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. Confirm your coverage before you commit to a procedure youre unsure about. Overview . Through the planning process, you will work with the same Care Advocate. Plan benefits and rates are effective for group plan year January 1, 2023 through December 31, 2024, and subject to change thereafter. 0000024943 00000 n Yes. Assign you a personal care coordinator to offer one-on-one guidance and support as you prepare for, undergo and recover from surgery. 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. When enrolling you may choose to also cover your spouse, domestic partner, and/or children up to age 26. This Coverage Policy addresses breast reduction for symptomatic macromastia and breast reduction surgery on Preventive & screening services, Medicare.gov, last accessed June 10, 2022. endobj 0000006640 00000 n 0000379543 00000 n You can choose whether or not to use SurgeryPlus for your surgical procedures. %%EOF You pay 20% of the Medicare Part B copay plus any out-of-pocket costs such as your deductible, medication costs and physician fees. such as Spine, General Surgery, Genitourinary, Orthopedic, Ear, Nose & Throat, Cardiac, GI, and Pain Management. This program utilizes the MetLife PDP Plus Network of participating dentists. <> 988 0 obj (Refer to your dental benefits plan summary for your out-of-network dental coverage.) TE 6Uz A$& &`5= X7"yH: wd`^+H(`q] DF9qt 0000019705 00000 n Updated 08/29/2019 . 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. Information gathered by our partners will be used for your benefit to help guide you on your path to wellness. We cover the most expensive costs associated with your surgery so you'll pay less for your procedure. A class is a group of people defined in the group policy. Scuba Certification; Private Scuba Lessons; Scuba Refresher for Certified Divers; Try Scuba Diving; Enriched Air Diver (Nitrox) Certain claim and network administration services are provided through Vision Service Plan (VSP), Rancho Cordova, CA. For example, rather than paying separately for the surgeon, facility, anesthesiologist, and radiologist, SurgeryPlus negotiates one bundled rate. SurgeryPlus is included in your medical benefits at no additional cost to you. How can we make this page better for you? Procedure charge schedules are subject to change each plan year. Please Note: Additional information about this benefit change will be posted as it becomes available and before the July 1, 2023 effective date. %PDF-1.4 % Does Medicare Cover Pre-existing Conditions? Medicare.com, last accessed June 10, 2022. %%EOF Facilitate and consolidate your payments. Jacksonville, FL 32256 Elected Officials If you need cataract surgery in both eyes . 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. Theres a lot of information in an SBC. 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. hb```f`` vAX,Xf000Z\ q1=nIc /( Medicare won't cover Lasik surgery just to avoid the need for glasses. For example, if youre still working and covered by your employer or your spouses employer sponsored health coverage, you may be able to wait. Negotiated fees are subject to change. Inpatient (Precertification is required): $350 per admission. At time of enrollment, you will choose how you want to pay. 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. SurgeryPlus Frequently Asked Questions General Questions . 0000401803 00000 n This may include surgery to remove cataracts or after an eye injury. local anesthesia, non-intravenous conscious sedation or analgesia such as nitrous oxide; Dental services arising out of accidental injury to the teeth and supporting structures, except for injuries to the teeth due to chewing or biting of food; Initial installation of a fixed and permanent Denture to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth; Other fixed Denture prosthetic services not described elsewhere in the certificate; Precision attachments, except when the precision attachment is related to implant prosthetics; Addition of teeth to a partial removable Denture to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth; Adjustment of a Denture made within 6 months after installation by the same Dentist who installed it; Implants supported prosthetics to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth; Fixed and removable appliances for correction of harmful habits; Appliances or treatment for bruxism (grinding teeth), including but not limited to occlusal guards and night guards; Diagnosis and treatment of temporomandibular joint (TMJ) disorders. 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 cover the most expensive costs associated with your surgery so youll pay less for your procedure. Whats a Summary of Benefits and Coverage? Voting & Elections Franchise Tax Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment. In some cases, your association and/or the plan administrator may incur costs in connection with providing oversight and administrative support for this sponsored plan. 125 0 obj <>stream Simply have your dentist submit a request online at www.metdental.com or call 1-877-MET-DDS9. You'll also pay a deductible of $233. . Weight-Loss (Bariatric) Surgery. For people 65+ or those under 65 who qualify due to a disability or special situation, For people who qualify for both Medicaid and Medicare, Individual & family plans short term, dental & more, Individual & family plans - Marketplace (ACA). SurgeryPlus negotiates a single cost (bundled rate) for the entire surgical procedure, resulting in savings to the State of Delaware. This benefit is available to those enrolled in one of the CEBT EPO, PPO or HDHP medical plans. Agent tip: "Original Medicare may cover 80% of a traditional cataract surgery. endstream endobj 124 0 obj <>/Filter/FlateDecode/Index[5 84]/Length 22/Size 89/Type/XRef/W[1 1 1]>>stream To connect with SurgeryPlus today, call 833-709-2445. Text Size Smaler, Make Text Size HVn7}Wt)A87HPV$(YXF;3as=sfj'O&y>=zF_Gmlr:v1z5`:A1suhMFY}r0_&o^w]vw%'o':~u>)|]!6nRBki;L}h0y^'#cCmJJc . This webpage is provided for summary purposes only and is not a complete description of the plan benefits, limitations, and exclusions. The SBC was created to make it easier to compare and shop for health plans. *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. 0000024865 00000 n Most common oral surgeries are covered, at least in part, by your dental insurance provider. What Part A covers, Medicare.gov, last accessed June 10, 2022. RSS Feeds, Make All health plan companies are required to provide an SBC for each of their different plans. 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. By receiving services through SurgeryPlus, you and your dependents can earn financial rewards. Corporations 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. The primary result of . 0 You'll be more confident on the beach with an extensive selection of plus-size swimwear. 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. These plans include all your Part A and Part B coverage and often provide extra coverage for services not included in Original Medicare. Out-of-pocket costs may be greater if you visit a dentist who does not participate in the network. Take your bill (s) to your State Farm agent's office. The SurgeryPlus Difference We allow you to focus on practicing medicine and caring for patients. Some general conditions to receive coverage from United Healthcare requires that you meet the following criteria: Have a body mass index over 40 OR. SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. Mastectomy surgery is a significant life event for many people. Medicare Part B benefits cover 80% of the Medicare-approved amount for cataract surgery. Coverage includes access to our network of excellent surgeons, consults and appointments with your SurgeryPlus provider, anesthesia, the procedure and facility (hospital) fees. You can also go through the SurgeryPlus member portal. This symbol denotes a Web Page. 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. What is Medicare Part C? U.S. Department of Health & Human Services, last accessed June 10, 2022. If you qualify for it, Medicaid, which is administered by states under federal guidelines, may cover nursing home care. 89 0 obj <> endobj Pre-/postnatal professional care: 35% of our allowance . SurgeryPlus Care Advocates are your connection to the SurgeryPlus benefit. This information is provided for educational purposes only. For specific LCDs/LCAs, refer to the table for Some links on this page may take you to Humana non-Medicare product or service pages or to a different website. 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. Medicare pays $781, and your cost is $195. To see if your procedure is covered, contact us. 1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. 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. 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 Please contact Member Benefits your plan administrator at 1-800-282-8626 for more information. <>stream Transparency 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. 0000012970 00000 n "Original Medicare may cover 80% of a traditional cataract surgery. The estimate helps you prepare for the cost of dental services. 0 Or Reach Us at 855-200-2099 " *" indicates required fields xref Benefits are subject to change upon agreement between Metropolitan Life Insurance Company and the participating organization. Effective July 1, 2023, bariatric surgery coverage will be available exclusively through the SurgeryPlus benefit. 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. The sharing of health information between these companies is permitted by regulation. 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. 0000005180 00000 n 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. 0000019224 00000 n You can choose whether or not to use SurgeryPlus for your surgical procedures. Wearing a swimsuit after a mastectomy can be a transition. 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. 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. Confirm your coverage before you commit to a procedure you're unsure about. 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. 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 . Mon-Fri, 8:30am-5:00pm (ET), Texas office SurgeryPlus provides an alternative to using your health plan for a planned surgical procedure that is not an emergency. Where two or more professionally acceptable dental treatments for a dental condition exist, reimbursement is based on the least costly treatment alternative. 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. You consent to receiving palliative care to make you comfortable versus care to try to cure your illness. endobj Negotiated fees are subject to change. endstream endobj 97 0 obj <>stream To get all the details, youll want to look at complete health plan documents. It all depends on your policy. 0000000016 00000 n All services defined in your group dental benefits plan certificate are covered. About SurgeryPlus SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. 3 You must be the contract holder or spouse, 18 or older, on a Standard or Basic Option Plan to earn incentive rewards. Pre-authorization will still need to be submitted by your provider to SurgeryPlus before the surgery is scheduled. This program will be available on January 1, 2020. Medically necessary services diagnose and treat health problems. Looser styling flatters while cleverly camouflaging around your middle. This exclusion will apply whether or not the person receiving the services is enrolled for the government plan. Some examples of comorbidities include high blood pressure, high cholesterol, obstructive sleep apnea, Type II Diabetes, angina or stroke. Its also possible to get an SBC in another language. <<7C167570AC52504DB41418C8CABC0A04>]/Prev 422895/XRefStm 1266>> SurgeryPlus is a supplemental benefit for non-emergency surgeries that provides high-quality care, What is the SurgeryPlus benefit? 00k` !" Your private health information is just that private. "L @Zd X$9RAC~yGz3)fjaPk !e E57 Hln8 ``:w0@6Cfmu ] Many Medicare Advantage plans include prescription drug coverage, in addition to all the benefits provided by Original Medicare Part A and Part B.