Outpatient: 15% of our allowance . Effective July 1, 2023, all bariatric surgeries will be required to be completed through the SurgeryPlus benefit and performed by a surgeon in the SurgeryPlus network. On average, cataract surgery costs about $5,000 per eye; however, in some places, this price can move up to over $10,000. Yes. This website is not intended as a contract of employment or a guarantee of current or future employment. You'll also pay a deductible of $233. %%EOF Yes. 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. 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). Because its all in the same format, its easier to make apples-to-apples comparisons when youre deciding which plan is best for you. You may choose to share the information with your doctor and other medical professionals. 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. Continuous Glucose Monitors (CGMs)examples include Dexcom and Libre. This document presents the majority of services within each category, but is not a complete description of the plan. Withholding Tax In . 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. Coverage Policy ; Coverage for bariatric surgery or revision of a bariatric surgical procedure varies across plans and may be governed by state mandates. 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. 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. Coverage will be considered under your out-of-network benefits. 00k` !" Administrative services provided by United HealthCare Services, Inc. or their affiliates. 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. Please review the plan summaries for summarized information and your certificate of insurance for detailed information about your plan benefits. Call our Health Response Center at. endstream SurgeryPlus negotiates a single cost (bundled rate) for the entire surgical procedure, resulting in savings to the State of Delaware. 0000018849 00000 n Learn more about a Summary of Benefits and Coverage, also commonly referred to as an SBC. 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. Corporations Privacy Policy Prescription drug planscalled Medicare Part Dare only available through private companies like Humana. What is the SurgeryPlus benefit? To see if your procedure is covered, contact us. However, this depends on the specific type of surgery you need, your dental plan, and your level of coverage. 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. Medicare Advantage plans may offer coverage for vision, hearing, dental and wellness services. Connect you with a top-ranked, board-certified and fellowship-trained surgeon near you. Theres a lot of information in an SBC. 0000379543 00000 n You can make monthly payments by monthly bank draft (ACH) or pay for the entire year via credit card payment. Your medical insurance may also pick up the cost in full or part for medically-related . Inpatient (Precertification is required): $350 per admission. 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. 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. 250 0 obj <> endobj such as Spine, General Surgery, Genitourinary, Orthopedic, Ear, Nose & Throat, Cardiac, GI, and Pain Management. Wearing a Suit After a Body-Altering Surgery. 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. 1096 0 obj Tax Center For the Plus Size Queens. Please fill out the contact form so the right person can be in touch quickly. 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. Procedures can cost from $700 to $2,000 per eye, depending on . HIP Plus is the plan for the best value.HIP Plus provides health coverage for a low, predictable monthly cost. Contact us or connect with customer service by calling the number on your health plan ID card to ask for a copy in the language you need. SurgeryPlus provides an alternative to using your health plan for a planned surgical procedure that is not an emergency. Locations Directory These partners are required to comply with all laws protecting privacy. The estimate helps you prepare for the cost of dental services. This symbol denotes a PDF Document. 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. Find out which Humana plans include your doctors and cover the medications you take now to help you estimate your costs. 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. Licensed Humana sales agents are available daily, 8a.m. 8 p.m. 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. Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment. Generally, most vision, dental and hearing services are not covered by Medicare Parts A and B. Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. endstream endobj 124 0 obj <>/Filter/FlateDecode/Index[5 84]/Length 22/Size 89/Type/XRef/W[1 1 1]>>stream 0 The effective date of coverage for newly added dependent(s) will depend on when we receive notice and required premium. 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. This is a voluntary benefit available to you if you're enrolled in the Core, Standard, Plus or High Cost Coverage medical option. 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 includes access to our network of excellent surgeons, consults and appointments with your SurgeryPlus provider, anesthesia, the procedure and facility (hospital) fees.
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