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. In certain markets, delegated vendor guidelines may be used to support medical necessity and other coverage determinations. To check to see if you may already have SurgeryPlus, begin to type the name of your employer in the space below. To assist, American Airlines has business relationships with third-party vendors, for example, BCBS, UHC, and WebMD Health Services. Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. Facilitate and consolidate your payments. SurgeryPlus Care Advocates are your connection to the SurgeryPlus benefit. 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. 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. Elected Officials
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Confirm your coverage before you commit to a procedure youre unsure about. Delaware Courts
Some types of surgery also change the connection between your stomach and intestines. Take some time to understand your Medicare plan. Most plans cover the entire cost of preventive care, plus a portion of the cost after you meet your deductible for other procedures. 0000024262 00000 n
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If you need cataract surgery in both eyes . 0000001651 00000 n
Medicare will not pay for 24-hour in-home care or meals delivered to you at home. 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. Yes. Your costs in Original Medicare For surgeries or procedures, it's hard to know the exact costs in advance. . This program utilizes the MetLife PDP Plus Network of participating dentists. Your medical insurance may also pick up the cost in full or part for medically-related . %%EOF A dental plan may cover routine office visits, fillings, crowns, root canals, oral surgery, periodontics, orthodontics, or bridges and dentures. The SBC was created to make it easier to compare and shop for health plans. Learn more aboutsavings and spending accounts. Hospice care, Medicare.gov, last accessed June 10, 2022. 0000006640 00000 n
Withholding Tax
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. h`06NH+500 Learn more about the ABN. You can choose whether or not to use SurgeryPlus for your surgical procedures. Delaware's Governor
Copyright 2023 Member Benefits. Medicare Advantage plans are provided by private companies with approval from Medicare. Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment. 989 0 obj 0000392965 00000 n
Guided Support The State Employee Benefits Committee (SEBC) believes in providing high quality care to members at an affordable cost. This document presents the majority of services within each category, but is not a complete description of the plan. 0000014251 00000 n
Connect you with a top-ranked, board-certified and fellowship-trained surgeon near you. Outpatient facility care: 35% of our allowance . By receiving services through SurgeryPlus, you and your dependents can earn financial rewards. Actual payments may vary from the pretreatment estimate depending upon annual maximums, plan frequency limits, deductibles and other limits applicable at time of payment. Take your bill (s) to your State Farm agent's office. Dependent age may vary by state. Privacy Policy Policy number 5343606-1-G (Low plan), Metropolitan Life Insurance Company, 200 Park Avenue, New York, NY 10166 Effective July 1, 2023, bariatric surgery coverage will be available exclusively through the SurgeryPlus benefit. Yes. Theres a lot of information in an SBC. 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. Reconstructive Procedures include surgery or other procedures which are related to a health condition. On average, cataract surgery costs about $5,000 per eye; however, in some places, this price can move up to over $10,000. It has less visits to physical, speech and occupational therapies than HIP Plus. This may include surgery to remove cataracts or after an eye injury. hbbd```b``+@$}D At time of enrollment, you will choose how you want to pay. Corporations
Inpatient hospital: $450 per admission copay for unlimited days, plus 35% of our allowance. If you qualify for it, Medicaid, which is administered by states under federal guidelines, may cover nursing home care. Your SurgeryPlus benefit will also help pay for necessary travel associated with the covered procedure. You can ask for a pretreatment estimate. (Based on internal analysis by MetLife. Coverage includes access to our network of excellent surgeons, consults and appointments with your SurgeryPlus provider, anesthesia, the procedure and facility (hospital) fees. Eleesha Lockett, Does Medicare Cover Plastic Surgery? Healthline, last accessed June 10, 2022. The primary result of . Call a Care Advocate at 833.709.2444 for more information. Remember that Medicare Advantage plans are required by law to offer all the benefits of Original Medicare, but most plans offer much more. 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. . We strongly encourage and seek out a workforce representative of Delaware including race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression. Coverage Policy ; Coverage for bariatric surgery or revision of a bariatric surgical procedure varies across plans and may be governed by state mandates. You'll be more confident on the beach with an extensive selection of plus-size swimwear. For procedures requiring inpatient admission or overnight recovery, the travel benefit covers the patient and one companion for a limited amount of time. Text Size Smaler, Make Text Size
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). 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. Please use this access code on website: surgeryplus. Hospital Care. 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. Heres a step-by-step look at what information is in an SBC: You can request a copy of an SBC anytime. 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. Expand your practice We route you incremental cases outside the typical radius of your practice. %PDF-1.6
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The specific travel benefit depends on the procedure, the provider, and the distance between the provider and a member's residence. 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. SurgeryPlus Frequently Asked Questions General Questions . Its also possible to get an SBC in another language. You can also go through the SurgeryPlus member portal. Only travel arrangements made through your Care Advocate are eligible for coverage under the SurgeryPlus benefit. Your general dentist or specialist usually sends MetLife a plan for your care and requests an estimate of benefits. startxref
00k` !" A reminder that the SBC is only a summary. Your private health information is just that private. 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. Consult your healthcare provider if you have questions or concerns. It is not to be used for medical advice, diagnosis or treatment. 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. Many offer affordable or even $0 monthly plan premiums, but you must continue to pay the Medicare Part B premium. 0000024865 00000 n
1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. 0000016018 00000 n
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Prescription drug planscalled Medicare Part Dare only available through private companies like Humana. Thats what SurgeryPlus does. 0000010311 00000 n
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If the MetLife dental benefit plan is primary, MetLife will pay the full amount of benefits that would normally be available under the plan. 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. Benefits are subject to change upon agreement between Metropolitan Life Insurance Company and the participating organization. coinsurance and/or deductible on PPO plans, or copay on EPO plans). For example, if youre still working and covered by your employer or your spouses employer sponsored health coverage, you may be able to wait. 10 frequently asked questions about Medicare plans, Deductibles for Medicare Part A and Part B. endstream
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The sharing of health information between these companies is permitted by regulation. Home health services, Medicare.gov, last accessed June 10, 2022. 0000001609 00000 n
About SurgeryPlus SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. Gross Receipts Tax
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. Coverage is provided under a group insurance policy (Policy form GPNP99) issued by MetLife. All services defined in your group dental benefits plan certificate are covered. 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 This is because you won't know what services you need until you meet with your provider. Tax Center
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. Please fill out the contact form so the right person can be in touch quickly.
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