%PDF-1.6 % 0000000016 00000 n This information is provided for educational purposes only. You earn the reward once the following occurs: The reward will then be credited to the savings and spending account of your choice. A prime example is breast implants done during or after breast cancer surgery. 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. 00k` !" Home. Coverage includes access to our network of excellent surgeons, consults and appointments with your SurgeryPlus provider, anesthesia, the procedure and facility (hospital) fees. endobj endstream endobj 97 0 obj <>stream . 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). Medically necessary services diagnose and treat health problems. He or she hasnt agreed to accept negotiated fees. A mastectomy bra can provide comfort, support, and security to an individual as they become accustomed to their new normal. %%EOF Delaware Courts It all depends on your policy. 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. Many Medicare Advantage plans, however, do include coverage for routine dental, vision and hearing care, including glasses and hearing aids. It has less visits to physical, speech and occupational therapies than HIP Plus. 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. 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. Child(ren)s eligibility for dental coverage is from birth up to age 26. 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. About SurgeryPlus SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. The SurgeryPlus Difference We allow you to focus on practicing medicine and caring for patients. Metlife will not pay Dental Insurance benefits for charges incurred for: Alternate Benefits For example, if youre still working and covered by your employer or your spouses employer sponsored health coverage, you may be able to wait. 866-855-1212. 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 Most plans cover the entire cost of preventive care, plus a portion of the cost after you meet your deductible for other procedures. hb```b``Nf`c`Wcd@ AV(G 2?X%c6g+S@|dHA[&@VS&-,&W\\f9v| **s)S\Ol%5T7A(F Mon-Fri, 8:30am-5:00pm (ET), Texas office What happens with my health information? What's not covered by Part A & Part B? Medicare.gov, last accessed June 10, 2022. Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. You'll also pay a deductible of $233. 285 0 obj <>stream A class is a group of people defined in the group policy. Text Size Smaler, Make Text Size Board Certification, Specialty Training Requirements, Procedure Volume Requirements, State Sanctions Check, Medical Malpractice Claims Review, Criminal Background Checks, CMS Quality Requirements (Hospital Only), Monthly Network Monitoring. Some links on this page may take you to Humana non-Medicare product or service pages or to a different website. Heres a step-by-step look at what information is in an SBC: You can request a copy of an SBC anytime. 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. This exclusion will apply whether or not the person receiving the services is enrolled for the government plan. Thats because its basically a document that outlines whats covered and not covered under a health plan. 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. 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. SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. Rest easy knowing you can afford the surgery you need, HDHP Plans will require a reduced deductible to be met first. Does Medicare Cover Pre-existing Conditions? Medicare.com, last accessed June 10, 2022. What Part A covers, Medicare.gov, last accessed June 10, 2022. (Negotiated fees are subject to change.). 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. hb``P```e```5c@L@q EP0 Agent tip: "Original Medicare may cover 80% of a traditional cataract surgery. 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. We recommend that you request a pre-treatment estimate for services in excess of $300. Mastectomy surgery is a significant life event for many people. Home health services, Medicare.gov, last accessed June 10, 2022. Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. Learn more about a Summary of Benefits and Coverage, also commonly referred to as an SBC. 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. (Based on internal analysis by MetLife. hb```f`` vAX,Xf000Z\ q1=nIc /( 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. Outpatient: 15% of our allowance . Your SurgeryPlus benefit will also help pay for necessary travel associated with the covered procedure. 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. Policy number 5343606-1-G (Low plan), Metropolitan Life Insurance Company, 200 Park Avenue, New York, NY 10166 Policy form GPNP99. Coverage Policies are not recommendations for treatment and should never be used as treatment guidelines. The estimate helps you prepare for the cost of dental services. SurgeryPlus is a voluntary benefit that provides pre-planned, non-emergency surgical services. 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. Visit ESPN for the game videos of the Brooklyn Nets vs. Boston Celtics NBA basketball game on March 3, 2023 Individuals enrolled in a State of Delaware Aetna or Highmark Delaware non-Medicare health plan are automatically enrolled in this FREE benefit. 0000007939 00000 n 0000011564 00000 n E-mail / Text Alerts "L @Zd X$9RAC~yGz3)fjaPk !e E57 Hln8 ``:w0@6Cfmu ] Inpatient (Precertification is required): $350 per admission. If the MetLife dental benefit plan is secondary, most coordination of benefits provisions require MetLife to determine benefits after benefits have been determined under the primary plan. 0000001436 00000 n 89 37 Take some time to understand your Medicare plan. Facilitate and consolidate your payments. Franchise Tax Coverage is provided under a group insurance policy (Policy form GPNP99) issued by MetLife. Yes. The time a mother and baby spend in the hospital after delivery is a medical decision. Please contact Member Benefits your plan administrator at 1-800-282-8626 for more information. The sharing of health information between these companies is permitted by regulation. Before undergoing surgery, youll want to be connected with the highest-quality providers and facilities. Call our Health Response Center at. Copyright 2022 Employer Direct HealthcareAll Rights Reserved. 250 0 obj <> endobj 1 Sturti / Getty Images Coverage Varies by Insurer Each health plan is different. Original Medicare generally doesnt cover the cost of a nursing home, assisted living or long-term care facility. 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. SurgeryPlus provides an alternative to using your health plan for a planned surgical procedure that is not an emergency. The State Employee Benefits Committee (SEBC) believes in providing high quality care to members at an affordable cost. Delaware's Governor Confirm your coverage before you commit to a procedure youre unsure about. What is the SurgeryPlus benefit? It does not cover bariatric surgery or jaw care (TMJ). Negotiated fees are subject to change. So you may be responsible for any difference in cost between the dentists fee and your plans benefit payment. 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. endstream %PDF-1.6 % At time of enrollment, you will choose how you want to pay. American Airlines manages employee and retiree health benefits. You consent to receiving palliative care to make you comfortable versus care to try to cure your illness. 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. Group dental insurance policies featuring the Preferred Dentist Program are underwritten by Metropolitan Life Insurance Company, New York, NY 10166. But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary.12. Policy form GPNP99 Eleesha Lockett, Does Medicare Cover Plastic Surgery? Healthline, last accessed June 10, 2022. }4Q2L_L 0fI\l!AN7za|*_)2:lU2_kciTX*R:N%` c8B=3 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. 0000392965 00000 n It can include Durable Medical Equipment (DME), mental healthcare or ambulance services.2 Preventive care services are health treatments that prevent illness or detect problems at an early stage, like flu shots or cancer screenings.3, There are some things Original Medicare wont cover. This Coverage Policy addresses breast reduction for symptomatic macromastia and breast reduction surgery on 89 0 obj <> endobj Take your bill (s) to your State Farm agent's office. You may choose to share the information with your doctor and other medical professionals. *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. This program utilizes the MetLife PDP Plus Network of participating dentists. Our licensed Humana sales agents are available to help you select the coverage that best meets your needs. A dental plan may cover routine office visits, fillings, crowns, root canals, oral surgery, periodontics, orthodontics, or bridges and dentures. Public Meetings This guide will explain the different types of . 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. 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. 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. RSS Feeds, Make 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. Click Register Now to create your profile and start exploring this free service. 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. 989 0 obj Scuba Certification; Private Scuba Lessons; Scuba Refresher for Certified Divers; Try Scuba Diving; Enriched Air Diver (Nitrox) %%EOF This website and phone number are for use by dental professionals only. Also, your doctor will need to certify that you need certain eligible in-home services. Some types of surgery also change the connection between your stomach and intestines. Rates are subject to change and depend on geographic area. Find out which Humana plans include your doctors and cover the medications you take now to help you estimate your costs. Please review the plan summaries for summarized information and your certificate of insurance for detailed information about your plan benefits. Surgical Coverage Surgery Surgery Medicare covers many medically necessary surgical procedures. 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 State Regulations xref h`06NH+500 Medicare Part B may cover diagnostic hearing and balance examstests your doctor requires if you need medical treatment. 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. Actual payments may vary from the pretreatment estimate depending upon annual maximums, plan frequency limits, deductibles and other limits applicable at time of payment. 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. 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. (Refer to your dental benefits plan summary for your out-of-network dental coverage.) <>/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 Or Reach Us at. All services defined in your group dental benefits plan certificate are covered. For example, rather than paying separately for the surgeon, facility, anesthesiologist, and radiologist, SurgeryPlus negotiates one bundled rate. The Plan Sponsor(s) reserve the right to amend or terminate each plan at any time. Many Medicare Advantage plans include prescription drug coverage, in addition to all the benefits provided by Original Medicare Part A and Part B. This website provides an overview of your benefit options. 866-855-1212 to request a claim form. HIP Plus is the plan for the best value.HIP Plus provides health coverage for a low, predictable monthly cost. You and your dentist will receive a benefit estimate for most procedures while you are still in the office. You'll be more confident on the beach with an extensive selection of plus-size swimwear. References to UnitedHealthcare pertain to each individual company or other UnitedHealthcare affiliated companies. Weather & Travel, Contact Us Privacy Policy Knowing which types of common medical costs are not covered will be helpful when planning for your out-of-pocket medical costs. coinsurance and/or deductible on PPO plans, or copay on EPO plans). <. Adjusting to the physical changes post-surgery can be difficult, and finding the right mastectomy bra is one of the most important steps in the process. To connect with SurgeryPlus today, call 833-709-2445. 0000018849 00000 n 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. State Agencies This benefit is available to those enrolled in one of the CEBT EPO, PPO or HDHP medical plans. Please fill out the contact form so the right person can be in touch quickly. An explanation of whats not covered and/or the limits on coverage, Information on costs you might have to pay like deductibles, coinsurance and copayments, Coverage examples, including how coverage works in the case of a pregnancy or a minor injury. Pick the option that's best for you. Original Medicare generally covers most pre-existing conditions. Its also possible to get an SBC in another language. Medicare Part A does cover care provided in a skilled nursing facility with certain conditions and time limitations. 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. 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. 9l J'X:50e0l`} }U,,Q`lam[5-0f`MVe` endstream 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. 0000015692 00000 n Business First Steps, Phone Directory You can also go through the SurgeryPlus member portal. startxref For the Plus Size Queens. About Us; Staff; Camps; Scuba. Hospice care, Medicare.gov, last accessed June 10, 2022. 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. 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. Your medical insurance may also pick up the cost in full or part for medically-related . 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. 0000024865 00000 n Updated 08/29/2019 . Only travel arrangements made through your Care Advocate are eligible for coverage under the SurgeryPlus benefit. Looser styling flatters while cleverly camouflaging around your middle. When enrolling you may choose to also cover your spouse, domestic partner, and/or children up to age 26. This symbol denotes a Web Page. 0000001266 00000 n What Part B covers, Medicare.gov, last accessed June 10, 2022. This symbol denotes a PDF Document. Malini Ghoshal, What You Need to Know About Medicare Prescription Drug Plans (Part D), Healthline, last accessed June 10, 2022. This communication does not guarantee benefits and does not indicate all services received will be covered by your plan. 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. This webpage is provided for summary purposes only and is not a complete description of the plan benefits, limitations, and exclusions. 0000378718 00000 n This Coverage Policy addresses bariatric surgery and procedures for the treatment of morbid obesity. 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. 0000023776 00000 n 0000019224 00000 n Have a body mass index over 35 with severe comorbidity. Do your homework. Effective July 1, 2023, bariatric surgery coverage will be available exclusively through the SurgeryPlus benefit. 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. 0000009101 00000 n 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. To provide and maintain this valuable membership benefit, MetLife reimburses the association and/or the plan administrator for these costs. Bariatric surgery is surgery to help you lose weight. Yes. Bigger. If the MetLife dental benefit plan is primary, MetLife will pay the full amount of benefits that would normally be available under the plan.