All health plan companies are required to provide an SBC for each of their different plans. Outpatient: 15% of our allowance . You earn the reward once the following occurs: The reward will then be credited to the savings and spending account of your choice. 9l J'X:50e0l`} }U,,Q`lam[5-0f`MVe` Through the planning process, you will work with the same Care Advocate. 1026 0 obj POWER Up to HIP Plus! 2 If you have Medicare Part B primary, your costs for prescription drugs may be lower. What's not covered by Part A & Part B? Medicare.gov, last accessed June 10, 2022. SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. Confirm your coverage before you commit to a procedure you're unsure about. Privacy Policy You and your dentist will receive a benefit estimate for most procedures while you are still in the office. Please fill out the contact form so the right person can be in touch quickly. These rules determine the order in which the plans will pay benefits. Some links on this page may take you to Humana non-Medicare product or service pages or to a different website. The time a mother and baby spend in the hospital after delivery is a medical decision. Your costs in Original Medicare For surgeries or procedures, it's hard to know the exact costs in advance. It requires doctors and facilities to meet strict credential guidelines leading to the highest quality care possible. 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. Learn more aboutsavings and spending accounts. A prime example is breast implants done during or after breast cancer surgery. The State of Delaware is an Equal Opportunity employer and values a diverse workforce. SurgeryPlus is a voluntary benefit that provides pre-planned, non-emergency surgical services. So you may be responsible for any difference in cost between the dentists fee and your plans benefit payment. However, if you choose a non-participating dentist, your out-of-pocket costs may be higher. Yes. 0000015930 00000 n To see if your procedure is covered, contact us. Most common oral surgeries are covered, at least in part, by your dental insurance provider. Our licensed Humana sales agents are available to help you select the coverage that best meets your needs. Home health services, Medicare.gov, last accessed June 10, 2022. E-mail / Text Alerts 0000019224 00000 n Updated 08/29/2019 . 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. 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. Voting & Elections Medicare Advantage plans may offer coverage for vision, hearing, dental and wellness services. The State Employee Benefits Committee (SEBC) believes in providing high quality care to members at an affordable cost. 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 Out-of-pocket costs may be greater if you visit a dentist who does not participate in the network. Your SurgeryPlus Care Advocate will provide you one-on-one, personalized help each step of the way. Some types of surgery also change the connection between your stomach and intestines. Yes. To assist, American Airlines has business relationships with third-party vendors, for example, BCBS, UHC, and WebMD Health Services. endstream endobj 124 0 obj <>/Filter/FlateDecode/Index[5 84]/Length 22/Size 89/Type/XRef/W[1 1 1]>>stream 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. 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. Bigger. What happens with my health information? Withholding Tax This program will be available on January 1, 2020. Reconstructive Procedures include surgery or other procedures which are related to a health condition. 0000000016 00000 n 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 Filing a health insurance claim is simple and can be done in one of two ways. Please review the plan summaries for summarized information and your certificate of insurance for detailed information about your plan benefits. Even though its meant to make the information easier to understand, it can seem like a lot at first. Medicare will only provide coverage through suppliers who participate in the Medicare program.10, Services that are not considered medically necessary are generally not covered by Medicare Part A or Part B. h`06NH+500 Rest easy knowing you can afford the surgery you need, HDHP Plans will require a reduced deductible to be met first. Overview . Procedure charge schedules are subject to change each plan year. Your doctor certifies that you are terminally ill, meaning that your life expectancy is 6 months or less. At time of enrollment, you will choose how you want to pay. Privacy Policy Coverage may not be available in all states. . But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary. 1096 0 obj Always err on the side of caution! SurgeryPlus Care Advocates are your connection to the SurgeryPlus benefit. By receiving services through SurgeryPlus, you and your dependents can earn financial rewards. 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. You consent to receiving palliative care to make you comfortable versus care to try to cure your illness. About SurgeryPlus SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. 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. Mon-Fri, 8:30am-5:00pm (ET), Texas office Individuals enrolled in a State of Delaware Aetna or Highmark Delaware non-Medicare health plan are automatically enrolled in this FREE benefit. <<7C167570AC52504DB41418C8CABC0A04>]/Prev 422895/XRefStm 1266>> By packaging surgical expenses into one simple, bundled rate, SurgeryPlus is able save money for you and the State of Florida. This benefit is available to those enrolled in one of the CEBT EPO, PPO or HDHP medical plans. Your SurgeryPlus benefit will also help pay for necessary travel associated with the covered procedure. Enter your ZIP code below to see plans with their premiums, copays, and participating doctors and pharmacies. Effective July 1, 2023, bariatric surgery coverage will be available exclusively through the SurgeryPlus benefit. Please Note: Additional information about this benefit change will be posted as it becomes available and before the July 1, 2023 effective date. Call our Health Response Center at. Negotiated fees for non-covered services may not apply in all states.). 1 Sturti / Getty Images Coverage Varies by Insurer Each health plan is different. You or your dependent use SurgeryPlus to receive a preoperative to post-operative bundled surgical service; SurgeryPlus validates that you or your dependent received the service; and. HIP Plus is the plan for the best value.HIP Plus provides health coverage for a low, predictable monthly cost. 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. 0000011564 00000 n 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. 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. endobj You simply need to provide the plan administrator with advanced written notice along with any required premium. 0 Licensed Humana sales agents are available daily, 8a.m. 8 p.m. Please use this access code on website: surgeryplus. 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 . Medicare Part A does cover care provided in a skilled nursing facility with certain conditions and time limitations. 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. 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. All rights reserved. 0000024943 00000 n Simply have your dentist submit a request online at www.metdental.com or call 1-877-MET-DDS9. 10 frequently asked questions about Medicare plans, Deductibles for Medicare Part A and Part B. VSP is not affiliated with Metropolitan Life Insurance Company or its affiliates. Coverage includes access to our network of excellent surgeons, consults and appointments with your SurgeryPlus provider, anesthesia, the procedure and facility (hospital) fees. 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. The estimate helps you prepare for the cost of dental services. Medicare Advantage plans are provided by private companies with approval from Medicare. 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. 0000015692 00000 n You can make monthly payments by monthly bank draft (ACH) or pay for the entire year via credit card payment. %%EOF 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. Coverage will be considered under your out-of-network benefits. xref 0000392965 00000 n The complete provisions of the plans are set forth in the Plan Documents and Summary Plan Description. 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. To get one, contact us. This symbol denotes a PDF Document. Vision benefits are underwritten by Metropolitan Life Insurance Company, New York, NY (MetLife). Weather & Travel, Contact Us Medicare pays 80% of the treatment costs, and the beneficiary contributes 20%. "_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 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. You can choose whether or not to use SurgeryPlus for your surgical procedures. This is a voluntary benefit available to you if you're enrolled in the Core, Standard, Plus or High Cost Coverage medical option. All services defined in your group dental benefits plan certificate are covered. Heres a step-by-step look at what information is in an SBC: You can request a copy of an SBC anytime. lbSy Many Medicare Advantage plans, however, do include coverage for routine dental, vision and hearing care, including glasses and hearing aids. (Due to contractual requirements, MetLife is prevented from soliciting certain providers.) 1XQg&.9mE#(Tq& When enrolling you may choose to also cover your spouse, domestic partner, and/or children up to age 26. However, Medicare doesnt cover routine hearing exams, hearing aids or fittings.7. 0000016018 00000 n Agent tip: "Original Medicare may cover 80% of a traditional cataract surgery. 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. Information gathered by our partners will be used for your benefit to help guide you on your path to wellness. Help Center You may need to exhaust your personal resources on medical care before you are eligible. Austin, TX 78735 Certain claim and network administration services are provided through Vision Service Plan (VSP), Rancho Cordova, CA. Delaware Marketplace Disclaimer 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. 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. 7500 Rialto Blvd, Building 1 Suite 250 This group plan is made available to through membership in the American Association of Business Networking (ABN). This symbol denotes a Web Page. Corporations 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. The choice is yours. SurgeryPlus is a supplemental benefit for non-emergency surgeries that provides high-quality care, How can we make this page better for you? To connect with SurgeryPlus today, call 833-709-2445. Assign you a personal care coordinator to offer one-on-one guidance and support as you prepare for, undergo and recover from surgery. General Assembly What is the SurgeryPlus benefit? 0 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. Thats what SurgeryPlus does. When will my medical insurance cover oral surgery? Benefits are subject to change upon agreement between Metropolitan Life Insurance Company and the participating organization. Starting January 1, 2018, HIP State Basic and HIP State Plus will cover members age 21 to 64. Actual payments may vary from the pretreatment estimate depending upon annual maximums, plan frequency limits, deductibles and other limits applicable at time of payment. 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. 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. It is not to be used for medical advice, diagnosis or treatment. A dental plan may cover routine office visits, fillings, crowns, root canals, oral surgery, periodontics, orthodontics, or bridges and dentures. Your general dentist or specialist usually sends MetLife a plan for your care and requests an estimate of benefits. 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. 0000379543 00000 n You are always free to select the dentist of your choice. 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. American Airlines manages employee and retiree health benefits. Policy form GPNP99. L0920007743[exp0922][All States][DC,GU,MP,PR,VI] 2020 MSS, Florida office (headquarters) SurgeryPlus is included in your medical benefits at no additional cost to you. When youre making decisions about buying a plan or using your benefits, an SBC can be a useful tool to help you compare costs and understand coverage options. Coverage includes access to our network of excellent surgeons, consults and appointments with your SurgeryPlus provider, anesthesia, the procedure and facility (hospital) fees. 0000004536 00000 n Visit ESPN for the game videos of the Brooklyn Nets vs. Boston Celtics NBA basketball game on March 3, 2023 The SurgeryPlus Difference We allow you to focus on practicing medicine and caring for patients. The specific travel benefit depends on the procedure, the provider, and the distance between the provider and a member's residence. Child(ren)s eligibility for dental coverage is from birth up to age 26. Pre-/postnatal professional care: 35% of our allowance . Premiums and the list of covered drugscalled a formularywill vary by plan.6. 00k` !" It can include Durable Medical Equipment (DME), mental healthcare or ambulance services.2 Preventive care services are health treatments that prevent illness or detect problems at an early stage, like flu shots or cancer screenings.3, There are some things Original Medicare wont cover. 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. Members will pay nothing out of pocket for bariatric surgery; however, financial incentives do not apply. Services which are not Dentally Necessary, those which do not meet generally accepted standards of care for treating the particular dental condition, or which We deem experimental in nature; Services for which covered person would not be required to pay in the absence of Dental Insurance; Services or supplies received by covered person before the Dental Insurance starts for that person; Services which are primarily cosmetic (for Texas residents, see notice page section in Certificate); Services which are neither performed nor prescribed by a Dentist except for those services of a licensed dental hygienist which are supervised and billed by a Dentist and which are for: Services or appliances which restore or alter occlusion or vertical dimension; Restoration of tooth structure damaged by attrition, abrasion or erosion, unless caused by disease; Restorations or appliances used for the purpose of periodontal splinting; Counseling or instruction about oral hygiene, plaque control, nutrition and tobacco; Personal supplies or devices including, but not limited to: water piks, toothbrushes, or dental floss; Decoration, personalization or inscription of any tooth, device, appliance, crown or other dental work; covered under any workers compensation or occupational disease law; covered under any employer liability law; for which the Policyholder of the person receiving such services is not required to pay; or. Hospice care, Medicare.gov, last accessed June 10, 2022. If you need cataract surgery in both eyes . 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. 12 Always err on the side of caution! If you qualify for it, Medicaid, which is administered by states under federal guidelines, may cover nursing home care. Know your options. The sharing of health information between these companies is permitted by regulation. Continuous Glucose Monitors (CGMs)examples include Dexcom and Libre. This website provides an overview of your benefit options. Effective July 1, 2023, bariatric surgery coverage will be available exclusively through the SurgeryPlus benefit. 988 0 obj Knowing which types of common medical costs are not covered will be helpful when planning for your out-of-pocket medical costs. 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. Cities & Towns Medicare pays $781, and your cost is $195. In certain markets, delegated vendor guidelines may be used to support medical necessity and other coverage determinations.