About SurgeryPlus SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. Some links on this page may take you to Humana non-Medicare product or service pages or to a different website. HVn7}Wt)A87HPV$(YXF;3as=sfj'O&y>=zF_Gmlr:v1z5`:A1suhMFY}r0_&o^w]vw%'o':~u>)|]!6nRBki;L}h0y^'#cCmJJc It all depends on your policy. You or your dependent use SurgeryPlus to receive a preoperative to post-operative bundled surgical service; SurgeryPlus validates that you or your dependent received the service; and. A dental plan may cover routine office visits, fillings, crowns, root canals, oral surgery, periodontics, orthodontics, or bridges and dentures. 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. These rules determine the order in which the plans will pay benefits. It also includes more benefits like dental, vision, or chiropractic.With HIP Plus, you do not have copays when you visit the doctor, fill a prescription or go to the hospital for an emergency.On average, HIP Plus members spend less money on their health care . 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. Coverage is provided under a group insurance policy (Policy form GPNP99) issued by MetLife. 0000015692 00000 n
Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment. You can use the SBC to compare prices, benefits and other health plan options and features that might be important to you. Local Coverage Determinations (LCDs)/Local Coverage Article (LCAs) exist and compliance with these policies is required where applicable. 1026 0 obj A mastectomy bra can provide comfort, support, and security to an individual as they become accustomed to their new normal. 0000024943 00000 n
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. 89 37
The estimate helps you prepare for the cost of dental services. Consult your doctor before beginning any new diet or exercise regimen. 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. SurgeryPlus is included in your medical benefits at no additional cost to you. 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. SurgeryPlus negotiates a single cost (bundled rate) for the entire surgical procedure, resulting in savings to the State of Delaware. SurgeryPlus is separate from your health plan and has its own network of high-quality providers. This is because you won't know what services you need until you meet with your provider. It requires doctors and facilities to meet strict credential guidelines leading to the highest quality care possible. Policy number 5343606-1-G (Low plan), Metropolitan Life Insurance Company, 200 Park Avenue, New York, NY 10166 Vision benefits are underwritten by Metropolitan Life Insurance Company, New York, NY (MetLife). This surgery makes the stomach smaller. 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. When will my medical insurance cover oral surgery? (Based on internal analysis by MetLife. This group plan is made available to through membership in the American Association of Business Networking (ABN). Cancellation/Termination of Benefits Your copays and deductibles will still apply. 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
Take some time to understand your Medicare plan. Thats what SurgeryPlus does. As a member of Humana, you can receive up to 15 percent off standard LASIK pricing (and 5 percent off promotional pricing) at specified in-network providers. All rights reserved. What is Medicare Part C? U.S. Department of Health & Human Services, last accessed June 10, 2022. Please remember to hold on to all receipts to submit a dental claim. 0
General Assembly
The SurgeryPlus Difference We allow you to focus on practicing medicine and caring for patients. Weather & Travel, Contact Us
Coverage may not be available in all states. A class is a group of people defined in the group policy. Wearing a swimsuit after a mastectomy can be a transition. 0000023776 00000 n
SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. Generally, most vision, dental and hearing services are not covered by Medicare Parts A and B. Information about where to go online to review and print copies of complete health plan documents, Where to find a list of network providers, Where to find prescription drug coverage information, Where to find a Glossary of Health Coverage and Medical Terms (also called a Uniform Glossary), A statement on whether the plan meets minimum essential coverage (MEC) for the, A statement that it meets minimum value (plan covers at least 60 percent of medical costs of benefits for a population on average), When changes happen within your health plan, Individual & Family ACA Marketplace plans, Heres what a sample SBC looks like (pdf), Glossary of Health Coverage and Medical Terms, Explore the benefits of UnitedHealthcare plans through work, Dual Special Needs Plans (D-SNP) from UnitedHealthcare, When you make a change or are added to a health plan for example if you get married, have a child, or experience another. Negotiated fees are subject to change. It has less visits to physical, speech and occupational therapies than HIP Plus. Your medical insurance may also pick up the cost in full or part for medically-related . Continuous Glucose Monitors (CGMs)examples include Dexcom and Libre. 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. Every SBC is created with four double-sided pages and 12-point type. Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. 0000378718 00000 n
0000392965 00000 n
0000000016 00000 n
The Plan Sponsor(s) reserve the right to amend or terminate each plan at any time. What is the SurgeryPlus benefit? Original Medicare generally doesnt cover the cost of a nursing home, assisted living or long-term care facility. Cities & Towns
Adjustable straps allow for a better, customized fit. Outpatient: 15% of our allowance . Coverage will be considered under your out-of-network benefits. Trust in our network About Us; Staff; Camps; Scuba. EXA!YA?fqLv1bd::M&a54g#A010p]p Dentists may submit your claims for you which means you have little or no paperwork. Will Medicare Cover LASIK Eye Surgery? Medicare.org, last accessed June 10, 2022. Complete and submit the form and well be in touch soon. If the information online is inconsistent with the Plan Documents, the Plan Documents will govern. Bigger. A prime example is breast implants done during or after breast cancer surgery. Coverage Policy ; Coverage for bariatric surgery or revision of a bariatric surgical procedure varies across plans and may be governed by state mandates. 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. Premiums and the list of covered drugscalled a formularywill vary by plan.6. 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. Heres a step-by-step look at what information is in an SBC: You can request a copy of an SBC anytime. It is not to be used for medical advice, diagnosis or treatment. 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. 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. To get one, contact us. Yes. 0000001651 00000 n
0000001036 00000 n
It can include Durable Medical Equipment (DME), mental healthcare or ambulance services.2 Preventive care services are health treatments that prevent illness or detect problems at an early stage, like flu shots or cancer screenings.3, There are some things Original Medicare wont cover. Public Meetings
Know your options. 0000004536 00000 n
0000007939 00000 n
Malini Ghoshal, What You Need to Know About Medicare Prescription Drug Plans (Part D), Healthline, last accessed June 10, 2022. Facilitate and consolidate your payments. Privacy Policy
SurgeryPlus offers surgical procedures that are covered under the State Group Health Insurance Program, but is different from your health insurance plan because the healthcare services are bundled together. Or Reach Us at. Jacksonville, FL 32256 866-855-1212. Medicare Part B contributes 80% of the cost of one pair of eyeglasses or set of contact lenses after cataract surgery after. For procedures requiring inpatient admission or overnight recovery, the travel benefit covers the patient and one companion for a limited amount of time. 00k` !" Mobile Apps
At time of enrollment, you will choose how you want to pay. . Pre-authorization will still need to be submitted by your provider to SurgeryPlus before the surgery is scheduled. Thats because its basically a document that outlines whats covered and not covered under a health plan. 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.