under the care of a doctor and treated under a plan of care that is monitored and reviewed by your doctor. To see if your procedure is covered, contact us. <>stream All services defined in your group dental benefits plan certificate are covered. 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. }4Q2L_L 0fI\l!AN7za|*_)2:lU2_kciTX*R:N%` c8B=3 Transparency 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. 0000024262 00000 n endstream endobj 97 0 obj <>stream <. What happens with my health information? Fair and simple terms We pay a fair, transparent rate for cases and streamline reimbursement, decreasing your administrative burden. Where two or more professionally acceptable dental treatments for a dental condition exist, reimbursement is based on the least costly treatment alternative. 0 What Part A covers, Medicare.gov, last accessed June 10, 2022. How can we make this page better for you? Most plans cover the entire cost of preventive care, plus a portion of the cost after you meet your deductible for other procedures. 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. If your current dentist does not participate in the network and you would like to encourage him or her to apply, ask your dentist to visit www.metdental.com, or call 1-866-PDP-NTWK for an application. The specific travel benefit depends on the procedure, the provider, and the distance between the provider and a member's residence. Text Size Smaler, Make Text Size Mobile Apps This website and phone number are for use by dental professionals only. Vision benefits are underwritten by Metropolitan Life Insurance Company, New York, NY (MetLife). Generally, most vision, dental and hearing services are not covered by Medicare Parts A and B. To assist, American Airlines has business relationships with third-party vendors, for example, BCBS, UHC, and WebMD Health Services. Individuals enrolled in a State of Delaware Aetna or Highmark Delaware non-Medicare health plan are automatically enrolled in this FREE benefit. This program utilizes the MetLife PDP Plus Network of participating dentists. 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. 0000015930 00000 n Voting & Elections 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. Coverage will be considered under your out-of-network benefits. Wearing a Suit After a Body-Altering Surgery. 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. %PDF-1.6 % Jacksonville, FL 32256 Original Medicare generally doesnt cover the cost of a nursing home, assisted living or long-term care facility. By packaging surgical expenses into one simple, bundled rate, SurgeryPlus is able save money for you and the State of Florida. It also doesnt cover help for whats called activities of daily living, like bathing, getting dressed, using the toilet, eating or moving from place to place within your home.9. Thats what SurgeryPlus does. Medicare Advantage plans are provided by private companies with approval from Medicare. Scuba Certification; Private Scuba Lessons; Scuba Refresher for Certified Divers; Try Scuba Diving; Enriched Air Diver (Nitrox) Mon-Fri, 8:30am-5:00pm (ET), Texas office Knowing which types of common medical costs are not covered will be helpful when planning for your out-of-pocket medical costs. Call a Care Advocate at 833.709.2444 for more information. Medicare Part B may cover diagnostic hearing and balance examstests your doctor requires if you need medical treatment. 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. 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. A dental plan may cover routine office visits, fillings, crowns, root canals, oral surgery, periodontics, orthodontics, or bridges and dentures. 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. hb```b``Nf`c`Wcd@ AV(G 2?X%c6g+S@|dHA[&@VS&-,&W\\f9v| **s)S\Ol%5T7A(F Benefits are subject to change upon agreement between Metropolitan Life Insurance Company and the participating organization. Your copays and deductibles will still apply. Wearing a swimsuit after a mastectomy can be a transition. To provide and maintain this valuable membership benefit, MetLife reimburses the association and/or the plan administrator for these costs. Alternatively, a Medicare Advantage plan often provides comprehensive vision coverage, plus cataract surgery without out-of-pocket coinsurance costs.". 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. 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. 0000004000 00000 n Many offer affordable or even $0 monthly plan premiums, but you must continue to pay the Medicare Part B premium. If the MetLife dental benefit plan is primary, MetLife will pay the full amount of benefits that would normally be available under the plan. Rest easy knowing you can afford the surgery you need, HDHP Plans will require a reduced deductible to be met first. 0000377893 00000 n SurgeryPlus Care Advocates are your connection to the SurgeryPlus benefit. 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. Consult your healthcare provider if you have questions or concerns.