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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. References to UnitedHealthcare pertain to each individual company or other UnitedHealthcare affiliated companies. Theres a lot of information in an SBC. There are no simple answers, but you can start here to find general answers to some of the most common questions about Medicare coverage. You can obtain an updated procedure charge schedule for your area via fax by dialing 1-800-942-0854 and using the MetLife Dental Automated Information Service. When will my medical insurance cover oral surgery? 0000007939 00000 n Looser styling flatters while cleverly camouflaging around your middle. SurgeryPlus Care Advocates are your connection to the SurgeryPlus benefit. Coverage may not be available in all states. 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. Your SurgeryPlus benefit will also help pay for necessary travel associated with the covered procedure. Mastectomy surgery is a significant life event for many people. Bariatric surgery is surgery to help you lose weight. Our licensed Humana sales agents are available to help you select the coverage that best meets your needs. Click Register Now to create your profile and start exploring this free service. Where two or more professionally acceptable dental treatments for a dental condition exist, reimbursement is based on the least costly treatment alternative. Simply have your dentist submit a request online at www.metdental.com or call 1-877-MET-DDS9. All rights reserved. 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. endstream 0000005131 00000 n 0000001266 00000 n 125 0 obj <>stream Pre-/postnatal professional care: 35% of our allowance . Whats a Summary of Benefits and Coverage? In certain markets, delegated vendor guidelines may be used to support medical necessity and other coverage determinations. Or Reach Us at. Policy form GPNP99. 0000015692 00000 n , begin to type the name of your employer in the space below. Out-of-pocket costs may be greater if you visit a dentist who does not participate in the network. Cancellation/Termination of Benefits This website and phone number are for use by dental professionals only. However, Medicare doesnt cover routine hearing exams, hearing aids or fittings.7. hbbd```b``+@$}D This is a voluntary benefit available to you if you're enrolled in the Core, Standard, Plus or High Cost Coverage medical option. 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. Many offer affordable or even $0 monthly plan premiums, but you must continue to pay the Medicare Part B premium. (Negotiated fees are subject to change.). You are always free to select the dentist of your choice. Inpatient hospital: $450 per admission copay for unlimited days, plus 35% of our allowance. Privacy Policy Withholding Tax Effective July 1, 2023, bariatric surgery coverage will be available exclusively through the SurgeryPlus benefit. Coverage includes access to our network of excellent surgeons, consults and appointments with your SurgeryPlus provider, anesthesia, the procedure and facility (hospital) fees. Delaware Topics 988 0 obj Consult your doctor before beginning any new diet or exercise regimen. 0000006640 00000 n Dentists may submit your claims for you which means you have little or no paperwork. 0000010311 00000 n Mon-Fri, 8:30am-5:00pm (CT). 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. 0000379543 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. Call a Care Advocate at 833.709.2444 for more information. Delaware Marketplace coinsurance and/or deductible on PPO plans, or copay on EPO plans). (Based on internal analysis by MetLife. 0000024943 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. Overview . Your costs in Original Medicare For surgeries or procedures, it's hard to know the exact costs in advance. 0000005180 00000 n Mobile Apps 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. 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. 0000001651 00000 n Continuous Glucose Monitors (CGMs)examples include Dexcom and Libre. Receiving care and earning rewards through SurgeryPlus, Contact a SurgeryPlus Care Advocate at 844-752-6170 to start the conversation about what services you need and let them guide you through the process or visit Florida.SurgeryPlus.com to learn more. Austin, TX 78735 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. The inclusion of a code does not imply any right to . 0 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. 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. Medicare won't cover Lasik surgery just to avoid the need for glasses. About SurgeryPlus SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. <>/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 The service categories and plan limitations shown below represent an overview of the plan benefits. 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. Consistent with federal law effective 1/1/98, the Cigna national maternity policy includes coverage for 48 hours of hospitalization following a normal vaginal delivery and 96 hours following an uncomplicated Caesarean section. . However, this depends on the specific type of surgery you need, your dental plan, and your level of coverage. State Employees These plans include all your Part A and Part B coverage and often provide extra coverage for services not included in Original Medicare. 0000000016 00000 n 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. endstream endobj 251 0 obj <. Pick the option that's best for you. All services defined in your group dental benefits plan certificate are covered. This Coverage Policy addresses bariatric surgery and procedures for the treatment of morbid obesity. Some general conditions to receive coverage from United Healthcare requires that you meet the following criteria: Have a body mass index over 40 OR. Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. 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. xref Guided Support Reconstructive Procedures include surgery or other procedures which are related to a health condition. 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. 0000014251 00000 n Elected Officials search a list of these participating dentists online, https://www.metlife.com/support-and-manage/forms-library/, One fluoride treatment per 12-month period for dependent children up to their 14th birthday, Total number of periodontal maintenance treatments and prophylaxis cannot exceed two treatments in a calendar year, For dependent children up to 14th birthday, once per lifetime per tooth area, One application of sealant material every 60 months for each non-restored, non-decayed 1st and 2nd molar of a dependent child up to their 16th birthday, Crown, Denture, and Bridge Repair / Recementations, Initial placement to replace one or more natural teeth, which are lost while covered by the plan, Root canal treatment limited to once per tooth per lifetime, When dentally necessary in connection with oral surgery, extractions or other covered dental services, Except as mentioned elsewhere in certificate, Periodontal scaling and root planning once per quadrant, every 24 months, Your Children, up to age 19, are covered while Dental Insurance is in effect. Original Medicare generally covers most pre-existing conditions. Some types of surgery also change the connection between your stomach and intestines. 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. Coverage terminates when your membership ceases, insurance ceases for your class, when your dental contributions cease or upon termination of the group policy by the Policyholder or MetLife. Only travel arrangements made through your Care Advocate are eligible for coverage under the SurgeryPlus benefit. Medicare covers hospice care if the following conditions are met: Medicare does help cover some in-home health services, including: To be eligible, you must be under the care of a doctor and treated under a plan of care that is monitored and reviewed by your doctor. Assign you a personal care coordinator to offer one-on-one guidance and support as you prepare for, undergo and recover from surgery. SurgeryPlus is a voluntary benefit that provides pre-planned, non-emergency surgical services. trailer 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. You may enroll for membership in the ABN directly through the ABN website or during your dental enrollment. endobj endstream endobj 97 0 obj <>stream 89 37 If it contains a form, you can print it and fill it out. endstream endobj 124 0 obj <>/Filter/FlateDecode/Index[5 84]/Length 22/Size 89/Type/XRef/W[1 1 1]>>stream 7500 Rialto Blvd, Building 1 Suite 250 So you may be responsible for any difference in cost between the dentists fee and your plans benefit payment. 0000019224 00000 n General Assembly Remember that Medicare Advantage plans are required by law to offer all the benefits of Original Medicare, but most plans offer much more. Copyright 2023 Member Benefits. SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. 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. Weather & Travel, Contact Us Negotiated fees typically range from 15-45% below the average fees charged in a dentists community for the same or substantially similar services. Coverage Policy ; Coverage for bariatric surgery or revision of a bariatric surgical procedure varies across plans and may be governed by state mandates. By packaging surgical expenses into one simple, bundled rate, SurgeryPlus is able save money for you and the State of Florida. We cover the most expensive costs associated with your surgery so youll pay less for your procedure. Yes. 1096 0 obj This group plan is made available to through membership in the American Association of Business Networking (ABN). Members of HumanaVision can receive deeper discounts on LASIK services, especially when using a specific in-network provider. hb```b``Nf`c`Wcd@ AV(G 2?X%c6g+S@|dHA[&@VS&-,&W\\f9v| **s)S\Ol%5T7A(F Tax Center Take your bill (s) to your State Farm agent's office. Thats what SurgeryPlus does. 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. Starting January 1, 2018, HIP State Basic and HIP State Plus will cover members age 21 to 64. Medicare Part A does cover care provided in a skilled nursing facility with certain conditions and time limitations. Child(ren)s eligibility for dental coverage is from birth up to age 26. Yes. You can also go through the SurgeryPlus member portal. Please contact Member Benefits your plan administrator at 1-800-282-8626 for more information. Agent tip: "Original Medicare may cover 80% of a traditional cataract surgery. This information is provided for educational purposes only. How can we make this page better for you? 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. %PDF-1.6 % Hospice care, Medicare.gov, last accessed June 10, 2022. Weight-Loss (Bariatric) Surgery. Adjustable straps allow for a better, customized fit. This is because you won't know what services you need until you meet with your provider. 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. Surgical Coverage Surgery Surgery Medicare covers many medically necessary surgical procedures.