Local Coverage Determinations (LCDs)/Local Coverage Article (LCAs) exist and compliance with these policies is required where applicable. There are no simple answers, but you can start here to find general answers to some of the most common questions about Medicare coverage. 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. Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. Group dental insurance policies featuring the Preferred Dentist Program are underwritten by Metropolitan Life Insurance Company, New York, NY 10166. 1XQg&.9mE#(Tq& Coverage includes access to our network of excellent surgeons, consults and appointments with your SurgeryPlus provider, anesthesia, the procedure and facility (hospital) fees. 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. "Original Medicare may cover 80% of a traditional cataract surgery. Delaware State Code Information gathered by our partners will be used for your benefit to help guide you on your path to wellness. Complete and submit the form and well be in touch soon. We cover the most expensive costs associated with your surgery so you'll pay less for your procedure. Your general dentist or specialist usually sends MetLife a plan for your care and requests an estimate of benefits. Please contact Member Benefits your plan administrator at 1-800-282-8626 for more information. Privacy Policy A reminder that the SBC is only a summary. 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. 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. You can track your claims online and even receive e-mail alerts when a claim has been processed. This is a voluntary benefit available to you if you're enrolled in the Core, Standard, Plus or High Cost Coverage medical option. A dental plan may cover routine office visits, fillings, crowns, root canals, oral surgery, periodontics, orthodontics, or bridges and dentures. Or Reach Us at. Guided Support Cancellation/Termination of Benefits Consult your healthcare provider if you have questions or concerns. Take your bill (s) to your State Farm agent's office. Always err on the side of caution! Knowing which types of common medical costs are not covered will be helpful when planning for your out-of-pocket medical costs. HIP Plus is the plan for the best value.HIP Plus provides health coverage for a low, predictable monthly cost. 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. 0000001609 00000 n Learn more about the ABN. However, this depends on the specific type of surgery you need, your dental plan, and your level of coverage. 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. Delaware Marketplace Elected Officials Consult your doctor before beginning any new diet or exercise regimen. Voting & Elections The effective date of coverage for newly added dependent(s) will depend on when we receive notice and required premium. Heres a step-by-step look at what information is in an SBC: You can request a copy of an SBC anytime. RSS Feeds, Make Corporations Delaware Topics Each company is a separate entity and is not responsible for another's financial or contractual obligations. Medicare Part B contributes 80% of the cost of one pair of eyeglasses or set of contact lenses after cataract surgery after. Weather & Travel, Contact Us What Part A covers, Medicare.gov, last accessed June 10, 2022. Please remember to hold on to all receipts to submit a dental claim. %PDF-1.6 % You'll be more confident on the beach with an extensive selection of plus-size swimwear. 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. You simply need to provide the plan administrator with advanced written notice along with any required premium. Before undergoing surgery, youll want to be connected with the highest-quality providers and facilities. Wearing a swimsuit after a mastectomy can be a transition. Original Medicare generally covers most pre-existing conditions. However, some UnitedHealthcare policies charge lower deductibles . 89 37 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. If it contains a form, you can fill it out online and submit it. Pick the option that's best for you. Wearing a Suit After a Body-Altering Surgery. Your private health information is just that private. Remember that Medicare Advantage plans are required by law to offer all the benefits of Original Medicare, but most plans offer much more. endstream hb``P```e```5c@L@q EP0 %%EOF 866-855-1212. 0000001036 00000 n Delaware's Governor 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. Our licensed Humana sales agents are available to help you select the coverage that best meets your needs. 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. These rules determine the order in which the plans will pay benefits. Coverage is provided under a group insurance policy (Policy form GPNP99) issued by MetLife. Policy number 5343606-1-G (Low plan), Metropolitan Life Insurance Company, 200 Park Avenue, New York, NY 10166 What is Medicare Part C? U.S. Department of Health & Human Services, last accessed June 10, 2022. Confirm your coverage before you commit to a procedure you're unsure about. The amount of benefits payable by MetLife may be reduced due to the benefits paid under the primary plan. This guide will explain the different types of . He or she hasnt agreed to accept negotiated fees. <>/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 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. 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. You and your dentist will receive a benefit estimate for most procedures while you are still in the office. The surgery and any facility costs will be 100% covered under your SurgeryPlus benefit. All health plan companies are required to provide an SBC for each of their different plans. Delaware Courts 1096 0 obj Many offer affordable or even $0 monthly plan premiums, but you must continue to pay the Medicare Part B premium. Home. Please fill out the contact form so the right person can be in touch quickly. Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment. 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. Tax Center Business First Steps, Phone Directory Your SurgeryPlus benefit will also help pay for necessary travel associated with the covered procedure. 0000000016 00000 n This symbol denotes a Web Page. This symbol denotes a PDF Document. What happens with my health information? Medicare Advantage plans may offer coverage for vision, hearing, dental and wellness services. 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. "L @Zd X$9RAC~yGz3)fjaPk !e E57 Hln8 ``:w0@6Cfmu ] 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. Expand your practice We route you incremental cases outside the typical radius of your practice. If it contains a form, you can print it and fill it out. Eleesha Lockett, Does Medicare Cover Plastic Surgery? Healthline, last accessed June 10, 2022. For the Plus Size Queens. Withholding Tax Because its all in the same format, its easier to make apples-to-apples comparisons when youre deciding which plan is best for you. 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. 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. You'll also pay a deductible of $233. 6 Original Medicare may even pay for corrective lenses if you have surgery to implant an intraocular lens (IOL). 0000005180 00000 n Medicare pays 80% of the cost of traditional cataract surgery, which would be covered by Medicare Part B. Franchise Tax Through the planning process, you will work with the same Care Advocate. Locations Directory 273 0 obj <>/Filter/FlateDecode/ID[<0FC6C6833B2C26439F46B854E028A8C8>]/Index[250 36]/Info 249 0 R/Length 110/Prev 207371/Root 251 0 R/Size 286/Type/XRef/W[1 3 1]>>stream Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. POWER Up to HIP Plus! hbbd```b``f+A$S$d@$&},L`1]`*z3`] rO o bHHj@&{:.a`$ S EXA!YA?fqLv1bd::M&a54g#A010p]p <<7C167570AC52504DB41418C8CABC0A04>]/Prev 422895/XRefStm 1266>> Where two or more professionally acceptable dental treatments for a dental condition exist, reimbursement is based on the least costly treatment alternative. 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. 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. 0000004536 00000 n A prime example is breast implants done during or after breast cancer surgery. xref Whats a Summary of Benefits and Coverage? Yes. <. Medicare will not pay for 24-hour in-home care or meals delivered to you at home. This website and phone number are for use by dental professionals only. Will Medicare Cover LASIK Eye Surgery? Medicare.org, last accessed June 10, 2022. Outpatient facility care: 35% of our allowance . However, if you choose a non-participating dentist, your out-of-pocket costs may be higher. 0000006640 00000 n Agent tip: "Original Medicare may cover 80% of a traditional cataract surgery. Please use this access code on website: surgeryplus. 0 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. 125 0 obj <>stream In . This benefit is available to those enrolled in one of the CEBT EPO, PPO or HDHP medical plans. 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. Some types of surgery also change the connection between your stomach and intestines. Call a Care Advocate at 833.709.2444 for more information. This website provides an overview of your benefit options. Take some time to understand your Medicare plan. 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. Actual payments may vary from the pretreatment estimate depending upon annual maximums, plan frequency limits, deductibles and other limits applicable at time of payment. Coverage includes access to our network of excellent surgeons, consults and appointments with your SurgeryPlus provider, anesthesia, the procedure and facility (hospital) fees. For procedures requiring inpatient admission or overnight recovery, the travel benefit covers the patient and one companion for a limited amount of time. Medicare won't cover Lasik surgery just to avoid the need for glasses. 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. You pay 20% of the Medicare Part B copay plus any out-of-pocket costs such as your deductible, medication costs and physician fees. Administrative services provided by United HealthCare Services, Inc. or their affiliates. hbbbd`b`` K Policy form GPNP99. 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. It has less visits to physical, speech and occupational therapies than HIP Plus. %PDF-1.6 % Updated 08/29/2019 . Facilitate and consolidate your payments. *Negotiated Fee refers to the fees that participating dentists have agreed to accept as payment in full, subject to any co-payments, deductibles, cost sharing and benefits maximums. Please review the plan summaries for summarized information and your certificate of insurance for detailed information about your plan benefits. Bigger. Original Medicare generally doesnt cover the cost of a nursing home, assisted living or long-term care facility. 0000015930 00000 n 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. Most plans cover the entire cost of preventive care, plus a portion of the cost after you meet your deductible for other procedures. Please Note: Additional information about this benefit change will be posted as it becomes available and before the July 1, 2023 effective date. You can also go through the SurgeryPlus member portal. 0000001436 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. 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. Overview . The choice is yours. Medicare Part B benefits cover 80% of the Medicare-approved amount for cataract surgery. 285 0 obj <>stream Coverage may not be available in all states. Members will pay nothing out of pocket for bariatric surgery; however, financial incentives do not apply. Call our Health Response Center at. The Plan Sponsor(s) reserve the right to amend or terminate each plan at any time. This symbol denotes a PDF Document. All rights reserved. Public Meetings Yes. 0000014887 00000 n To get all the details, youll want to look at complete health plan documents. Click Register Now to create your profile and start exploring this free service. Other services not covered by Medicare Parts A and B include:4, Medicare Part C is also known as Medicare Advantage. 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. 9l J'X:50e0l`} }U,,Q`lam[5-0f`MVe` You may enroll for membership in the ABN directly through the ABN website or during your dental enrollment. Hearing & balance exams, Medicare.gov, last accessed June 10, 2022. Help Center 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. 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. About Us; Staff; Camps; Scuba. The service categories and plan limitations shown below represent an overview of the plan benefits. endstream endobj 97 0 obj <>stream 1026 0 obj 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. hb```b``Nf`c`Wcd@ AV(G 2?X%c6g+S@|dHA[&@VS&-,&W\\f9v| **s)S\Ol%5T7A(F 0000007939 00000 n Only travel arrangements made through your Care Advocate are eligible for coverage under the SurgeryPlus benefit. 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. Medicare Advantage plans are provided by private companies with approval from Medicare. Filing a health claim. Individuals enrolled in a State of Delaware Aetna or Highmark Delaware non-Medicare health plan are automatically enrolled in this FREE benefit. 0000015806 00000 n About SurgeryPlus SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. All other HIP plans cover members ages 19 to 64. Some examples of comorbidities include high blood pressure, high cholesterol, obstructive sleep apnea, Type II Diabetes, angina or stroke. Thats because its basically a document that outlines whats covered and not covered under a health plan. 0000016018 00000 n If you need cataract surgery in both eyes . endobj 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. State Regulations The complete provisions of the plans are set forth in the Plan Documents and Summary Plan Description. 0000001651 00000 n Mobile Apps 0000379543 00000 n This document presents the majority of services within each category, but is not a complete description of the plan. To see if your procedure is covered, contact us. For specific LCDs/LCAs, refer to the table for 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. This benefit is available to those enrolled in one of the CEBT EPO, PPO or HDHP medical plans. . endstream endobj 251 0 obj <. You can choose whether or not to use SurgeryPlus for your surgical procedures. 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. 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. Assign you a personal care coordinator to offer one-on-one guidance and support as you prepare for, undergo and recover from surgery. 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. Coverage Policy ; Coverage for bariatric surgery or revision of a bariatric surgical procedure varies across plans and may be governed by state mandates. 0000418667 00000 n SurgeryPlus provides an alternative to using your health plan for a planned surgical procedure that is not an emergency. %PDF-1.4 % 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. such as Spine, General Surgery, Genitourinary, Orthopedic, Ear, Nose & Throat, Cardiac, GI, and Pain Management. Scuba Certification; Private Scuba Lessons; Scuba Refresher for Certified Divers; Try Scuba Diving; Enriched Air Diver (Nitrox) SurgeryPlus is separate from your health plan and has its own network of high-quality providers. Every SBC is created with four double-sided pages and 12-point type. Bariatric surgery is surgery to help you lose weight. Many Medicare Advantage plans include prescription drug coverage, in addition to all the benefits provided by Original Medicare Part A and Part B. You may choose to share the information with your doctor and other medical professionals. We recommend that you request a pre-treatment estimate for services in excess of $300. Licensed Humana sales agents are available daily, 8a.m. 8 p.m. By receiving services through SurgeryPlus, you and your dependents can earn financial rewards. Effective July 1, 2023, bariatric surgery coverage will be available exclusively through the SurgeryPlus benefit. 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 To get one, contact us. The SurgeryPlus Difference We allow you to focus on practicing medicine and caring for patients. 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. 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. 0000401803 00000 n Transparency 0000377893 00000 n Your costs in Original Medicare For surgeries or procedures, it's hard to know the exact costs in advance. 0000001266 00000 n Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, reductions, limitations, waiting periods and terms for keeping them in force. SurgeryPlus notifies that you or your dependent earned the reward. In certain markets, delegated vendor guidelines may be used to support medical necessity and other coverage determinations. You may need to exhaust your personal resources on medical care before you are eligible. Effective July 1, 2023, bariatric surgery coverage will be available exclusively through the SurgeryPlus benefit. 0000024865 00000 n Looser styling flatters while cleverly camouflaging around your middle. 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 can use the SBC to compare prices, benefits and other health plan options and features that might be important to you. 12 Always err on the side of caution! 00k` !" Negotiated fees typically range from 15-45% below the average fees charged in a dentists community for the same or substantially similar services. Refer to the customer's benefit plan document for coverage details. 989 0 obj SurgeryPlus negotiates a single cost (bundled rate) for the entire surgical procedure, resulting in savings to the State of Delaware. cost of cataract surgery with medicare. (Refer to your dental benefits plan summary for your out-of-network dental coverage.) Inpatient hospital: $450 per admission copay for unlimited days, plus 35% of our allowance. You earn the reward once the following occurs: The reward will then be credited to the savings and spending account of your choice. The sharing of health information between these companies is permitted by regulation. What Part B covers, Medicare.gov, last accessed June 10, 2022. Hospice care, Medicare.gov, last accessed June 10, 2022. Some links on this page may take you to Humana non-Medicare product or service pages or to a different website. VSP is not affiliated with Metropolitan Life Insurance Company or its affiliates. 89 0 obj <> 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.
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