State Employees Reconstructive Procedures include surgery or other procedures which are related to a health condition. 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. Please Note: Additional information about this benefit change will be posted as it becomes available and before the July 1, 2023 effective date. such as Spine, General Surgery, Genitourinary, Orthopedic, Ear, Nose & Throat, Cardiac, GI, and Pain Management. You can use the SBC to compare prices, benefits and other health plan options and features that might be important to you. This Coverage Policy addresses breast reduction for symptomatic macromastia and breast reduction surgery on 0000015692 00000 n The specific travel benefit depends on the procedure, the provider, and the distance between the provider and a member's residence. 0000001266 00000 n At time of enrollment, you will choose how you want to pay. Do your homework. %PDF-1.4 % Preventive & screening services, Medicare.gov, last accessed June 10, 2022. An estimated cost of cataract surgery may be*: In a surgery center or clinic, the average total cost is $977. Negotiated fees are subject to change. For example, rather than paying separately for the surgeon, facility, anesthesiologist, and radiologist, SurgeryPlus negotiates one bundled rate. So you may be responsible for any difference in cost between the dentists fee and your plans benefit payment. endstream Bariatric surgery is surgery to help you lose weight. This benefit is available to those enrolled in one of the CEBT EPO, PPO or HDHP medical plans. It is not to be used for medical advice, diagnosis or treatment. This program will be available on January 1, 2020. Please contact Member Benefits your plan administrator at 1-800-282-8626 for more information. To provide and maintain this valuable membership benefit, MetLife reimburses the association and/or the plan administrator for these costs. lbSy 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. Policy form GPNP99 You can also go through the SurgeryPlus member portal. 0000418667 00000 n The inclusion of a code does not imply any right to . Confirm your coverage before you commit to a procedure you're unsure about. To check to see if you may already have SurgeryPlus, begin to type the name of your employer in the space below. SurgeryPlus is a supplemental benefit for non-emergency surgeries that provides high-quality care, Procedure charge schedules are subject to change each plan year. 0000023776 00000 n 0000001436 00000 n Consult your healthcare provider if you have questions or concerns. 0000025231 00000 n International dental travel assistance services are administered by AXA Assistance USA, Inc. AXA Assistance is not affiliated with MetLife or any of its affiliates, and the services they provide are separate from the benefits provided by MetLife. Individuals enrolled in a State of Delaware Aetna or Highmark Delaware non-Medicare health plan are automatically enrolled in this FREE benefit. If the information online is inconsistent with the Plan Documents, the Plan Documents will govern. Visit ESPN for the game videos of the Brooklyn Nets vs. Boston Celtics NBA basketball game on March 3, 2023 Medicare Advantage plans may offer coverage for vision, hearing, dental and wellness services. A class is a group of people defined in the group policy. Thats what SurgeryPlus does. 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. This group plan is made available to through membership in the American Association of Business Networking (ABN). This may include surgery to remove cataracts or after an eye injury. You are always free to select the dentist of your choice. These partners are required to comply with all laws protecting privacy. SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. Know your options. This is because you won't know what services you need until you meet with your provider. If your current dentist does not participate in the network and you would like to encourage him or her to apply, ask your dentist to visit www.metdental.com, or call 1-866-PDP-NTWK for an application. Eleesha Lockett, Does Medicare Cover Plastic Surgery? Healthline, last accessed June 10, 2022. Your doctor certifies that you are terminally ill, meaning that your life expectancy is 6 months or less. 125 0 obj <>stream hbbd```b``+@$}D 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. Enter your ZIP code below to see plans with their premiums, copays, and participating doctors and pharmacies. 0000014251 00000 n 0000378718 00000 n hbbbd`b`` K SurgeryPlus is a voluntary benefit that provides pre-planned, non-emergency surgical services. 0000005131 00000 n To assist, American Airlines has business relationships with third-party vendors, for example, BCBS, UHC, and WebMD Health Services. Each company is a separate entity and is not responsible for another's financial or contractual obligations. Trust in our network Prescription drug planscalled Medicare Part Dare only available through private companies like Humana. But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary. If permitted, you may only be responsible for the negotiated fee. Have a body mass index over 35 with severe comorbidity. Policy form GPNP99. Disclaimer All other HIP plans cover members ages 19 to 64. Coverage includes access to our network of excellent surgeons, consults and appointments with your SurgeryPlus provider, anesthesia, the procedure and facility (hospital) fees. You may choose to share the information with your doctor and other medical professionals. 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. (Refer to your dental benefits plan summary for your out-of-network dental coverage.) 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. This website provides an overview of your benefit options. Wearing a swimsuit after a mastectomy can be a transition. Coverage will be considered under your out-of-network benefits. For people 65+ or those under 65 who qualify due to a disability or special situation, For people who qualify for both Medicaid and Medicare, Individual & family plans short term, dental & more, Individual & family plans - Marketplace (ACA). For some conditions, such as end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS), you could be eligible for Medicare before you turn 65.13. 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. Medicare pays 80% of the treatment costs, and the beneficiary contributes 20%. Also, your doctor will need to certify that you need certain eligible in-home services. 0000379543 00000 n 12 Always err on the side of caution! (Due to contractual requirements, MetLife is prevented from soliciting certain providers.) Whats a Summary of Benefits and Coverage? By receiving services through SurgeryPlus, you and your dependents can earn financial rewards. Medicare Part B benefits cover 80% of the Medicare-approved amount for cataract surgery. <>stream Always err on the side of caution! Help Center endobj Pre-/postnatal professional care: 35% of our allowance . For procedures requiring inpatient admission or overnight recovery, the travel benefit covers the patient and one companion for a limited amount of time. 7500 Rialto Blvd, Building 1 Suite 250 Arrives by Mon, Mar 13 Buy Samickarr Clearance items!Wireless Support Bras For Women Full Coverage And Lift Plus Size Bras Post-Surgery Bra Wirefree Bralette Minimizer Bra For Everyday Comfort at Walmart.com 0000010311 00000 n 0000019224 00000 n What's not covered by Part A & Part B? Medicare.gov, last accessed June 10, 2022. If it contains a form, you can print it and fill it out. Some examples of comorbidities include high blood pressure, high cholesterol, obstructive sleep apnea, Type II Diabetes, angina or stroke. 866-855-1212. Metlife will not pay Dental Insurance benefits for charges incurred for: Alternate Benefits What is the SurgeryPlus benefit? 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. You consent to receiving palliative care to make you comfortable versus care to try to cure your illness. Your general dentist or specialist usually sends MetLife a plan for your care and requests an estimate of benefits. This webpage is provided for summary purposes only and is not a complete description of the plan benefits, limitations, and exclusions. endstream endobj startxref 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. Franchise Tax A prime example is breast implants done during or after breast cancer surgery. Procedures can cost from $700 to $2,000 per eye, depending on . Confirm your coverage before you commit to a procedure youre unsure about. Filing a health insurance claim is simple and can be done in one of two ways. Mobile Apps 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. Mastectomy surgery is a significant life event for many people. 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. 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. Overview . Before undergoing surgery, youll want to be connected with the highest-quality providers and facilities. 0000011564 00000 n Tax Center You simply need to provide the plan administrator with advanced written notice along with any required premium. Jacksonville, FL 32256 SurgeryPlus is separate from your health plan and has its own network of high-quality providers. SurgeryPlus Care Advocates are your connection to the SurgeryPlus benefit. 0000012970 00000 n Inpatient hospital: $450 per admission copay for unlimited days, plus 35% of our allowance. Rates are subject to change and depend on geographic area. Even though its meant to make the information easier to understand, it can seem like a lot at first. (Negotiated fees are subject to change.). We cover the most expensive costs associated with your surgery so you'll pay less for your procedure. 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. What Part A covers, Medicare.gov, last accessed June 10, 2022. This symbol denotes a Web Page. You can choose whether or not to use SurgeryPlus for your surgical procedures. The sharing of health information between these companies is permitted by regulation. General Assembly Your private health information is just that private. This website is not intended as a contract of employment or a guarantee of current or future employment. Premiums and the list of covered drugscalled a formularywill vary by plan.6. 0000006640 00000 n Examples of procedures covered are hernia repair, hysterectomy, colonoscopy, tendon release, spine injections and fusions, knee replacements, and many more. 3 You must be the contract holder or spouse, 18 or older, on a Standard or Basic Option Plan to earn incentive rewards. Negotiated fees typically range from 15-45% below the average fees charged in a dentists community for the same or substantially similar services. <<7C167570AC52504DB41418C8CABC0A04>]/Prev 422895/XRefStm 1266>> 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. Personal Income Tax This is a voluntary benefit available to you if you're enrolled in the Core, Standard, Plus or High Cost Coverage medical option. 988 0 obj 0 Call a Care Advocate at 833.709.2444 for more information. 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. The SBC was created to make it easier to compare and shop for health plans. Does Medicare Cover Pre-existing Conditions? Medicare.com, last accessed June 10, 2022. 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. "Original Medicare may cover 80% of a traditional cataract surgery. h`06NH+500 Please remember to hold on to all receipts to submit a dental claim. 0000019705 00000 n Your SurgeryPlus benefit will also help pay for necessary travel associated with the covered procedure. In . Dependent age may vary by state. POWER Up to HIP Plus! Yes. You can also go through the SurgeryPlus member portal. Most plans cover the entire cost of preventive care, plus a portion of the cost after you meet your deductible for other procedures. Out-of-pocket costs may be greater if you visit a dentist who does not participate in the network. 2 If you have Medicare Part B primary, your costs for prescription drugs may be lower. 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. When enrolling you may choose to also cover your spouse, domestic partner, and/or children up to age 26. 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. Please review the plan summaries for summarized information and your certificate of insurance for detailed information about your plan benefits. L0920007743[exp0922][All States][DC,GU,MP,PR,VI] 2020 MSS, Florida office (headquarters) You'll also pay a deductible of $233. Our licensed Humana sales agents are available to help you select the coverage that best meets your needs. References to UnitedHealthcare pertain to each individual company or other UnitedHealthcare affiliated companies. Scuba Certification; Private Scuba Lessons; Scuba Refresher for Certified Divers; Try Scuba Diving; Enriched Air Diver (Nitrox) 0 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. Policy number 5343606-1-G (Low plan), Metropolitan Life Insurance Company, 200 Park Avenue, New York, NY 10166 The choice is yours. Learn more aboutsavings and spending accounts. SurgeryPlus notifies that you or your dependent earned the reward. 555 17th Street, Suite 2050 | Denver, CO 80202, 2023 CEBT :: CEBT is administered by WTW, When you use SurgeryPlus, CEBT will potentially waive your Out-of-Pocket costs (i.e. EXA!YA?fqLv1bd::M&a54g#A010p]p 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. If the MetLife dental benefit plan is primary, MetLife will pay the full amount of benefits that would normally be available under the plan.
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