Effective July 1, 2023, bariatric surgery coverage will be available exclusively through the SurgeryPlus benefit. 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. 0000001266 00000 n Individuals enrolled in a State of Delaware Aetna or Highmark Delaware non-Medicare health plan are automatically enrolled in this FREE benefit. By packaging surgical expenses into one simple, bundled rate, SurgeryPlus is able save money for you and the State of Florida. The effective date of coverage for newly added dependent(s) will depend on when we receive notice and required premium. It all depends on your policy. To assist, American Airlines has business relationships with third-party vendors, for example, BCBS, UHC, and WebMD Health Services. Please fill out the contact form so the right person can be in touch quickly. 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 Copyright 2022 Employer Direct HealthcareAll Rights Reserved. endobj About SurgeryPlus SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. 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. 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. A dental plan may cover routine office visits, fillings, crowns, root canals, oral surgery, periodontics, orthodontics, or bridges and dentures. All services defined in your group dental benefits plan certificate are covered. Your costs in Original Medicare For surgeries or procedures, it's hard to know the exact costs in advance. Each company is a separate entity and is not responsible for another's financial or contractual obligations. Fair and simple terms We pay a fair, transparent rate for cases and streamline reimbursement, decreasing your administrative burden. endstream endobj 251 0 obj <. %%EOF What happens with my health information? Negotiated fees are subject to change. You can also go through the SurgeryPlus member portal. He or she hasnt agreed to accept negotiated fees. Coverage will be considered under your out-of-network benefits. 0000001609 00000 n State Agencies But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary. By receiving services through SurgeryPlus, you and your dependents can earn financial rewards. 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. This symbol denotes a PDF Document. Medicare won't cover Lasik surgery just to avoid the need for glasses. 989 0 obj 0000019224 00000 n 0 273 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 ic+C@nN`RYva@\}KRr>Wq8=Rw+{a .n!LF40d=DdcB42r7hRXyMQ"wDYfuwO se)D+jd7bLB,2}a'_UOaB:.bwRIQGp)` aHeO\@qPtn#u,{n{@|=V<^N}Ap2,+H>0$_ -C Yes. Learn more about a Summary of Benefits and Coverage, also commonly referred to as an SBC. 0000014251 00000 n Medicare Part B benefits cover 80% of the Medicare-approved amount for cataract surgery. This program will be available on January 1, 2020. State Employees When it comes to Medicare, the question we hear most often after What does it cost? is, What does it cover?. hb```b``Nf`c`Wcd@ AV(G 2?X%c6g+S@|dHA[&@VS&-,&W\\f9v| **s)S\Ol%5T7A(F 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. (Refer to your dental benefits plan summary for your out-of-network dental coverage.) 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. Only travel arrangements made through your Care Advocate are eligible for coverage under the SurgeryPlus benefit. 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. VSP is not affiliated with Metropolitan Life Insurance Company or its affiliates. If the information online is inconsistent with the Plan Documents, the Plan Documents will govern. hbbbd`b`` K Procedure charge schedules are subject to change each plan year. You'll also pay a deductible of $233. Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. Your medical insurance may also pick up the cost in full or part for medically-related . Procedures can cost from $700 to $2,000 per eye, depending on . 0000001036 00000 n SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. If you qualify for it, Medicaid, which is administered by states under federal guidelines, may cover nursing home care. 0000019705 00000 n SurgeryPlus is a supplemental benefit for non-emergency surgeries that provides high-quality care, Simply have your dentist submit a request online at www.metdental.com or call 1-877-MET-DDS9. 3 You must be the contract holder or spouse, 18 or older, on a Standard or Basic Option Plan to earn incentive rewards. This website and phone number are for use by dental professionals only. Your SurgeryPlus Care Advocate will provide you one-on-one, personalized help each step of the way. Knowing which types of common medical costs are not covered will be helpful when planning for your out-of-pocket medical costs. Elected Officials The service categories and plan limitations shown below represent an overview of the plan benefits. Whats a Summary of Benefits and Coverage? Many offer affordable or even $0 monthly plan premiums, but you must continue to pay the Medicare Part B premium. The time a mother and baby spend in the hospital after delivery is a medical decision. In addition, it comes with a concierge service (Care Advocate) and travel benefits. Please remember to hold on to all receipts to submit a dental claim. General Assembly 1XQg&.9mE#(Tq& The primary result of . Original Medicare generally doesnt cover the cost of a nursing home, assisted living or long-term care facility. It has less visits to physical, speech and occupational therapies than HIP Plus. }4Q2L_L 0fI\l!AN7za|*_)2:lU2_kciTX*R:N%` c8B=3 Mobile Apps 0000381088 00000 n endstream *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. Heres a step-by-step look at what information is in an SBC: You can request a copy of an SBC anytime. 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. Corporations If permitted, you may only be responsible for the negotiated fee. 0000015692 00000 n You'll be more confident on the beach with an extensive selection of plus-size swimwear. This symbol denotes a Web Page. It does not cover bariatric surgery or jaw care (TMJ). Premiums and the list of covered drugscalled a formularywill vary by plan.6. Negotiated fees are subject to change. endstream endobj 124 0 obj <>/Filter/FlateDecode/Index[5 84]/Length 22/Size 89/Type/XRef/W[1 1 1]>>stream This communication does not guarantee benefits and does not indicate all services received will be covered by your plan. Cancellation/Termination of Benefits Coverage Policy ; Coverage for bariatric surgery or revision of a bariatric surgical procedure varies across plans and may be governed by state mandates. 0000007939 00000 n The SBC was created to make it easier to compare and shop for health plans. Will Medicare Cover LASIK Eye Surgery? Medicare.org, last accessed June 10, 2022. 0000023776 00000 n 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. You can ask for a pretreatment estimate. Original Medicare generally covers most pre-existing conditions. 0000005180 00000 n If it contains a form, you can print it and fill it out. Copyright 2023 Member Benefits. 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. Do your homework. Surgical Coverage Surgery Surgery Medicare covers many medically necessary surgical procedures. Hospice care, Medicare.gov, last accessed June 10, 2022. Remember that Medicare Advantage plans are required by law to offer all the benefits of Original Medicare, but most plans offer much more. SurgeryPlus is included in your medical benefits at no additional cost to you. Rates are subject to change and depend on geographic area. 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. 0000024865 00000 n Gross Receipts Tax Medicare Part B contributes 80% of the cost of one pair of eyeglasses or set of contact lenses after cataract surgery after. Your private health information is just that private. 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. 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. 125 0 obj <>stream Coverage is provided under a group insurance policy (Policy form GPNP99) issued by MetLife. 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.
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