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. Heres a step-by-step look at what information is in an SBC: You can request a copy of an SBC anytime. Your SurgeryPlus Care Advocate will provide you one-on-one, personalized help each step of the way. Yes. Examples of procedures covered are hernia repair, hysterectomy, colonoscopy, tendon release, spine injections and fusions, knee replacements, and many more. 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. 1. 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). Your private health information is just that private. 1XQg&.9mE#(Tq& Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. 0000024262 00000 n %%EOF You'll be more confident on the beach with an extensive selection of plus-size swimwear. 0000001266 00000 n Assign you a personal care coordinator to offer one-on-one guidance and support as you prepare for, undergo and recover from surgery. Wearing a swimsuit after a mastectomy can be a transition. Elected Officials 0000392965 00000 n Personal Income Tax Some types of surgery also change the connection between your stomach and intestines. You can choose whether or not to use SurgeryPlus for your surgical procedures. What Part B covers, Medicare.gov, last accessed June 10, 2022. 0000014251 00000 n Overview . Policy number TS 05343606-G (High plan) Policy number 5343606-1-G (Low plan) Metropolitan Life Insurance Company, 200 Park Avenue, New York, NY 10166. Confirm your coverage before you commit to a procedure youre unsure about. Delaware Marketplace Consult your healthcare provider if you have questions or concerns. Help Center This Coverage Policy addresses breast reduction for symptomatic macromastia and breast reduction surgery on Always err on the side of caution! Negotiated fees are subject to change. Our licensed Humana sales agents are available to help you select the coverage that best meets your needs. SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. . This program will be available on January 1, 2020. 2 If you have Medicare Part B primary, your costs for prescription drugs may be lower. The SurgeryPlus Difference We allow you to focus on practicing medicine and caring for patients. Administrative services provided by United HealthCare Services, Inc. or their affiliates. It requires doctors and facilities to meet strict credential guidelines leading to the highest quality care possible. Policy form GPNP99. Dentists may submit your claims for you which means you have little or no paperwork. such as Spine, General Surgery, Genitourinary, Orthopedic, Ear, Nose & Throat, Cardiac, GI, and Pain Management. Certain claim and network administration services are provided through Vision Service Plan (VSP), Rancho Cordova, CA. EXA!YA?fqLv1bd::M&a54g#A010p]p <>/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 You may choose to share the information with your doctor and other medical professionals. 0000001436 00000 n You can use the SBC to compare prices, benefits and other health plan options and features that might be important to you. 0000000016 00000 n If it contains a form, you can fill it out online and submit it. ii AF! 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. Hospice care, Medicare.gov, last accessed June 10, 2022. Medicare pays 80% of the cost of traditional cataract surgery, which would be covered by Medicare Part B. Guided Support The SBC was created to make it easier to compare and shop for health plans. Updated 08/29/2019 . Thats because its basically a document that outlines whats covered and not covered under a health plan. Medicare won't cover Lasik surgery just to avoid the need for glasses. POWER Up to HIP Plus! "L @Zd X$9RAC~yGz3)fjaPk !e E57 Hln8 ``:w0@6Cfmu ] What is Medicare Part C? U.S. Department of Health & Human Services, last accessed June 10, 2022. Your costs in Original Medicare For surgeries or procedures, it's hard to know the exact costs in advance. Locations Directory Or Reach Us at. 0000377893 00000 n Policy number TS 05343606-G (High plan) 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. To connect with SurgeryPlus today, call 833-709-2445. You are always free to select the dentist of your choice. Procedure charge schedules are subject to change each plan year. It does not cover bariatric surgery or jaw care (TMJ). Your doctor certifies that you are terminally ill, meaning that your life expectancy is 6 months or less. Franchise Tax 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. To connect with SurgeryPlus today, call 833-709-2445. 250 0 obj <> endobj Medicare Advantage plans are provided by private companies with approval from Medicare. This surgery makes the stomach smaller. 0000010311 00000 n Adjusting to the physical changes post-surgery can be difficult, and finding the right mastectomy bra is one of the most important steps in the process. endobj Cities & Towns Copyright 2022 Employer Direct HealthcareAll Rights Reserved. Have a body mass index over 35 with severe comorbidity. Some general conditions to receive coverage from United Healthcare requires that you meet the following criteria: Have a body mass index over 40 OR. References to UnitedHealthcare pertain to each individual company or other UnitedHealthcare affiliated companies. endstream SurgeryPlus is separate from your health plan and has its own network of high-quality providers. 0000004536 00000 n State Agencies 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. 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. 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. coinsurance and/or deductible on PPO plans, or copay on EPO plans). Its also possible to get an SBC in another language. 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. Will Medicare Cover LASIK Eye Surgery? Medicare.org, last accessed June 10, 2022. This information is provided for educational purposes only. 0 The Plan Sponsor(s) reserve the right to amend or terminate each plan at any time. The State of Delaware is an Equal Opportunity employer and values a diverse workforce. To get all the details, youll want to look at complete health plan documents. Membership in the ABN in required to enroll in this plan. Read your certificate of insurance for details on plan benefits, limitations, and exclusions. 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. 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. Jacksonville, FL 32256 Cancellation/Termination of Benefits Coverage will be considered under your out-of-network benefits. 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 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. Group dental insurance policies featuring the Preferred Dentist Program are underwritten by Metropolitan Life Insurance Company, New York, NY 10166. The State Employee Benefits Committee (SEBC) believes in providing high quality care to members at an affordable cost. Thats what SurgeryPlus does. Call a Care Advocate at 833.709.2444 for more information. Because its all in the same format, its easier to make apples-to-apples comparisons when youre deciding which plan is best for you. 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. Learn more about the ABN. A class is a group of people defined in the group policy. 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. Negotiated fees for non-covered services may not apply in all states.). 0000016018 00000 n Do your homework. Rest easy knowing you can afford the surgery you need, HDHP Plans will require a reduced deductible to be met first. 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. Your SurgeryPlus benefit will also help pay for necessary travel associated with the covered procedure. 89 37 But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary. SurgeryPlus provides an alternative to using your health plan for a planned surgical procedure that is not an emergency. This symbol denotes a PDF Document. Bariatric surgery is surgery to help you lose weight. About Us; Staff; Camps; Scuba. Yes. Mon-Fri, 8:30am-5:00pm (ET), Texas office Adjustable straps allow for a better, customized fit. Even though its meant to make the information easier to understand, it can seem like a lot at first. Please use this access code on website: surgeryplus. Other services not covered by Medicare Parts A and B include:4, Medicare Part C is also known as Medicare Advantage. 0000025231 00000 n %%EOF 0000015806 00000 n This communication does not guarantee benefits and does not indicate all services received will be covered by your plan. 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. In . Please fill out the contact form so the right person can be in touch quickly. SurgeryPlus is a supplemental benefit for non-emergency surgeries that provides high-quality care, The choice is yours. 00k` !" Your copays and deductibles will still apply. Coverage includes access to our network of excellent surgeons, consults and appointments with your SurgeryPlus provider, anesthesia, the procedure and facility (hospital) fees. 0 Home. Original Medicare generally doesnt cover the cost of a nursing home, assisted living or long-term care facility. Your medical insurance may also pick up the cost in full or part for medically-related . 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. endstream endobj 97 0 obj <>stream The time a mother and baby spend in the hospital after delivery is a medical decision. The sharing of health information between these companies is permitted by regulation. The surgery and any facility costs will be 100% covered under your SurgeryPlus benefit. 866-855-1212 to request a claim form. Negotiated fees typically range from 15-45% below the average fees charged in a dentists community for the same or substantially similar services. Mobile Apps endobj These partners are required to comply with all laws protecting privacy. Whats especially helpful is that every health plan has to use the same outline to show the costs and coverage for each of the plans they offer. , begin to type the name of your employer in the space below. 0000012970 00000 n 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. Yes. Prescription drug planscalled Medicare Part Dare only available through private companies like Humana. 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. TE 6Uz A$& &`5= X7"yH: wd`^+H(`q] DF9qt 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. Generally, Medicare Part A (also known as hospital insurance) can cover inpatient hospital care, nursing facility care, nursing home care, hospice care and home healthcare.1, Medicare Part B (also known as medical insurance) offers coverage for medically necessary and preventive care services. 9l J'X:50e0l`} }U,,Q`lam[5-0f`MVe` When will my medical insurance cover oral surgery? These rules determine the order in which the plans will pay benefits. Delaware's Governor Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, reductions, limitations, waiting periods and terms for keeping them in force.
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