, begin to type the name of your employer in the space below. Pre-authorization will still need to be submitted by your provider to SurgeryPlus before the surgery is scheduled. 2 If you have Medicare Part B primary, your costs for prescription drugs may be lower. Administrative services provided by United HealthCare Services, Inc. or their affiliates. Call our Health Response Center at. Enter your ZIP code below to see plans with their premiums, copays, and participating doctors and pharmacies. SurgeryPlus negotiates a single cost (bundled rate) for the entire surgical procedure, resulting in savings to the State of Delaware. 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. Corporations Some types of surgery also change the connection between your stomach and intestines. It requires doctors and facilities to meet strict credential guidelines leading to the highest quality care possible. For example, if youre still working and covered by your employer or your spouses employer sponsored health coverage, you may be able to wait. These plans include all your Part A and Part B coverage and often provide extra coverage for services not included in Original Medicare. Prescription drug planscalled Medicare Part Dare only available through private companies like Humana. 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. The primary result of . 0000024943 00000 n Medicare will not pay for 24-hour in-home care or meals delivered to you at home. 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. Consult your healthcare provider if you have questions or concerns. When enrolling you may choose to also cover your spouse, domestic partner, and/or children up to age 26. Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. Members of HumanaVision can receive deeper discounts on LASIK services, especially when using a specific in-network provider. 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. 0000001651 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. Withholding Tax 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. 1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. State Regulations 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. SurgeryPlus provides an alternative to using your health plan for a planned surgical procedure that is not an emergency. The surgery and any facility costs will be 100% covered under your SurgeryPlus benefit. Heres a step-by-step look at what information is in an SBC: You can request a copy of an SBC anytime. endstream What is Medicare Part C? U.S. Department of Health & Human Services, last accessed June 10, 2022. Cancellation/Termination of Benefits To provide and maintain this valuable membership benefit, MetLife reimburses the association and/or the plan administrator for these costs. Benefits are subject to change upon agreement between Metropolitan Life Insurance Company and the participating organization. 0000401803 00000 n Inpatient hospital: $450 per admission copay for unlimited days, plus 35% of our allowance. Some links on this page may take you to Humana non-Medicare product or service pages or to a different website. %%EOF Thats what SurgeryPlus does. Members will pay nothing out of pocket for bariatric surgery; however, financial incentives do not apply. This symbol denotes a PDF Document. Your copays and deductibles will still apply. 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. Privacy Policy 0000011564 00000 n Your general dentist or specialist usually sends MetLife a plan for your care and requests an estimate of benefits. 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. This symbol denotes a PDF Document. endstream endobj startxref Remember that Medicare Advantage plans are required by law to offer all the benefits of Original Medicare, but most plans offer much more. You can make monthly payments by monthly bank draft (ACH) or pay for the entire year via credit card payment. POWER Up to HIP Plus! Home health services, Medicare.gov, last accessed June 10, 2022. SurgeryPlus is included in your medical benefits at no additional cost to you. Through the planning process, you will work with the same Care Advocate. . Negotiated fees typically range from 15-45% below the average fees charged in a dentists community for the same or substantially similar services. Yes. Many offer affordable or even $0 monthly plan premiums, but you must continue to pay the Medicare Part B premium. 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. h`06NH+500 0000015692 00000 n Alternatively, a Medicare Advantage plan often provides comprehensive vision coverage, plus cataract surgery without out-of-pocket coinsurance costs.". Business First Steps, Phone Directory 6 Original Medicare may even pay for corrective lenses if you have surgery to implant an intraocular lens (IOL). 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. 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. Group dental insurance policies featuring the Preferred Dentist Program are underwritten by Metropolitan Life Insurance Company, New York, NY 10166. This website is not intended as a contract of employment or a guarantee of current or future employment. 0000418667 00000 n 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. Please fill out the contact form so the right person can be in touch quickly. Click Register Now to create your profile and start exploring this free service. 0000000016 00000 n (Negotiated fees are subject to change.). 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 Many Medicare Advantage plans, however, do include coverage for routine dental, vision and hearing care, including glasses and hearing aids. Wearing a Suit After a Body-Altering Surgery. By receiving services through SurgeryPlus, you and your dependents can earn financial rewards. 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. Original Medicare generally covers most pre-existing conditions. Yes. You and your dentist will receive a benefit estimate for most procedures while you are still in the office. This communication does not guarantee benefits and does not indicate all services received will be covered by your plan. Visit ESPN for the game videos of the Brooklyn Nets vs. Boston Celtics NBA basketball game on March 3, 2023 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. The SurgeryPlus Difference We allow you to focus on practicing medicine and caring for patients. 0000014887 00000 n All services defined in your group dental benefits plan certificate are covered. 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. Medicare pays 80% of the cost of traditional cataract surgery, which would be covered by Medicare Part B. Facilitate and consolidate your payments. This exclusion will apply whether or not the person receiving the services is enrolled for the government plan. Transparency You are always free to select the dentist of your choice. Surgical Coverage Surgery Surgery Medicare covers many medically necessary surgical procedures. Policy number TS 05343606-G (High plan) 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. This Coverage Policy addresses breast reduction for symptomatic macromastia and breast reduction surgery on SurgeryPlus is a voluntary benefit that provides pre-planned, non-emergency surgical services. Most plans cover the entire cost of preventive care, plus a portion of the cost after you meet your deductible for other procedures. Malini Ghoshal, What You Need to Know About Medicare Prescription Drug Plans (Part D), Healthline, last accessed June 10, 2022. 0000378718 00000 n %PDF-1.4 % Fair and simple terms We pay a fair, transparent rate for cases and streamline reimbursement, decreasing your administrative burden. American Airlines manages employee and retiree health benefits. Looser styling flatters while cleverly camouflaging around your middle. In certain markets, delegated vendor guidelines may be used to support medical necessity and other coverage determinations. Yes. But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary. Policy number 5343606-1-G (Low plan), Metropolitan Life Insurance Company, 200 Park Avenue, New York, NY 10166 Medicare won't cover Lasik surgery just to avoid the need for glasses. By packaging surgical expenses into one simple, bundled rate, SurgeryPlus is able save money for you and the State of Florida. Information gathered by our partners will be used for your benefit to help guide you on your path to wellness. Privacy Policy Your doctor certifies that you are terminally ill, meaning that your life expectancy is 6 months or less. Connect you with a top-ranked, board-certified and fellowship-trained surgeon near you. 00k` !" %PDF-1.6 % You may need to exhaust your personal resources on medical care before you are eligible. 989 0 obj 866-855-1212. 0000014251 00000 n 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. Negotiated fees are subject to change. 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. Delaware Topics Durable medical equipment (DME) coverage, Medicare.gov, last accessed June 10, 2022. trailer 1096 0 obj These rules determine the order in which the plans will pay benefits. If you need cataract surgery in both eyes . 1XQg&.9mE#(Tq& 0000004536 00000 n lbSy For the Plus Size Queens. hbbd```b``f+A$S$d@$&},L`1]`*z3`] rO o bHHj@&{:.a`$ S However, some UnitedHealthcare policies charge lower deductibles . You can ask for a pretreatment estimate. Have a body mass index over 35 with severe comorbidity. 0000019224 00000 n The service categories and plan limitations shown below represent an overview of the plan benefits. 0000023776 00000 n It does not cover bariatric surgery or jaw care (TMJ). In addition, it comes with a concierge service (Care Advocate) and travel benefits. 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. 866-855-1212 to request a claim form. 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. You can use the SBC to compare prices, benefits and other health plan options and features that might be important to you. 0000001266 00000 n <<7C167570AC52504DB41418C8CABC0A04>]/Prev 422895/XRefStm 1266>> This symbol denotes a Web Page. 0000010311 00000 n Coverage Policies are not recommendations for treatment and should never be used as treatment guidelines. The Plan Sponsor(s) reserve the right to amend or terminate each plan at any time. 0000001436 00000 n 250 0 obj <> endobj Its also possible to get an SBC in another language. Many Medicare Advantage plans include prescription drug coverage, in addition to all the benefits provided by Original Medicare Part A and Part B. 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. Services which are not Dentally Necessary, those which do not meet generally accepted standards of care for treating the particular dental condition, or which We deem experimental in nature; Services for which covered person would not be required to pay in the absence of Dental Insurance; Services or supplies received by covered person before the Dental Insurance starts for that person; Services which are primarily cosmetic (for Texas residents, see notice page section in Certificate); Services which are neither performed nor prescribed by a Dentist except for those services of a licensed dental hygienist which are supervised and billed by a Dentist and which are for: Services or appliances which restore or alter occlusion or vertical dimension; Restoration of tooth structure damaged by attrition, abrasion or erosion, unless caused by disease; Restorations or appliances used for the purpose of periodontal splinting; Counseling or instruction about oral hygiene, plaque control, nutrition and tobacco; Personal supplies or devices including, but not limited to: water piks, toothbrushes, or dental floss; Decoration, personalization or inscription of any tooth, device, appliance, crown or other dental work; covered under any workers compensation or occupational disease law; covered under any employer liability law; for which the Policyholder of the person receiving such services is not required to pay; or. 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. "L @Zd X$9RAC~yGz3)fjaPk !e E57 Hln8 ``:w0@6Cfmu ] HVn7}Wt)A87HPV$(YXF;3as=sfj'O&y>=zF_Gmlr:v1z5`:A1suhMFY}r0_&o^w]vw%'o':~u>)|]!6nRBki;L}h0y^'#cCmJJc Locations Directory startxref 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. If permitted, you may only be responsible for the negotiated fee. hb```b``Nf`c`Wcd@ AV(G 2?X%c6g+S@|dHA[&@VS&-,&W\\f9v| **s)S\Ol%5T7A(F 3 You must be the contract holder or spouse, 18 or older, on a Standard or Basic Option Plan to earn incentive rewards. Voting & Elections Medically necessary services diagnose and treat health problems. 9l J'X:50e0l`} }U,,Q`lam[5-0f`MVe` Outpatient facility care: 35% of our allowance . Pick the option that's best for you. The time a mother and baby spend in the hospital after delivery is a medical decision. All rights reserved. 0000001609 00000 n 89 0 obj <> 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. hb``P```e```5c@L@q EP0 Coverage Policy ; Coverage for bariatric surgery or revision of a bariatric surgical procedure varies across plans and may be governed by state mandates. This website provides an overview of your benefit options. 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. Jacksonville, FL 32256 Delaware Courts General Assembly Negotiated fees for non-covered services may not apply in all states.). The estimate helps you prepare for the cost of dental services. 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. 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. Disclaimer 0000009101 00000 n You may choose to share the information with your doctor and other medical professionals. 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. Copyright 2023 Member Benefits. L0920007743[exp0922][All States][DC,GU,MP,PR,VI] 2020 MSS, Florida office (headquarters) Take your bill (s) to your State Farm agent's office. This guide will explain the different types of . 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. Updated 08/29/2019 . The amount of benefits payable by MetLife may be reduced due to the benefits paid under the primary plan. 0000001036 00000 n 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. 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. 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. Does Medicare Cover Pre-existing Conditions? Medicare.com, last accessed June 10, 2022. Some examples of comorbidities include high blood pressure, high cholesterol, obstructive sleep apnea, Type II Diabetes, angina or stroke. Text Size Smaler, Make Text Size You can choose whether or not to use SurgeryPlus for your surgical procedures. Filing a health insurance claim is simple and can be done in one of two ways. Medicare Part B contributes 80% of the cost of one pair of eyeglasses or set of contact lenses after cataract surgery after. 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. 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. 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. Procedures can cost from $700 to $2,000 per eye, depending on . Vision benefits are underwritten by Metropolitan Life Insurance Company, New York, NY (MetLife). But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary.12. Certain claim and network administration services are provided through Vision Service Plan (VSP), Rancho Cordova, CA. Yes. Learn more about a Summary of Benefits and Coverage, also commonly referred to as an SBC. To assist, American Airlines has business relationships with third-party vendors, for example, BCBS, UHC, and WebMD Health Services. You sign a consent form to receive hospice care instead of other Medicare-covered treatments for your terminal condition. 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. Medicare Advantage plans are provided by private companies with approval from Medicare. 0000018849 00000 n %PDF-1.6 % Coverage is provided under a group insurance policy (Policy form GPNP99) issued by MetLife. Learn more aboutsavings and spending accounts. This program utilizes the MetLife PDP Plus Network of participating dentists. Even though its meant to make the information easier to understand, it can seem like a lot at first. Agent tip: "Original Medicare may cover 80% of a traditional cataract surgery. Weight-Loss (Bariatric) Surgery. 1. 988 0 obj 12 Always err on the side of caution! Or Reach Us at 855-200-2099 " *" indicates required fields Confirm your coverage before you commit to a procedure you're unsure about. hb```f`` vAX,Xf000Z\ q1=nIc /( The State Employee Benefits Committee (SEBC) believes in providing high quality care to members at an affordable cost. ii AF! We cover the most expensive costs associated with your surgery so youll pay less for your procedure. 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. If the MetLife dental benefit plan is primary, MetLife will pay the full amount of benefits that would normally be available under the plan. 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.
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