endobj 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. Overview . 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. If you need cataract surgery in both eyes . 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. 3 You must be the contract holder or spouse, 18 or older, on a Standard or Basic Option Plan to earn incentive rewards. Metlife - Member Dental Plan Benefits - Member Benefits By receiving services through SurgeryPlus, you and your dependents can earn financial rewards. Many Medicare Advantage plans, however, do include coverage for routine dental, vision and hearing care, including glasses and hearing aids. Does United Healthcare Cover Cataract Surgery? Members of HumanaVision can receive deeper discounts on LASIK services, especially when using a specific in-network provider. %PDF-1.6 % 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. 0000016018 00000 n 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. Coverage includes access to our network of excellent surgeons, consults and appointments with your SurgeryPlus provider, anesthesia, the procedure and facility (hospital) fees. Bariatric surgery is surgery to help you lose weight. To see if your procedure is covered, contact us. 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. 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. 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. hb``P```e```5c@L@q EP0 We cover the most expensive costs associated with your surgery so youll pay less for your procedure. Corporations (Negotiated fees are subject to change.). Public Meetings For procedures requiring inpatient admission or overnight recovery, the travel benefit covers the patient and one companion for a limited amount of time. Your Care Advocate will provide you with personalized support, helping you to understand your benefit, find you excellent care, coordinate any consults and appointments with your SurgeryPlus surgeon and make sure you feel informed every step of the way. 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. Benefit coverage for health services is determined by the member specific benefit plan document and applic able laws that may require coverage for a specific service. %PDF-1.4 % Adjustable straps allow for a better, customized fit. 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. Outpatient facility care: 35% of our allowance . You earn the reward once the following occurs: The reward will then be credited to the savings and spending account of your choice. 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. 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. 0000006640 00000 n 0000024262 00000 n A reminder that the SBC is only a summary. Information gathered by our partners will be used for your benefit to help guide you on your path to wellness. Only travel arrangements made through your Care Advocate are eligible for coverage under the SurgeryPlus benefit. 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 These partners are required to comply with all laws protecting privacy. Procedures can cost from $700 to $2,000 per eye, depending on . To get one, contact us. To provide and maintain this valuable membership benefit, MetLife reimburses the association and/or the plan administrator for these costs. hbbbd`b`` K Please use this access code on website: surgeryplus. 0000004536 00000 n For Providers - Surgery Plus Elected Officials 0000381088 00000 n Find out which Humana plans include your doctors and cover the medications you take now to help you estimate your costs. You sign a consent form to receive hospice care instead of other Medicare-covered treatments for your terminal condition. Is Oral Surgery Covered by Medical or Dental Insurance? Facilitate and consolidate your payments. Expand your practice We route you incremental cases outside the typical radius of your practice. This Coverage Policy addresses breast reduction for symptomatic macromastia and breast reduction surgery on It requires doctors and facilities to meet strict credential guidelines leading to the highest quality care possible. They help you find a great doctor for your procedure, schedule your procedure appointments, make travel reservations (if travel is required), transfer your medical records, and coordinate all your surgery bills. Enter your ZIP code below to see plans with their premiums, copays, and participating doctors and pharmacies. HVn7}Wt)A87HPV$(YXF;3as=sfj'O&y>=zF_Gmlr:v1z5`:A1suhMFY}r0_&o^w]vw%'o':~u>)|]!6nRBki;L}h0y^'#cCmJJc About SurgeryPlus SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. 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. The inclusion of a code does not imply any right to . 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. endstream endobj startxref This may include surgery to remove cataracts or after an eye injury. 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. 6 Original Medicare may even pay for corrective lenses if you have surgery to implant an intraocular lens (IOL). endstream endobj 90 0 obj <>/Metadata 3 0 R/OpenAction 91 0 R/Pages 2 0 R/StructTreeRoot 5 0 R/Type/Catalog/ViewerPreferences<>>> endobj 91 0 obj <> endobj 92 0 obj >/PageTransformationMatrixList<0[1.0 0.0 0.0 1.0 0.0 -396.0]>>/PageUIDList<0 878>>/PageWidthList<0 612.0>>>>>>/Resources<>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 93 0 obj <> endobj 94 0 obj <> endobj 95 0 obj [/Indexed/DeviceRGB 250 104 0 R] endobj 96 0 obj <>stream Nets vs. Celtics - NBA Game Videos - March 3, 2023 | ESPN What Part A covers, Medicare.gov, last accessed June 10, 2022. Call a Care Advocate at 833.709.2444 for more information. You are always free to select the dentist of your choice. Your private health information is just that private. This webpage is provided for summary purposes only and is not a complete description of the plan benefits, limitations, and exclusions. 0000012970 00000 n An estimated cost of cataract surgery may be*: In a surgery center or clinic, the average total cost is $977. Most plans cover the entire cost of preventive care, plus a portion of the cost after you meet your deductible for other procedures. You simply need to provide the plan administrator with advanced written notice along with any required premium. All rights reserved. It does not cover bariatric surgery or jaw care (TMJ). Take your bill (s) to your State Farm agent's office. Group dental insurance policies featuring the Preferred Dentist Program are underwritten by Metropolitan Life Insurance Company, New York, NY 10166. 0000401803 00000 n Even though its meant to make the information easier to understand, it can seem like a lot at first. Most common oral surgeries are covered, at least in part, by your dental insurance provider. All health plan companies are required to provide an SBC for each of their different plans. <<7C167570AC52504DB41418C8CABC0A04>]/Prev 422895/XRefStm 1266>> 10 frequently asked questions about Medicare plans, Deductibles for Medicare Part A and Part B. You may need to exhaust your personal resources on medical care before you are eligible.
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