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. Or Reach Us at. endstream Certain claim and network administration services are provided through Vision Service Plan (VSP), Rancho Cordova, CA. Mon-Fri, 8:30am-5:00pm (ET), Texas office You can ask for a pretreatment estimate. It has less visits to physical, speech and occupational therapies than HIP Plus. 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. 0 A reminder that the SBC is only a summary. What is the SurgeryPlus benefit? A dental plan may cover routine office visits, fillings, crowns, root canals, oral surgery, periodontics, orthodontics, or bridges and dentures. 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. 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 . Coverage Policy ; Coverage for bariatric surgery or revision of a bariatric surgical procedure varies across plans and may be governed by state mandates. 0000381088 00000 n This symbol denotes a PDF Document. Please review the plan summaries for summarized information and your certificate of insurance for detailed information about your plan benefits. Assign you a personal care coordinator to offer one-on-one guidance and support as you prepare for, undergo and recover from surgery. 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. Or Reach Us at 855-200-2099 " *" indicates required fields Inpatient hospital: $450 per admission copay for unlimited days, plus 35% of our allowance. Learn more about the ABN. This is because you won't know what services you need until you meet with your provider. }4Q2L_L 0fI\l!AN7za|*_)2:lU2_kciTX*R:N%` c8B=3 Please remember to hold on to all receipts to submit a dental claim. Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment. Out-of-pocket costs may be greater if you visit a dentist who does not participate in the network. However, this depends on the specific type of surgery you need, your dental plan, and your level of coverage. Theres a lot of information in an SBC. You can make monthly payments by monthly bank draft (ACH) or pay for the entire year via credit card payment. 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. 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. Original Medicare generally covers most pre-existing conditions. What is Medicare Part C? U.S. Department of Health & Human Services, last accessed June 10, 2022. But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary.12. 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. 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. Privacy Policy 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. 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 Generally, most vision, dental and hearing services are not covered by Medicare Parts A and B. Disclaimer 00k` !" We recommend that you request a pre-treatment estimate for services in excess of $300. This communication does not guarantee benefits and does not indicate all services received will be covered by your plan. Coverage will be considered under your out-of-network benefits. L0920007743[exp0922][All States][DC,GU,MP,PR,VI] 2020 MSS, Florida office (headquarters) 1XQg&.9mE#(Tq& Voting & Elections To get you to the right place, click the link below to indicate whether you are a member of Surgery Direct or Cancer Care Direct. Because its all in the same format, its easier to make apples-to-apples comparisons when youre deciding which plan is best for you. 125 0 obj <>stream Examples of procedures covered are hernia repair, hysterectomy, colonoscopy, tendon release, spine injections and fusions, knee replacements, and many more. To see if your procedure is covered, contact us. Effective July 1, 2023, bariatric surgery coverage will be available exclusively through the SurgeryPlus benefit. 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. A prime example is breast implants done during or after breast cancer surgery. Before undergoing surgery, youll want to be connected with the highest-quality providers and facilities. Some links on this page may take you to Humana non-Medicare product or service pages or to a different website. You can choose whether or not to use SurgeryPlus for your surgical procedures. Group dental insurance policies featuring the Preferred Dentist Program are underwritten by Metropolitan Life Insurance Company, New York, NY 10166. Premiums and the list of covered drugscalled a formularywill vary by plan.6. If you qualify for it, Medicaid, which is administered by states under federal guidelines, may cover nursing home care. 0000006640 00000 n Updated 08/29/2019 . hbbd```b``f+A$S$d@$&},L`1]`*z3`] rO o bHHj@&{:.a`$ S Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. Do your homework. 0000401803 00000 n Whats a Summary of Benefits and Coverage? Your doctor certifies that you are terminally ill, meaning that your life expectancy is 6 months or less. Dentists may submit your claims for you which means you have little or no paperwork. 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. 0000025231 00000 n Pre-authorization will still need to be submitted by your provider to SurgeryPlus before the surgery is scheduled. (Portal access Code: surgeryplus). If permitted, you may only be responsible for the negotiated fee. Bigger. Facilitate and consolidate your payments. To get one, contact us. Simply have your dentist submit a request online at www.metdental.com or call 1-877-MET-DDS9. It requires doctors and facilities to meet strict credential guidelines leading to the highest quality care possible. At time of enrollment, you will choose how you want to pay. Starting January 1, 2018, HIP State Basic and HIP State Plus will cover members age 21 to 64. POWER Up to HIP Plus! However, some UnitedHealthcare policies charge lower deductibles . Delaware's Governor Medicare will only provide coverage through suppliers who participate in the Medicare program.10, Services that are not considered medically necessary are generally not covered by Medicare Part A or Part B. SurgeryPlus negotiates a single cost (bundled rate) for the entire surgical procedure, resulting in savings to the State of Delaware. For procedures requiring inpatient admission or overnight recovery, the travel benefit covers the patient and one companion for a limited amount of time. You sign a consent form to receive hospice care instead of other Medicare-covered treatments for your terminal condition. You may enroll for membership in the ABN directly through the ABN website or during your dental enrollment. This information is provided for educational purposes only. Outpatient facility care: 35% of our allowance . Only travel arrangements made through your Care Advocate are eligible for coverage under the SurgeryPlus benefit. The SurgeryPlus Difference We allow you to focus on practicing medicine and caring for patients. Mastectomy surgery is a significant life event for many people. The State Employee Benefits Committee (SEBC) believes in providing high quality care to members at an affordable cost. If it contains a form, you can print it and fill it out. SurgeryPlus is included in your medical benefits at no additional cost to you. Members will pay nothing out of pocket for bariatric surgery; however, financial incentives do not apply. Hospice care, Medicare.gov, last accessed June 10, 2022. Blue Distinction Centers for Substance Use Treatment and Recovery aims to improve patient outcomes and value by focusing on providers across the full continuum of care who deliver and facilitate treatment for substance use disorder, including opioid use disorder. Inpatient (Precertification is required): $350 per admission. ic+C@nN`RYva@\}KRr>Wq8=Rw+{a .n!LF40d=DdcB42r7hRXyMQ"wDYfuwO se)D+jd7bLB,2}a'_UOaB:.bwRIQGp)` aHeO\@qPtn#u,{n{@|=V<^N}Ap2,+H>0$_ -C Locations Directory 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. Some examples of comorbidities include high blood pressure, high cholesterol, obstructive sleep apnea, Type II Diabetes, angina or stroke. 0000000016 00000 n Licensed Humana sales agents are available daily, 8a.m. 8 p.m. Consult your doctor before beginning any new diet or exercise regimen. The sharing of health information between these companies is permitted by regulation. 0000010311 00000 n Please use this access code on website: surgeryplus. The complete provisions of the plans are set forth in the Plan Documents and Summary Plan Description. Does Medicare Cover Pre-existing Conditions? Medicare.com, last accessed June 10, 2022. 0000004000 00000 n Delaware Topics When will my medical insurance cover oral surgery? Some general conditions to receive coverage from United Healthcare requires that you meet the following criteria: Have a body mass index over 40 OR. Rates are subject to change and depend on geographic area. This exclusion does not apply to residents of New Mexico This exclusion does not apply to residents of Minnesota; Orthodontic services or appliances (APPLIES TO LOW PPO OPTION ONLY); Repair or replacement of an orthodontic device; Services, to the extent such services, or benefits for such services, are available under a government plan. Once your policy takes effect, you can still add or remove dependents to your coverage once per year on the group plan anniversary date of Jan 1 or if you have a qualifying event such as marriage, divorce, birth of a child, and spouses termination of employment. This program will be available on January 1, 2020. 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.
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