This exclusion will apply whether or not the person receiving the services is enrolled for the government plan. This communication does not guarantee benefits and does not indicate all services received will be covered by your plan. You'll also pay a deductible of $233. Your general dentist or specialist usually sends MetLife a plan for your care and requests an estimate of benefits. endstream endobj 251 0 obj <. Hospice care, Medicare.gov, last accessed June 10, 2022. Medicare Advantage plans may offer coverage for vision, hearing, dental and wellness services. Because its all in the same format, its easier to make apples-to-apples comparisons when youre deciding which plan is best for you. A prime example is breast implants done during or after breast cancer surgery. Effective July 1, 2023, bariatric surgery coverage will be available exclusively through the SurgeryPlus benefit. 866-855-1212. Tax Center 0000000016 00000 n To get one, contact us. 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. Weather & Travel, Contact Us 0000012970 00000 n At time of enrollment, you will choose how you want to pay. 0000001651 00000 n Does Medicare Cover Pre-existing Conditions? Medicare.com, last accessed June 10, 2022. Pick the option that's best for you. Elected Officials 0000019224 00000 n endstream endobj startxref 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. Or Reach Us at 855-200-2099 " *" indicates required fields You may choose to share the information with your doctor and other medical professionals. They help you find a great doctor for your procedure, schedule your procedure appointments, make travel reservations (if travel is required), transfer your medical records, and coordinate all your surgery bills. Members will pay nothing out of pocket for bariatric surgery; however, financial incentives do not apply. %%EOF You can use the SBC to compare prices, benefits and other health plan options and features that might be important to you. %PDF-1.4 % 0000005131 00000 n 0000010311 00000 n 0000016018 00000 n 0000401803 00000 n These partners are required to comply with all laws protecting privacy. Home. The complete provisions of the plans are set forth in the Plan Documents and Summary Plan Description. How can we make this page better for you? 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. Delaware's Governor 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. 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. Delaware Courts Medicare Part B benefits cover 80% of the Medicare-approved amount for cataract surgery. 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. endstream endobj 97 0 obj <>stream Most plans cover the entire cost of preventive care, plus a portion of the cost after you meet your deductible for other procedures. cost of cataract surgery with medicare. Or Reach Us at. 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 HVn7}Wt)A87HPV$(YXF;3as=sfj'O&y>=zF_Gmlr:v1z5`:A1suhMFY}r0_&o^w]vw%'o':~u>)|]!6nRBki;L}h0y^'#cCmJJc Before undergoing surgery, youll want to be connected with the highest-quality providers and facilities. Coverage may not be available in all states. Medicare won't cover Lasik surgery just to avoid the need for glasses. trailer Please fill out the contact form so the right person can be in touch quickly. You can track your claims online and even receive e-mail alerts when a claim has been processed. So you may be responsible for any difference in cost between the dentists fee and your plans benefit payment. 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. %PDF-1.6 % 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. SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. <> "_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 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. Medicare pays 80% of the treatment costs, and the beneficiary contributes 20%. , begin to type the name of your employer in the space below. About SurgeryPlus SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. Yes. 0000015692 00000 n "L @Zd X$9RAC~yGz3)fjaPk !e E57 Hln8 ``:w0@6Cfmu ] Corporations Delaware State Code When will my medical insurance cover oral surgery? 0000001436 00000 n Dependent age may vary by state. lbSy 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. All other HIP plans cover members ages 19 to 64. Outpatient facility care: 35% of our allowance . 00k` !" 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. Learn more about the ABN. Home health services, Medicare.gov, last accessed June 10, 2022. It all depends on your policy. SurgeryPlus is included in your medical benefits at no additional cost to you. Policy form GPNP99. 0000006640 00000 n This symbol denotes a Web Page. 0000014887 00000 n 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. Austin, TX 78735 0 When enrolling you may choose to also cover your spouse, domestic partner, and/or children up to age 26. Information gathered by our partners will be used for your benefit to help guide you on your path to wellness. (Due to contractual requirements, MetLife is prevented from soliciting certain providers.) Please remember to hold on to all receipts to submit a dental claim. Policy number TS 05343606-G (High plan) Whats a Summary of Benefits and Coverage? *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. Delaware Marketplace Trust in our network such as Spine, General Surgery, Genitourinary, Orthopedic, Ear, Nose & Throat, Cardiac, GI, and Pain Management. You may enroll for membership in the ABN directly through the ABN website or during your dental enrollment. Locations Directory Inpatient (Precertification is required): $350 per admission. Inpatient hospital: $450 per admission copay for unlimited days, plus 35% of our allowance. We cover the most expensive costs associated with your surgery so you'll pay less for your procedure. 0000005180 00000 n The choice is yours. The specific travel benefit depends on the procedure, the provider, and the distance between the provider and a member's residence. 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. 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. Adjustable straps allow for a better, customized fit. You may need to exhaust your personal resources on medical care before you are eligible. This document presents the majority of services within each category, but is not a complete description of the plan. Bariatric surgery is surgery to help you lose weight. To get all the details, youll want to look at complete health plan documents. Consult your healthcare provider if you have questions or concerns. Will Medicare Cover LASIK Eye Surgery? Medicare.org, last accessed June 10, 2022. On average, cataract surgery costs about $5,000 per eye; however, in some places, this price can move up to over $10,000. E-mail / Text Alerts You and your dentist will receive a benefit estimate for most procedures while you are still in the office. 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. State Agencies Benefits are subject to change upon agreement between Metropolitan Life Insurance Company and the participating organization. SurgeryPlus is a supplemental benefit for non-emergency surgeries that provides high-quality care, Visit ESPN for the game videos of the Brooklyn Nets vs. Boston Celtics NBA basketball game on March 3, 2023 Transparency This is a voluntary benefit available to you if you're enrolled in the Core, Standard, Plus or High Cost Coverage medical option. Overview . Some examples of comorbidities include high blood pressure, high cholesterol, obstructive sleep apnea, Type II Diabetes, angina or stroke. 1XQg&.9mE#(Tq& 1 Sturti / Getty Images Coverage Varies by Insurer Each health plan is different. There is a long list of items covered, including: Before renting or purchasing any medical equipment, be sure to ask if the retailer or supplier participates in Medicare. (Based on internal analysis by MetLife. 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