Or Reach Us at. 89 0 obj <> endobj Cancellation/Termination of Benefits 0000010311 00000 n Local Coverage Determinations (LCDs)/Local Coverage Article (LCAs) exist and compliance with these policies is required where applicable. Your doctor certifies that you are terminally ill, meaning that your life expectancy is 6 months or less. To get one, contact us. The surgery and any facility costs will be 100% covered under your SurgeryPlus benefit. 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. 1 Sturti / Getty Images Coverage Varies by Insurer Each health plan is different. VSP is not affiliated with Metropolitan Life Insurance Company or its affiliates. It has less visits to physical, speech and occupational therapies than HIP Plus. Alternatively, a Medicare Advantage plan often provides comprehensive vision coverage, plus cataract surgery without out-of-pocket coinsurance costs.". Many offer affordable or even $0 monthly plan premiums, but you must continue to pay the Medicare Part B premium. 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. 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. Cities & Towns Eleesha Lockett, Does Medicare Cover Plastic Surgery? Healthline, last accessed June 10, 2022. Facilitate and consolidate your payments. (Due to contractual requirements, MetLife is prevented from soliciting certain providers.) Effective July 1, 2023, bariatric surgery coverage will be available exclusively through the SurgeryPlus benefit. If it contains a form, you can fill it out online and submit it. Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. Tax Center Connect you with a top-ranked, board-certified and fellowship-trained surgeon near you. To see if your procedure is covered, contact us. Yes. This information is provided for educational purposes only. You can use the Glossary of Health Coverage and Medical Terms, also called a Uniform Glossary to get clear, simple answers about what terms mean. Take your bill (s) to your State Farm agent's office. 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. 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. The State Employee Benefits Committee (SEBC) believes in providing high quality care to members at an affordable cost. This is a voluntary benefit available to you if you're enrolled in the Core, Standard, Plus or High Cost Coverage medical option. However, Medicare doesnt cover routine hearing exams, hearing aids or fittings.7. 0000018849 00000 n General Assembly SurgeryPlus notifies that you or your dependent earned the reward. 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. Learn more about the ABN. This benefit is available to those enrolled in one of the CEBT EPO, PPO or HDHP medical plans. Even though its meant to make the information easier to understand, it can seem like a lot at first. 0000004536 00000 n If the MetLife dental benefit plan is primary, MetLife will pay the full amount of benefits that would normally be available under the plan. 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. The amount of benefits payable by MetLife may be reduced due to the benefits paid under the primary plan. 0000001436 00000 n You can choose whether or not to use SurgeryPlus for your surgical procedures. Enter your ZIP code below to see plans with their premiums, copays, and participating doctors and pharmacies. Out-of-pocket costs may be greater if you visit a dentist who does not participate in the network. Read your certificate of insurance for details on plan benefits, limitations, and exclusions. Child(ren)s eligibility for dental coverage is from birth up to age 26. This program utilizes the MetLife PDP Plus Network of participating dentists. Medicare pays 80% of the cost of traditional cataract surgery, which would be covered by Medicare Part B. 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. This document presents the majority of services within each category, but is not a complete description of the plan. Benefits are subject to change upon agreement between Metropolitan Life Insurance Company and the participating organization. This symbol denotes a Web Page. Preventive & screening services, Medicare.gov, last accessed June 10, 2022. Thats because its basically a document that outlines whats covered and not covered under a health plan. 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. Overview . 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. In addition, it comes with a concierge service (Care Advocate) and travel benefits. xref 0000015930 00000 n 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. L0920007743[exp0922][All States][DC,GU,MP,PR,VI] 2020 MSS, Florida office (headquarters) To connect with SurgeryPlus today, call 833-709-2445. Trust in our network Copyright 2023 Member Benefits. 0000016018 00000 n EXA!YA?fqLv1bd::M&a54g#A010p]p You'll be more confident on the beach with an extensive selection of plus-size swimwear. 250 0 obj <> endobj Visit ESPN for the game videos of the Brooklyn Nets vs. Boston Celtics NBA basketball game on March 3, 2023 By receiving services through SurgeryPlus, you and your dependents can earn financial rewards. such as Spine, General Surgery, Genitourinary, Orthopedic, Ear, Nose & Throat, Cardiac, GI, and Pain Management. endobj Dentists may submit your claims for you which means you have little or no paperwork. Agent tip: "Original Medicare may cover 80% of a traditional cataract surgery. Weather & Travel, Contact Us 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. Medicare Part B (medical insurance) helps cover the cost of medically necessary durable medical equipment if your doctor prescribes it for use in your home. All other HIP plans cover members ages 19 to 64. 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. Most plans cover the entire cost of preventive care, plus a portion of the cost after you meet your deductible for other procedures. Or Reach Us at 855-200-2099 " *" indicates required fields Its also possible to get an SBC in another language. Your general dentist or specialist usually sends MetLife a plan for your care and requests an estimate of benefits. What Part B covers, Medicare.gov, last accessed June 10, 2022. 0000024943 00000 n Only travel arrangements made through your Care Advocate are eligible for coverage under the SurgeryPlus benefit. 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. 0000001036 00000 n Procedure charge schedules are subject to change each plan year. Coverage includes access to our network of excellent surgeons, consults and appointments with your SurgeryPlus provider, anesthesia, the procedure and facility (hospital) fees. Mastectomy surgery is a significant life event for many people. You and your dentist will receive a benefit estimate for most procedures while you are still in the office. Where two or more professionally acceptable dental treatments for a dental condition exist, reimbursement is based on the least costly treatment alternative. 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. 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. To get all the details, youll want to look at complete health plan documents. Corporations 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. At time of enrollment, you will choose how you want to pay. You consent to receiving palliative care to make you comfortable versus care to try to cure your illness. 0000001609 00000 n You may enroll for membership in the ABN directly through the ABN website or during your dental enrollment. State Regulations 0000004000 00000 n Medically necessary services diagnose and treat health problems. <> Expand your practice We route you incremental cases outside the typical radius of your practice. Prescription drug planscalled Medicare Part Dare only available through private companies like Humana. startxref 00k` !" You can also go through the SurgeryPlus member portal. 866-855-1212. The service categories and plan limitations shown below represent an overview of the plan benefits. Franchise Tax The effective date of coverage for newly added dependent(s) will depend on when we receive notice and required premium. Consult your doctor before beginning any new diet or exercise regimen. 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. Delaware's Governor Malini Ghoshal, What You Need to Know About Medicare Prescription Drug Plans (Part D), Healthline, last accessed June 10, 2022. Transparency Dependent age may vary by state. The choice is yours. Hospital Care. About Us; Staff; Camps; Scuba. State Agencies Yes. Medicare Advantage plans may offer coverage for vision, hearing, dental and wellness services. This communication does not guarantee benefits and does not indicate all services received will be covered by your plan. 125 0 obj <>stream 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. h`06NH+500 A dental plan may cover routine office visits, fillings, crowns, root canals, oral surgery, periodontics, orthodontics, or bridges and dentures. American Airlines manages employee and retiree health benefits. 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. Public Meetings Learn more aboutsavings and spending accounts. endobj Please fill out the contact form so the right person can be in touch quickly. Rates are subject to change and depend on geographic area. Each company is a separate entity and is not responsible for another's financial or contractual obligations. Medicare will not pay for 24-hour in-home care or meals delivered to you at home. startxref You pay 20% of the Medicare Part B copay plus any out-of-pocket costs such as your deductible, medication costs and physician fees. %PDF-1.4 % The specific travel benefit depends on the procedure, the provider, and the distance between the provider and a member's residence. However, if you choose a non-participating dentist, your out-of-pocket costs may be higher. trailer We cover the most expensive costs associated with your surgery so youll pay less for your procedure. %%EOF This benefit is available to those enrolled in one of the CEBT EPO, PPO or HDHP medical plans. 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. Many Medicare Advantage plans include prescription drug coverage, in addition to all the benefits provided by Original Medicare Part A and Part B. Policy form GPNP99. Through the planning process, you will work with the same Care Advocate. To check to see if you may already have SurgeryPlus, begin to type the name of your employer in the space below. Yes. You can also go through the SurgeryPlus member portal. Wearing a Suit After a Body-Altering Surgery. 0000014887 00000 n 7500 Rialto Blvd, Building 1 Suite 250 The SurgeryPlus Difference We allow you to focus on practicing medicine and caring for patients. Remember that Medicare Advantage plans are required by law to offer all the benefits of Original Medicare, but most plans offer much more. 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. The SBC was created to make it easier to compare and shop for health plans. 1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your 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. If the information online is inconsistent with the Plan Documents, the Plan Documents will govern. Thats what SurgeryPlus does. Premiums and the list of covered drugscalled a formularywill vary by plan.6. %%EOF 6 Original Medicare may even pay for corrective lenses if you have surgery to implant an intraocular lens (IOL). 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. 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. Every SBC is created with four double-sided pages and 12-point type. Withholding Tax Delaware Marketplace 0 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 endobj 97 0 obj <>stream All rights reserved. 0000418667 00000 n For the Plus Size Queens. 0000014251 00000 n endstream endobj startxref You simply need to provide the plan administrator with advanced written notice along with any required premium. 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. Negotiated fees typically range from 15-45% below the average fees charged in a dentists community for the same or substantially similar services. You'll also pay a deductible of $233. 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. SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. %PDF-1.6 % Coverage Policy ; Coverage for bariatric surgery or revision of a bariatric surgical procedure varies across plans and may be governed by state mandates. Please Note: Additional information about this benefit change will be posted as it becomes available and before the July 1, 2023 effective date. We cover the most expensive costs associated with your surgery so you'll pay less for your procedure. 989 0 obj 0000000016 00000 n 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. Your SurgeryPlus benefit will also help pay for necessary travel associated with the covered procedure. You and your dentist will each receive an Explanation of Benefits (EOB) outlining the services provided, your plans reimbursement for those services, and your out-of-pocket expense. 555 17th Street, Suite 2050 | Denver, CO 80202, 2023 CEBT :: CEBT is administered by WTW, When you use SurgeryPlus, CEBT will potentially waive your Out-of-Pocket costs (i.e. A prime example is breast implants done during or after breast cancer surgery. It is not to be used for medical advice, diagnosis or treatment. SurgeryPlus is a voluntary benefit that provides pre-planned, non-emergency surgical services. If permitted, you may only be responsible for the negotiated fee. 0 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. 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
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