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 negotiates a single cost (bundled rate) for the entire surgical procedure, resulting in savings to the State of Delaware. Preventive & screening services, Medicare.gov, last accessed June 10, 2022. Your medical insurance may also pick up the cost in full or part for medically-related . You can choose whether or not to use SurgeryPlus for your surgical procedures. Membership in the ABN in required to enroll in this plan. Home health services, Medicare.gov, last accessed June 10, 2022. Out-of-pocket costs may be greater if you visit a dentist who does not participate in the network. Trust in our network Original Medicare generally covers most pre-existing conditions. Where two or more professionally acceptable dental treatments for a dental condition exist, reimbursement is based on the least costly treatment alternative. Members will pay nothing out of pocket for bariatric surgery; however, financial incentives do not apply. Scuba Certification; Private Scuba Lessons; Scuba Refresher for Certified Divers; Try Scuba Diving; Enriched Air Diver (Nitrox) 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. SurgeryPlus is a supplemental benefit for non-emergency surgeries that provides high-quality care, (Due to contractual requirements, MetLife is prevented from soliciting certain providers.) 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. Delaware State Code 0000001609 00000 n endobj Coverage will be considered under your out-of-network benefits. Information gathered by our partners will be used for your benefit to help guide you on your path to wellness. 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. Only travel arrangements made through your Care Advocate are eligible for coverage under the SurgeryPlus benefit. 0000379543 00000 n Cancellation/Termination of Benefits What Part B covers, Medicare.gov, last accessed June 10, 2022. When enrolling you may choose to also cover your spouse, domestic partner, and/or children up to age 26. 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. trailer This benefit is available to those enrolled in one of the CEBT EPO, PPO or HDHP medical plans. The sharing of health information between these companies is permitted by regulation. This information is provided for educational purposes only. To check to see if you may already have SurgeryPlus, begin to type the name of your employer in the space below. Medicare Advantage plans are provided by private companies with approval from Medicare. You'll be more confident on the beach with an extensive selection of plus-size swimwear. Read your certificate of insurance for details on plan benefits, limitations, and exclusions. Because its all in the same format, its easier to make apples-to-apples comparisons when youre deciding which plan is best for you. 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. 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. Reconstructive Procedures include surgery or other procedures which are related to a health condition. L0920007743[exp0922][All States][DC,GU,MP,PR,VI] 2020 MSS, Florida office (headquarters) 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. This website provides an overview of your benefit options. (Portal access Code: surgeryplus). Please fill out the contact form so the right person can be in touch quickly. This may include surgery to remove cataracts or after an eye injury. Your costs in Original Medicare For surgeries or procedures, it's hard to know the exact costs in advance. 0000024943 00000 n You may choose to share the information with your doctor and other medical professionals. }4Q2L_L 0fI\l!AN7za|*_)2:lU2_kciTX*R:N%` c8B=3 , begin to type the name of your employer in the space below. Enter your ZIP code below to see plans with their premiums, copays, and participating doctors and pharmacies. Medicare pays 80% of the cost of traditional cataract surgery, which would be covered by Medicare Part B. Policy form GPNP99. POWER Up to HIP Plus! Original Medicare generally doesnt cover the cost of a nursing home, assisted living or long-term care facility. You may enroll for membership in the ABN directly through the ABN website or during your dental enrollment. This program will be available on January 1, 2020. The estimate helps you prepare for the cost of dental services. 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. 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. The choice is yours. Learn more about a Summary of Benefits and Coverage, also commonly referred to as an SBC. Other services not covered by Medicare Parts A and B include:4, Medicare Part C is also known as Medicare Advantage. Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. 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. In addition, it comes with a concierge service (Care Advocate) and travel benefits. Alternatively, a Medicare Advantage plan often provides comprehensive vision coverage, plus cataract surgery without out-of-pocket coinsurance costs.". Find out which Humana plans include your doctors and cover the medications you take now to help you estimate your costs. Learn more about the ABN. All rights reserved. endstream Jacksonville, FL 32256 285 0 obj <>stream Weight-Loss (Bariatric) Surgery. Text Size Smaler, Make Text Size Surgical Coverage Surgery Surgery Medicare covers many medically necessary surgical procedures. 866-855-1212 to request a claim form. Please review the plan summaries for summarized information and your certificate of insurance for detailed information about your plan benefits. Business First Steps, Phone Directory For specific LCDs/LCAs, refer to the table for 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 . Locations Directory 1. By packaging surgical expenses into one simple, bundled rate, SurgeryPlus is able save money for you and the State of Florida. 12 Always err on the side of caution! Filing a health insurance claim is simple and can be done in one of two ways. 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. However, if you choose a non-participating dentist, your out-of-pocket costs may be higher. Child(ren)s eligibility for dental coverage is from birth up to age 26. Administrative services provided by United HealthCare Services, Inc. or their affiliates. Take your bill (s) to your State Farm agent's office. Actual payments may vary from the pretreatment estimate depending upon annual maximums, plan frequency limits, deductibles and other limits applicable at time of payment. An estimated cost of cataract surgery may be*: In a surgery center or clinic, the average total cost is $977. 0000024865 00000 n The following services that are in progress while coverage is in effect will be paid after the coverage ends, if the applicable installment or the treatment is finished within 31 days after individual termination of coverage: Completion of a prosthetic device, crown or root canal therapy. Thats because its basically a document that outlines whats covered and not covered under a health plan. Many Medicare Advantage plans also provide prescription drug coverage (also known as Part D).5, Original Medicare does not include coverage for prescription drugs, but you can buy a stand-alone prescription drug plan to help manage your drug costs. Call our Health Response Center at. Savings from enrolling in the MetLife Dental Plan will depend on various factors, including how often participants visit the dentist and the costs for services rendered. You can use the SBC to compare prices, benefits and other health plan options and features that might be important to you. Agent tip: "Original Medicare may cover 80% of a traditional cataract surgery. hbbd```b``f+A$S$d@$&},L`1]`*z3`] rO o bHHj@&{:.a`$ S Hearing & balance exams, Medicare.gov, last accessed June 10, 2022. Pick the option that's best for you. 0000012970 00000 n SurgeryPlus is included in your medical benefits at no additional cost to you. 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 complete provisions of the plans are set forth in the Plan Documents and Summary Plan Description. endstream endobj startxref . But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary.
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