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(Portal access Code: surgeryplus). Inpatient hospital: $450 per admission copay for unlimited days, plus 35% of our allowance. 10 frequently asked questions about Medicare plans, Deductibles for Medicare Part A and Part B. Yes. 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. Hearing & balance exams, Medicare.gov, last accessed June 10, 2022. Coverage is provided under a group insurance policy (Policy form GPNP99) issued by MetLife. 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. Updated 08/29/2019 . Most plans cover the entire cost of preventive care, plus a portion of the cost after you meet your deductible for other procedures. All rights reserved. 0000015930 00000 n What is Medicare Part C? U.S. Department of Health & Human Services, last accessed June 10, 2022. The complete provisions of the plans are set forth in the Plan Documents and Summary Plan Description. When it comes to Medicare, the question we hear most often after What does it cost? is, What does it cover?. 0000004536 00000 n 12 Always err on the side of caution! 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. This program utilizes the MetLife PDP Plus Network of participating dentists. Bariatric surgery is surgery to help you lose weight. . 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. Adjustable straps allow for a better, customized fit. This information is provided for educational purposes only. Please contact Member Benefits your plan administrator at 1-800-282-8626 for more information. 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 How can we make this page better for you? Some general conditions to receive coverage from United Healthcare requires that you meet the following criteria: Have a body mass index over 40 OR. 2 If you have Medicare Part B primary, your costs for prescription drugs may be lower. SurgeryPlus notifies that you or your dependent earned the reward. The State Employee Benefits Committee (SEBC) believes in providing high quality care to members at an affordable cost. Group dental insurance policies featuring the Preferred Dentist Program are underwritten by Metropolitan Life Insurance Company, New York, NY 10166. Weight-Loss (Bariatric) Surgery. Members will pay nothing out of pocket for bariatric surgery; however, financial incentives do not apply. <. We cover the most expensive costs associated with your surgery so youll pay less for your procedure. 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. "L @Zd X$9RAC~yGz3)fjaPk !e E57 Hln8 ``:w0@6Cfmu ] However, some UnitedHealthcare policies charge lower deductibles . 0000012970 00000 n To connect with SurgeryPlus today, call 833-709-2445. 0000378718 00000 n Delaware Marketplace Transparency Agent tip: "Original Medicare may cover 80% of a traditional cataract surgery. Policy form GPNP99. 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. When enrolling you may choose to also cover your spouse, domestic partner, and/or children up to age 26. SurgeryPlus negotiates a single cost (bundled rate) for the entire surgical procedure, resulting in savings to the State of Delaware. Local Coverage Determinations (LCDs)/Local Coverage Article (LCAs) exist and compliance with these policies is required where applicable. 0000001036 00000 n 0000001609 00000 n Coverage Policy ; Coverage for bariatric surgery or revision of a bariatric surgical procedure varies across plans and may be governed by state mandates. 0000024262 00000 n }4Q2L_L 0fI\l!AN7za|*_)2:lU2_kciTX*R:N%` c8B=3 If it contains a form, you can print it and fill it out. EXA!YA?fqLv1bd::M&a54g#A010p]p Find out which Humana plans include your doctors and cover the medications you take now to help you estimate your costs. . 0000014887 00000 n 89 0 obj <> endobj Also, your doctor will need to certify that you need certain eligible in-home services. This webpage is provided for summary purposes only and is not a complete description of the plan benefits, limitations, and exclusions. Call a Care Advocate at 833.709.2444 for more information. 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. 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. 0000000016 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. Or Reach Us at 855-200-2099 " *" indicates required fields Please remember to hold on to all receipts to submit a dental claim. Some links on this page may take you to Humana non-Medicare product or service pages or to a different website. Mastectomy surgery is a significant life event for many people. Simply have your dentist submit a request online at www.metdental.com or call 1-877-MET-DDS9. Corporations Alternatively, a Medicare Advantage plan often provides comprehensive vision coverage, plus cataract surgery without out-of-pocket coinsurance costs.". To see if your procedure is covered, contact us. Hospital Care. 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. Durable medical equipment (DME) coverage, Medicare.gov, last accessed June 10, 2022. 0 Cities & Towns If you need cataract surgery in both eyes . Members of HumanaVision can receive deeper discounts on LASIK services, especially when using a specific in-network provider. Pre-authorization will still need to be submitted by your provider to SurgeryPlus before the surgery is scheduled. State Regulations Preventive & screening services, Medicare.gov, last accessed June 10, 2022. cost of cataract surgery with medicare. Pick the option that's best for you. For the Plus Size Queens. What's not covered by Part A & Part B? Medicare.gov, last accessed June 10, 2022. The inclusion of a code does not imply any right to . Read your certificate of insurance for details on plan benefits, limitations, and exclusions. 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. In addition, it comes with a concierge service (Care Advocate) and travel benefits. 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. Many Medicare Advantage plans, however, do include coverage for routine dental, vision and hearing care, including glasses and hearing aids. Yes. Original Medicare generally doesnt cover the cost of a nursing home, assisted living or long-term care facility. Disclaimer It all depends on your policy. But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary. SurgeryPlus is a supplemental benefit for non-emergency surgeries that provides high-quality care, endstream You may need to exhaust your personal resources on medical care before you are eligible. If permitted, you may only be responsible for the negotiated fee. 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 . We cover the most expensive costs associated with your surgery so you'll pay less for your procedure. For specific LCDs/LCAs, refer to the table for Starting January 1, 2018, HIP State Basic and HIP State Plus will cover members age 21 to 64. You can also go through the SurgeryPlus member portal. SurgeryPlus is a voluntary benefit that provides pre-planned, non-emergency surgical services. Privacy Policy Take some time to understand your Medicare plan. Jacksonville, FL 32256 Our licensed Humana sales agents are available to help you select the coverage that best meets your needs. This benefit is available to those enrolled in one of the CEBT EPO, PPO or HDHP medical plans. You are always free to select the dentist of your choice. "Original Medicare may cover 80% of a traditional cataract surgery. Reconstructive Procedures include surgery or other procedures which are related to a health condition. 00k` !" Remember that Medicare Advantage plans are required by law to offer all the benefits of Original Medicare, but most plans offer much more. 0000001436 00000 n A participating dentist is a general dentist or specialist who has agreed to accept negotiated fees as payment in full for services provided to plan members. 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. Examples of procedures covered are hernia repair, hysterectomy, colonoscopy, tendon release, spine injections and fusions, knee replacements, and many more. 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. endstream 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 Cancellation/Termination of Benefits You may enroll for membership in the ABN directly through the ABN website or during your dental enrollment. Wearing a swimsuit after a mastectomy can be a transition. Rates are subject to change and depend on geographic area. You earn the reward once the following occurs: The reward will then be credited to the savings and spending account of your choice. 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. Elected Officials 0000019224 00000 n 1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. Thats what SurgeryPlus does. 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. What is the SurgeryPlus benefit? such as Spine, General Surgery, Genitourinary, Orthopedic, Ear, Nose & Throat, Cardiac, GI, and Pain Management. The State of Delaware is an Equal Opportunity employer and values a diverse workforce. 0 0000006640 00000 n Tax Center Medicare Part B may cover diagnostic hearing and balance examstests your doctor requires if you need medical treatment. Enter your ZIP code below to see plans with their premiums, copays, and participating doctors and pharmacies. Mon-Fri, 8:30am-5:00pm (ET), Texas office 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. 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. 866-855-1212 to request a claim form. Because its all in the same format, its easier to make apples-to-apples comparisons when youre deciding which plan is best for you. Yes. 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. Your private health information is just that private. American Airlines manages employee and retiree health benefits. The amount of benefits payable by MetLife may be reduced due to the benefits paid under the primary plan. This Coverage Policy addresses breast reduction for symptomatic macromastia and breast reduction surgery on Guided Support Each company is a separate entity and is not responsible for another's financial or contractual obligations. There are no simple answers, but you can start here to find general answers to some of the most common questions about Medicare coverage. Malini Ghoshal, What You Need to Know About Medicare Prescription Drug Plans (Part D), Healthline, last accessed June 10, 2022. About SurgeryPlus SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. Always err on the side of caution! ii AF! Medicare pays $781, and your cost is $195. <<7C167570AC52504DB41418C8CABC0A04>]/Prev 422895/XRefStm 1266>> In certain markets, delegated vendor guidelines may be used to support medical necessity and other coverage determinations. SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. 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. 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. What Part A covers, Medicare.gov, last accessed June 10, 2022. Your medical insurance may also pick up the cost in full or part for medically-related . 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. A mastectomy bra can provide comfort, support, and security to an individual as they become accustomed to their new normal. Many offer affordable or even $0 monthly plan premiums, but you must continue to pay the Medicare Part B premium. Voting & Elections endstream endobj startxref Your general dentist or specialist usually sends MetLife a plan for your care and requests an estimate of benefits. Prescription drug planscalled Medicare Part Dare only available through private companies like Humana. 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. HIP Plus is the plan for the best value.HIP Plus provides health coverage for a low, predictable monthly cost. Does Medicare Cover Pre-existing Conditions? Medicare.com, last accessed June 10, 2022. The SurgeryPlus Difference We allow you to focus on practicing medicine and caring for patients. Public Meetings 0000011564 00000 n Certain claim and network administration services are provided through Vision Service Plan (VSP), Rancho Cordova, CA. Benefits are subject to change upon agreement between Metropolitan Life Insurance Company and the participating organization. This symbol denotes a PDF Document. You can also go through the SurgeryPlus member portal. (Due to contractual requirements, MetLife is prevented from soliciting certain providers.) Coverage Policies are not recommendations for treatment and should never be used as treatment guidelines. Medicare Part B contributes 80% of the cost of one pair of eyeglasses or set of contact lenses after cataract surgery after. Your copays and deductibles will still apply. Negotiated fees typically range from 15-45% below the average fees charged in a dentists community for the same or substantially similar services. Looser styling flatters while cleverly camouflaging around your middle. If the information online is inconsistent with the Plan Documents, the Plan Documents will govern. 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. Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. Expand your practice We route you incremental cases outside the typical radius of your practice. However, this depends on the specific type of surgery you need, your dental plan, and your level of coverage. This website and phone number are for use by dental professionals only. 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. The surgery and any facility costs will be 100% covered under your SurgeryPlus benefit. 3 You must be the contract holder or spouse, 18 or older, on a Standard or Basic Option Plan to earn incentive rewards. Delaware Topics %%EOF On average, cataract surgery costs about $5,000 per eye; however, in some places, this price can move up to over $10,000. You can track your claims online and even receive e-mail alerts when a claim has been processed. A dental plan may cover routine office visits, fillings, crowns, root canals, oral surgery, periodontics, orthodontics, or bridges and dentures. Your doctor certifies that you are terminally ill, meaning that your life expectancy is 6 months or less. L0920007743[exp0922][All States][DC,GU,MP,PR,VI] 2020 MSS, Florida office (headquarters) Coverage may not be available in all states. Outpatient facility care: 35% of our allowance . Effective July 1, 2023, bariatric surgery coverage will be available exclusively through the SurgeryPlus benefit. Confirm your coverage before you commit to a procedure you're unsure about. Your SurgeryPlus Care Advocate will provide you one-on-one, personalized help each step of the way. Rest easy knowing you can afford the surgery you need, HDHP Plans will require a reduced deductible to be met first. The primary result of . Yes. For procedures requiring inpatient admission or overnight recovery, the travel benefit covers the patient and one companion for a limited amount of time. To provide and maintain this valuable membership benefit, MetLife reimburses the association and/or the plan administrator for these costs. 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. 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. Where two or more professionally acceptable dental treatments for a dental condition exist, reimbursement is based on the least costly treatment alternative. This is a voluntary benefit available to you if you're enrolled in the Core, Standard, Plus or High Cost Coverage medical option. Licensed Humana sales agents are available daily, 8a.m. 8 p.m. Medicare Part A does cover care provided in a skilled nursing facility with certain conditions and time limitations. Your SurgeryPlus benefit will also help pay for necessary travel associated with the covered procedure. The time a mother and baby spend in the hospital after delivery is a medical decision. Complete and submit the form and well be in touch soon. The service categories and plan limitations shown below represent an overview of the plan benefits. Facilitate and consolidate your payments. Gross Receipts Tax However, Medicare doesnt cover routine hearing exams, hearing aids or fittings.7. All health plan companies are required to provide an SBC for each of their different plans. General Assembly 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.