All other HIP plans cover members ages 19 to 64. Or Reach Us at 855-200-2099 " *" indicates required fields Vision benefits are underwritten by Metropolitan Life Insurance Company, New York, NY (MetLife). 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. American Airlines manages employee and retiree health benefits. 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. If it contains a form, you can print it and fill it out. 0000001609 00000 n 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. You earn the reward once the following occurs: The reward will then be credited to the savings and spending account of your choice. Learn more about a Summary of Benefits and Coverage, also commonly referred to as an SBC. Negotiated fees are subject to change. Delaware State Code Updated 08/29/2019 . Metlife will not pay Dental Insurance benefits for charges incurred for: Alternate Benefits SurgeryPlus provides an alternative to using your health plan for a planned surgical procedure that is not an emergency. hbbbd`b`` K How can we make this page better for you? Wearing a swimsuit after a mastectomy can be a transition. By packaging surgical expenses into one simple, bundled rate, SurgeryPlus is able save money for you and the State of Florida. Wearing a Suit After a Body-Altering Surgery. Information gathered by our partners will be used for your benefit to help guide you on your path to wellness. You are always free to select the dentist of your choice. 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. Coverage is provided under a group insurance policy (Policy form GPNP99) issued by MetLife. It requires doctors and facilities to meet strict credential guidelines leading to the highest quality care possible. 1096 0 obj 3 You must be the contract holder or spouse, 18 or older, on a Standard or Basic Option Plan to earn incentive rewards. State Agencies Gross Receipts Tax For example, if youre still working and covered by your employer or your spouses employer sponsored health coverage, you may be able to wait. 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. Medicare Part B contributes 80% of the cost of one pair of eyeglasses or set of contact lenses after cataract surgery after. Will Medicare Cover LASIK Eye Surgery? Medicare.org, last accessed June 10, 2022. For specific LCDs/LCAs, refer to the table for SurgeryPlus is included in your medical benefits at no additional cost to you. RSS Feeds, Make Yes. 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. As a member of Humana, you can receive up to 15 percent off standard LASIK pricing (and 5 percent off promotional pricing) at specified in-network providers. This document presents the majority of services within each category, but is not a complete description of the plan. Copyright 2022 Employer Direct HealthcareAll Rights Reserved. Or Reach Us at. 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. Adjustable straps allow for a better, customized fit. To provide and maintain this valuable membership benefit, MetLife reimburses the association and/or the plan administrator for these costs. If you need cataract surgery in both eyes . When will my medical insurance cover oral surgery? Original Medicare generally covers most pre-existing conditions. endstream endobj 97 0 obj <>stream 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. <> Yes. Trust in our network Blue Distinction Centers for Substance Use Treatment and Recovery aims to improve patient outcomes and value by focusing on providers across the full continuum of care who deliver and facilitate treatment for substance use disorder, including opioid use disorder. Some types of surgery also change the connection between your stomach and intestines. For example, rather than paying separately for the surgeon, facility, anesthesiologist, and radiologist, SurgeryPlus negotiates one bundled rate. Medicare pays 80% of the cost of traditional cataract surgery, which would be covered by Medicare Part B. Call a Care Advocate at 833.709.2444 for more information. Public Meetings Where two or more professionally acceptable dental treatments for a dental condition exist, reimbursement is based on the least costly treatment alternative. 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. Facilitate and consolidate your payments. Some general conditions to receive coverage from United Healthcare requires that you meet the following criteria: Have a body mass index over 40 OR. What Part A covers, Medicare.gov, last accessed June 10, 2022. Visit ESPN for the game videos of the Brooklyn Nets vs. Boston Celtics NBA basketball game on March 3, 2023 Mon-Fri, 8:30am-5:00pm (ET), Texas office POWER Up to HIP Plus! Delaware Marketplace This symbol denotes a PDF Document. If permitted, you may only be responsible for the negotiated fee. 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. Procedures can cost from $700 to $2,000 per eye, depending on . You can choose whether or not to use SurgeryPlus for your surgical procedures. This benefit is available to those enrolled in one of the CEBT EPO, PPO or HDHP medical plans. Inpatient hospital: $450 per admission copay for unlimited days, plus 35% of our allowance. Consult your doctor before beginning any new diet or exercise regimen. Pre-/postnatal professional care: 35% of our allowance . Take your bill (s) to your State Farm agent's office. An explanation of whats not covered and/or the limits on coverage, Information on costs you might have to pay like deductibles, coinsurance and copayments, Coverage examples, including how coverage works in the case of a pregnancy or a minor injury. "_P^)J^:+&!nI-eMNYrVY;QU&+,SUdTVvSN(GTDS o5q_H\%lqbF$M2Q::=x?c}Efl 2"PwyOP# 3V&$b$E7TXI!"?k* NZOLizJT5A7a Xk56C*I~EOv {)Z` YFJ#i'O>4@6.\7=dBkwR)K@kJ^.|xs-v(\irQJhpQ-[":wwT%9KBU2hNU^ 6/En!`}#Yrud9,/R Yes. This symbol denotes a Web Page. 250 0 obj <> endobj Call our Health Response Center at. You may choose to share the information with your doctor and other medical professionals. 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. If you qualify for it, Medicaid, which is administered by states under federal guidelines, may cover nursing home care. 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. 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. Membership in the ABN in required to enroll in this plan. 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. This webpage is provided for summary purposes only and is not a complete description of the plan benefits, limitations, and exclusions. Mon-Fri, 8:30am-5:00pm (CT). 0000023776 00000 n Bariatric surgery is surgery to help you lose weight. 285 0 obj <>stream hbbd```b``f+A$S$d@$&},L`1]`*z3`] rO o bHHj@&{:.a`$ S This website and phone number are for use by dental professionals only. Policy form GPNP99. Only travel arrangements made through your Care Advocate are eligible for coverage under the SurgeryPlus benefit. Fair and simple terms We pay a fair, transparent rate for cases and streamline reimbursement, decreasing your administrative burden. To see if your procedure is covered, contact us. 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. 0000015806 00000 n Other services not covered by Medicare Parts A and B include:4, Medicare Part C is also known as Medicare Advantage. Benefits are subject to change upon agreement between Metropolitan Life Insurance Company and the participating organization. What is the SurgeryPlus benefit? Policy number 5343606-1-G (Low plan), Metropolitan Life Insurance Company, 200 Park Avenue, New York, NY 10166 <>/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 But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary. Learn more about the ABN. The estimate helps you prepare for the cost of dental services. endstream endobj startxref Voting & Elections Coverage includes access to our network of excellent surgeons, consults and appointments with your SurgeryPlus provider, anesthesia, the procedure and facility (hospital) fees. 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. Many Medicare Advantage plans, however, do include coverage for routine dental, vision and hearing care, including glasses and hearing aids. 0000418667 00000 n , begin to type the name of your employer in the space below. All services defined in your group dental benefits plan certificate are covered. 7500 Rialto Blvd, Building 1 Suite 250 You can track your claims online and even receive e-mail alerts when a claim has been processed. 0000006640 00000 n Filing a health claim. 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. endobj A reminder that the SBC is only a summary. 10739 Deerwood Park Blvd, Suite 200-B You can also go through the SurgeryPlus member portal. However, if you choose a non-participating dentist, your out-of-pocket costs may be higher. Please contact Member Benefits your plan administrator at 1-800-282-8626 for more information. 0000005131 00000 n 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. Certain claim and network administration services are provided through Vision Service Plan (VSP), Rancho Cordova, CA. You and your dentist will receive a benefit estimate for most procedures while you are still in the office. 0 Negotiated fees for non-covered services may not apply in all states.). HV[kH~GTfJ4C-lKM#si+4swzZ\|P/_^jji>W(W^"SZE~?xerLgibT}gyQtjSFGil2ZZb6#NWM[]uT{:Gk)0 >IZn,:-/855fOneI4nUGqK9G{-hb!E|VXM)65}`OLX|Tb)k``K}L@6%y+ba}f[#e5pr>i:r. coinsurance and/or deductible on PPO plans, or copay on EPO plans). Heres a step-by-step look at what information is in an SBC: You can request a copy of an SBC anytime. Original Medicare generally doesnt cover the cost of a nursing home, assisted living or long-term care facility. 0000019224 00000 n endobj Business First Steps, Phone Directory This communication does not guarantee benefits and does not indicate all services received will be covered by your plan. 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. 0000018849 00000 n Your doctor certifies that you are terminally ill, meaning that your life expectancy is 6 months or less. Weight-Loss (Bariatric) Surgery. The choice is yours. When you already have a health plan, youll get an SBC automatically at certain times: Even though an SBC is made to make it easier to understand health plan information, sometimes the terms in them can be confusing. Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. Individuals enrolled in a State of Delaware Aetna or Highmark Delaware non-Medicare health plan are automatically enrolled in this FREE benefit. Cancellation/Termination of Benefits The SurgeryPlus Difference We allow you to focus on practicing medicine and caring for patients. Home health services, Medicare.gov, last accessed June 10, 2022. The Plan Sponsor(s) reserve the right to amend or terminate each plan at any time. Medicare pays 80% of the treatment costs, and the beneficiary contributes 20%. Many Medicare Advantage plans include prescription drug coverage, in addition to all the benefits provided by Original Medicare Part A and Part B. endobj What happens with my health information? Scuba Certification; Private Scuba Lessons; Scuba Refresher for Certified Divers; Try Scuba Diving; Enriched Air Diver (Nitrox) Bigger. 9l J'X:50e0l`} }U,,Q`lam[5-0f`MVe` It all depends on your policy. About SurgeryPlus SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. 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. Members of HumanaVision can receive deeper discounts on LASIK services, especially when using a specific in-network provider. 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. (Based on internal analysis by MetLife. Medicare Advantage plans are provided by private companies with approval from Medicare. Pick the option that's best for you. 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. Yes. 866-855-1212. To get one, contact us. 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. The sharing of health information between these companies is permitted by regulation. Agent tip: "Original Medicare may cover 80% of a traditional cataract surgery. Durable medical equipment (DME) coverage, Medicare.gov, last accessed June 10, 2022. The service categories and plan limitations shown below represent an overview of the plan benefits. This benefit is available to those enrolled in one of the CEBT EPO, PPO or HDHP medical plans. 0000004536 00000 n Read your certificate of insurance for details on plan benefits, limitations, and exclusions. You simply need to provide the plan administrator with advanced written notice along with any required premium. To get all the details, youll want to look at complete health plan documents. endstream Please note: If you are covered under the State of Delaware Group Health Insurance Plan as secondary, refer to the SurgeryPlus plan document for details on bariatric coverage. 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 Medicare won't cover Lasik surgery just to avoid the need for glasses. 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. Medicare Part B may cover diagnostic hearing and balance examstests your doctor requires if you need medical treatment. 0000000016 00000 n Starting January 1, 2018, HIP State Basic and HIP State Plus will cover members age 21 to 64. 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. Generally, most vision, dental and hearing services are not covered by Medicare Parts A and B. Out-of-pocket costs may be greater if you visit a dentist who does not participate in the network. In addition, it comes with a concierge service (Care Advocate) and travel benefits. Premiums and the list of covered drugscalled a formularywill vary by plan.6. The inclusion of a code does not imply any right to . This website provides an overview of your benefit options. . Inpatient (Precertification is required): $350 per admission. *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. Theres a lot of information in an SBC. %%EOF 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. Some examples of comorbidities include high blood pressure, high cholesterol, obstructive sleep apnea, Type II Diabetes, angina or stroke. When enrolling you may choose to also cover your spouse, domestic partner, and/or children up to age 26. 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. 1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary.12. Privacy Policy You consent to receiving palliative care to make you comfortable versus care to try to cure your illness. You can ask for a pretreatment estimate. Looser styling flatters while cleverly camouflaging around your middle. Please fill out the contact form so the right person can be in touch quickly. However, Medicare doesnt cover routine hearing exams, hearing aids or fittings.7. This program will be available on January 1, 2020. Franchise Tax You can use the SBC to compare prices, benefits and other health plan options and features that might be important to you. Coverage Policy ; Coverage for bariatric surgery or revision of a bariatric surgical procedure varies across plans and may be governed by state mandates. Pre-authorization will still need to be submitted by your provider to SurgeryPlus before the surgery is scheduled. Medicare Part B benefits cover 80% of the Medicare-approved amount for cataract surgery. 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. 0000381088 00000 n So you may be responsible for any difference in cost between the dentists fee and your plans benefit payment.