Vision benefits are underwritten by Metropolitan Life Insurance Company, New York, NY (MetLife). 988 0 obj 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. You are always free to select the dentist of your choice. Voting & Elections Transparency The State of Delaware is an Equal Opportunity employer and values a diverse workforce. Prescription drug planscalled Medicare Part Dare only available through private companies like Humana. 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. endstream 0000379543 00000 n You and your dentist will receive a benefit estimate for most procedures while you are still in the office. The primary result of . Weight-Loss (Bariatric) Surgery. Help Center 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. 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. SurgeryPlus negotiates a single cost (bundled rate) for the entire surgical procedure, resulting in savings to the State of Delaware. It also includes more benefits like dental, vision, or chiropractic.With HIP Plus, you do not have copays when you visit the doctor, fill a prescription or go to the hospital for an emergency.On average, HIP Plus members spend less money on their health care . (Refer to your dental benefits plan summary for your out-of-network dental coverage.) 0000006640 00000 n The service categories and plan limitations shown below represent an overview of the plan benefits. This may include surgery to remove cataracts or after an eye injury. <>/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 The State Employee Benefits Committee (SEBC) believes in providing high quality care to members at an affordable cost. EXA!YA?fqLv1bd::M&a54g#A010p]p This exclusion will apply whether or not the person receiving the services is enrolled for the government plan. All other HIP plans cover members ages 19 to 64. Yes. You'll also pay a deductible of $233. You'll be more confident on the beach with an extensive selection of plus-size swimwear. "L @Zd X$9RAC~yGz3)fjaPk !e E57 Hln8 ``:w0@6Cfmu ] This benefit is available to those enrolled in one of the CEBT EPO, PPO or HDHP medical plans. The requirements needed for surgery, including any pre-operative tests, screenings, evaluations, and post-operative care will continue to be covered under your Aetna or Highmark Delaware non-Medicare health plan. Locations Directory 0000378718 00000 n The choice is yours. 0000004536 00000 n Many Medicare Advantage plans also provide prescription drug coverage (also known as Part D).5, Original Medicare does not include coverage for prescription drugs, but you can buy a stand-alone prescription drug plan to help manage your drug costs. hb```f`` vAX,Xf000Z\ q1=nIc /( Text Size Smaler, Make Text Size Members will pay nothing out of pocket for bariatric surgery; however, financial incentives do not apply. endstream endobj 90 0 obj <>/Metadata 3 0 R/OpenAction 91 0 R/Pages 2 0 R/StructTreeRoot 5 0 R/Type/Catalog/ViewerPreferences<>>> endobj 91 0 obj <> endobj 92 0 obj >/PageTransformationMatrixList<0[1.0 0.0 0.0 1.0 0.0 -396.0]>>/PageUIDList<0 878>>/PageWidthList<0 612.0>>>>>>/Resources<>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 93 0 obj <> endobj 94 0 obj <> endobj 95 0 obj [/Indexed/DeviceRGB 250 104 0 R] endobj 96 0 obj <>stream 866-855-1212 to request a claim form. Pick the option that's best for you. Does Medicare Cover Pre-existing Conditions? Medicare.com, last accessed June 10, 2022. Gross Receipts Tax Maybe youve heard the term, Summary of Benefits and Coverage also called SBC. Its often talked about when it comes to choosing health plans and learning about costs. 0000012970 00000 n POWER Up to HIP Plus! hbbd```b``f+A$S$d@$&},L`1]`*z3`] rO o bHHj@&{:.a`$ S Medicare Advantage plans may offer coverage for vision, hearing, dental and wellness services. 0000014887 00000 n Refer to the customer's benefit plan document for coverage details. To connect with SurgeryPlus today, call 833-709-2445. Delaware Courts You can also go through the SurgeryPlus member portal. This document presents the majority of services within each category, but is not a complete description of the plan. hbbbd`b`` K We recommend that you request a pre-treatment estimate for services in excess of $300. Reconstructive Procedures include surgery or other procedures which are related to a health condition. 1. Thats because its basically a document that outlines whats covered and not covered under a health plan. Many Medicare Advantage plans include prescription drug coverage, in addition to all the benefits provided by Original Medicare Part A and Part B. 0000001609 00000 n Members of HumanaVision can receive deeper discounts on LASIK services, especially when using a specific in-network provider. When it comes to Medicare, the question we hear most often after What does it cost? is, What does it cover?. But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary. SurgeryPlus Frequently Asked Questions General Questions . Filing a health insurance claim is simple and can be done in one of two ways. 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. Mobile Apps 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. 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. Your doctor certifies that you are terminally ill, meaning that your life expectancy is 6 months or less. Simply have your dentist submit a request online at www.metdental.com or call 1-877-MET-DDS9. Some examples of comorbidities include high blood pressure, high cholesterol, obstructive sleep apnea, Type II Diabetes, angina or stroke. 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. Consult your healthcare provider if you have questions or concerns. Home health services, Medicare.gov, last accessed June 10, 2022. Where two or more professionally acceptable dental treatments for a dental condition exist, reimbursement is based on the least costly treatment alternative. Or Reach Us at. References to UnitedHealthcare pertain to each individual company or other UnitedHealthcare affiliated companies. endstream endobj startxref Your SurgeryPlus Care Advocate will provide you one-on-one, personalized help each step of the way. But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary.12. 0000015692 00000 n A dental plan may cover routine office visits, fillings, crowns, root canals, oral surgery, periodontics, orthodontics, or bridges and dentures. %%EOF This Coverage Policy addresses breast reduction for symptomatic macromastia and breast reduction surgery on 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. The inclusion of a code does not imply any right to . For specific LCDs/LCAs, refer to the table for Coverage includes access to our network of excellent surgeons, consults and appointments with your SurgeryPlus provider, anesthesia, the procedure and facility (hospital) fees. %%EOF 89 37 Alternatively, a Medicare Advantage plan often provides comprehensive vision coverage, plus cataract surgery without out-of-pocket coinsurance costs.". You consent to receiving palliative care to make you comfortable versus care to try to cure your illness. Wearing a Suit After a Body-Altering Surgery. Original Medicare generally doesnt cover the cost of a nursing home, assisted living or long-term care facility. 12 Always err on the side of caution! Metlife will not pay Dental Insurance benefits for charges incurred for: Alternate Benefits The SurgeryPlus Difference We allow you to focus on practicing medicine and caring for patients. To provide and maintain this valuable membership benefit, MetLife reimburses the association and/or the plan administrator for these costs. Adjustable straps allow for a better, customized fit. Consistent with federal law effective 1/1/98, the Cigna national maternity policy includes coverage for 48 hours of hospitalization following a normal vaginal delivery and 96 hours following an uncomplicated Caesarean section. hb```b``Nf`c`Wcd@ AV(G 2?X%c6g+S@|dHA[&@VS&-,&W\\f9v| **s)S\Ol%5T7A(F Please Note: Additional information about this benefit change will be posted as it becomes available and before the July 1, 2023 effective date. 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. About Us; Staff; Camps; Scuba. 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. 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. This benefit is available to those enrolled in one of the CEBT EPO, PPO or HDHP medical plans. Procedures can cost from $700 to $2,000 per eye, depending on . By packaging surgical expenses into one simple, bundled rate, SurgeryPlus is able save money for you and the State of Florida. endobj Cities & Towns Weather & Travel, Contact Us Call a Care Advocate at 833.709.2444 for more information. 125 0 obj <>stream 1XQg&.9mE#(Tq& 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. 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. 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. Some links on this page may take you to Humana non-Medicare product or service pages or to a different website. 0000001266 00000 n 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. "Original Medicare may cover 80% of a traditional cataract surgery. (Negotiated fees are subject to change.). Mon-Fri, 8:30am-5:00pm (ET), Texas office Child(ren)s eligibility for dental coverage is from birth up to age 26. Negotiated fees are subject to change. Confirm your coverage before you commit to a procedure you're unsure about. 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. 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. Take your bill (s) to your State Farm agent's office. 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. 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. You sign a consent form to receive hospice care instead of other Medicare-covered treatments for your terminal condition. To get one, contact us. Bariatric surgery is surgery to help you lose weight. %%EOF 0000001651 00000 n Scuba Certification; Private Scuba Lessons; Scuba Refresher for Certified Divers; Try Scuba Diving; Enriched Air Diver (Nitrox) This symbol denotes a PDF Document. 0000000016 00000 n 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. Read your certificate of insurance for details on plan benefits, limitations, and exclusions. Will Medicare Cover LASIK Eye Surgery? Medicare.org, last accessed June 10, 2022. 0000018849 00000 n Dependent age may vary by state. A prime example is breast implants done during or after breast cancer surgery. The time a mother and baby spend in the hospital after delivery is a medical decision. Guided Support This Coverage Policy addresses bariatric surgery and procedures for the treatment of morbid obesity. If you need cataract surgery in both eyes . The complete provisions of the plans are set forth in the Plan Documents and Summary Plan Description. Eleesha Lockett, Does Medicare Cover Plastic Surgery? Healthline, last accessed June 10, 2022. 0000023776 00000 n Dentists may submit your claims for you which means you have little or no paperwork. 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. Many offer affordable or even $0 monthly plan premiums, but you must continue to pay the Medicare Part B premium. . You may need to exhaust your personal resources on medical care before you are eligible. To see if your procedure is covered, contact us. Mon-Fri, 8:30am-5:00pm (CT). Have a body mass index over 35 with severe comorbidity. SurgeryPlus is separate from your health plan and has its own network of high-quality providers. 3 You must be the contract holder or spouse, 18 or older, on a Standard or Basic Option Plan to earn incentive rewards. Medicare will not pay for 24-hour in-home care or meals delivered to you at home. 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. Procedure charge schedules are subject to change each plan year. This program utilizes the MetLife PDP Plus Network of participating dentists. Bigger. 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. 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. 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 This assures State of Delaware Aetna and Highmark Delaware members will have access to surgeons and facilities that meet strict SurgeryPlus credentialing guidelines, leading to the highest quality care possible. The estimate helps you prepare for the cost of dental services. To check to see if you may already have SurgeryPlus, begin to type the name of your employer in the space below. }4Q2L_L 0fI\l!AN7za|*_)2:lU2_kciTX*R:N%` c8B=3 Most plans cover the entire cost of preventive care, plus a portion of the cost after you meet your deductible for other procedures. This website and phone number are for use by dental professionals only. 89 0 obj <> endobj SurgeryPlus notifies that you or your dependent earned the reward. Medicare Part B may cover diagnostic hearing and balance examstests your doctor requires if you need medical treatment. 866-855-1212. Click Register Now to create your profile and start exploring this free service. The SBC was created to make it easier to compare and shop for health plans. Remember that Medicare Advantage plans are required by law to offer all the benefits of Original Medicare, but most plans offer much more. It all depends on your policy. startxref 0000015806 00000 n You can choose whether or not to use SurgeryPlus for your surgical procedures. It requires doctors and facilities to meet strict credential guidelines leading to the highest quality care possible. endobj 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. Please contact Member Benefits your plan administrator at 1-800-282-8626 for more information. 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. Pre-authorization will still need to be submitted by your provider to SurgeryPlus before the surgery is scheduled. Delaware State Code Inpatient hospital: $450 per admission copay for unlimited days, plus 35% of our allowance. The surgery and any facility costs will be 100% covered under your SurgeryPlus benefit. The sharing of health information between these companies is permitted by regulation. "_P^)J^:+&!nI-eMNYrVY;QU&+,SUdTVvSN(GTDS o5q_H\%lqbF$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 Public Meetings 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. Inpatient (Precertification is required): $350 per admission. General Assembly Policy form GPNP99 <<7C167570AC52504DB41418C8CABC0A04>]/Prev 422895/XRefStm 1266>> , begin to type the name of your employer in the space below. 0000381088 00000 n 0000019224 00000 n 10 frequently asked questions about Medicare plans, Deductibles for Medicare Part A and Part B. There is a long list of items covered, including: Before renting or purchasing any medical equipment, be sure to ask if the retailer or supplier participates in Medicare. Hospital Care. This is because you won't know what services you need until you meet with your provider. ic+C@nN`RYva@\}KRr>Wq8=Rw+{a .n!LF40d=DdcB42r7hRXyMQ"wDYfuwO se)D+jd7bLB,2}a'_UOaB:.bwRIQGp)` aHeO\@qPtn#u,{n{@|=V<^N}Ap2,+H>0$_ -C endstream Hearing & balance exams, Medicare.gov, last accessed June 10, 2022. We cover the most expensive costs associated with your surgery so you'll pay less for your procedure. <. 10739 Deerwood Park Blvd, Suite 200-B Please review the plan summaries for summarized information and your certificate of insurance for detailed information about your plan benefits. Negotiated fees typically range from 15-45% below the average fees charged in a dentists community for the same or substantially similar services. These plans include all your Part A and Part B coverage and often provide extra coverage for services not included in Original Medicare. Visit ESPN for the game videos of the Brooklyn Nets vs. Boston Celtics NBA basketball game on March 3, 2023 Agent tip: "Original Medicare may cover 80% of a traditional cataract surgery. Surgical Coverage Surgery Surgery Medicare covers many medically necessary surgical procedures. Coverage is provided under a group insurance policy (Policy form GPNP99) issued by MetLife. 0 0000005131 00000 n You can also go through the SurgeryPlus member portal. 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. 9l J'X:50e0l`} }U,,Q`lam[5-0f`MVe` 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. What is the SurgeryPlus benefit? Overview . Every SBC is created with four double-sided pages and 12-point type. Benefits are subject to change upon agreement between Metropolitan Life Insurance Company and the participating organization. Durable medical equipment (DME) coverage, Medicare.gov, last accessed June 10, 2022. These rules determine the order in which the plans will pay benefits. However, some UnitedHealthcare policies charge lower deductibles . Yes. Theres a lot of information in an SBC. Even though its meant to make the information easier to understand, it can seem like a lot at first. 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. 0000014251 00000 n Corporations This program will be available on January 1, 2020. 1026 0 obj 0000009101 00000 n Arrives by Mon, Mar 13 Buy Samickarr Clearance items!Wireless Support Bras For Women Full Coverage And Lift Plus Size Bras Post-Surgery Bra Wirefree Bralette Minimizer Bra For Everyday Comfort at Walmart.com 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. Its also possible to get an SBC in another language. Information gathered by our partners will be used for your benefit to help guide you on your path to wellness. 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. 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. 285 0 obj <>stream trailer Coverage will be considered under your out-of-network benefits. Malini Ghoshal, What You Need to Know About Medicare Prescription Drug Plans (Part D), Healthline, last accessed June 10, 2022. 1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. In certain markets, delegated vendor guidelines may be used to support medical necessity and other coverage determinations. SurgeryPlus provides an alternative to using your health plan for a planned surgical procedure that is not an emergency. Disclaimer He or she hasnt agreed to accept negotiated fees. 0000016018 00000 n L0920007743[exp0922][All States][DC,GU,MP,PR,VI] 2020 MSS, Florida office (headquarters)
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