Licensed Humana sales agents are available daily, 8a.m. 8 p.m. Please fill out the contact form so the right person can be in touch quickly. 0000379543 00000 n Dentists may submit your claims for you which means you have little or no paperwork. It does not cover bariatric surgery or jaw care (TMJ). h`06NH+500 In certain markets, delegated vendor guidelines may be used to support medical necessity and other coverage determinations. Updated 08/29/2019 . 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. Some general conditions to receive coverage from United Healthcare requires that you meet the following criteria: Have a body mass index over 40 OR. hbbbd`b`` K endstream endobj 124 0 obj <>/Filter/FlateDecode/Index[5 84]/Length 22/Size 89/Type/XRef/W[1 1 1]>>stream What's not covered by Part A & Part B? Medicare.gov, last accessed June 10, 2022. You can search a list of these participating dentists online or call 1-800-942-0854 to have a list faxed or mailed to you. 0000015692 00000 n <. Whats a Summary of Benefits and Coverage? This website is not intended as a contract of employment or a guarantee of current or future employment. An estimated cost of cataract surgery may be*: In a surgery center or clinic, the average total cost is $977. Out-of-pocket costs may be greater if you visit a dentist who does not participate in the network. Mobile Apps Generally, most vision, dental and hearing services are not covered by Medicare Parts A and B. Where two or more professionally acceptable dental treatments for a dental condition exist, reimbursement is based on the least costly treatment alternative. Medicare Advantage plans may offer coverage for vision, hearing, dental and wellness services. 9l J'X:50e0l`} }U,,Q`lam[5-0f`MVe` 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. 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. Learn more about COVID-19 and the vaccine from the Division of Public Health, Learn about your benefits and resources for Behavioral Health & Emotional Wellbeing More Info. 0000001651 00000 n Administrative services provided by United HealthCare Services, Inc. or their affiliates. 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. On average, cataract surgery costs about $5,000 per eye; however, in some places, this price can move up to over $10,000. 10 frequently asked questions about Medicare plans, Deductibles for Medicare Part A and Part B. Hearing & balance exams, Medicare.gov, last accessed June 10, 2022. However, some UnitedHealthcare policies charge lower deductibles . ii AF! <>stream 10739 Deerwood Park Blvd, Suite 200-B startxref POWER Up to HIP Plus! 3 You must be the contract holder or spouse, 18 or older, on a Standard or Basic Option Plan to earn incentive rewards. The complete provisions of the plans are set forth in the Plan Documents and Summary Plan Description. endstream endobj 97 0 obj <>stream This may include surgery to remove cataracts or after an eye injury. This guide will explain the different types of . 0 endstream 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. 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. Privacy Policy (Negotiated fees are subject to change.). Original Medicare generally covers most pre-existing conditions. Your costs in Original Medicare For surgeries or procedures, it's hard to know the exact costs in advance. SurgeryPlus Frequently Asked Questions General Questions . Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment. Please Note: Additional information about this benefit change will be posted as it becomes available and before the July 1, 2023 effective date. Negotiated fees are subject to change. These rules determine the order in which the plans will pay benefits. If the MetLife dental benefit plan is primary, MetLife will pay the full amount of benefits that would normally be available under the plan. 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. Benefits are subject to change upon agreement between Metropolitan Life Insurance Company and the participating organization. The amount of benefits payable by MetLife may be reduced due to the benefits paid under the primary plan. If the information online is inconsistent with the Plan Documents, the Plan Documents will govern. To get one, contact us. Your private health information is just that private. It is not to be used for medical advice, diagnosis or treatment. Medicare Part A does cover care provided in a skilled nursing facility with certain conditions and time limitations. 285 0 obj <>stream To check to see if you may already have SurgeryPlus, begin to type the name of your employer in the space below. 0000014887 00000 n 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). 0000010311 00000 n Delaware's Governor Surgical Coverage Surgery Surgery Medicare covers many medically necessary surgical procedures. startxref For specific LCDs/LCAs, refer to the table for You can choose whether or not to use SurgeryPlus for your surgical procedures. coinsurance and/or deductible on PPO plans, or copay on EPO plans). To connect with SurgeryPlus today, call 833-709-2445. This webpage is provided for summary purposes only and is not a complete description of the plan benefits, limitations, and exclusions. Also, your doctor will need to certify that you need certain eligible in-home services. "_P^)J^:+&!nI-eMNYrVY;QU&+,SUdTVvSN(GTDS o5q_H\%lqbF$M2Q::=x?c}Efl 2"PwyOP# 3V&$b$E7TXI!"?k* NZOLizJT5A7a Xk56C*I~EOv {)Z` YFJ#i'O>4@6.\7=dBkwR)K@kJ^.|xs-v(\irQJhpQ-[":wwT%9KBU2hNU^ 6/En!`}#Yrud9,/R We cover the most expensive costs associated with your surgery so you'll pay less for your procedure. 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. Certain claim and network administration services are provided through Vision Service Plan (VSP), Rancho Cordova, CA. Wearing a Suit After a Body-Altering Surgery. Transparency hb``P```e```5c@L@q EP0 You may choose to share the information with your doctor and other medical professionals. Inpatient (Precertification is required): $350 per admission. References to UnitedHealthcare pertain to each individual company or other UnitedHealthcare affiliated companies. If permitted, you may only be responsible for the negotiated fee. trailer If it contains a form, you can fill it out online and submit it. 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. Filing a health claim. %%EOF This benefit is available to those enrolled in one of the CEBT EPO, PPO or HDHP medical plans. 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. Disclaimer Through international dental travel assistance services* you can obtain a referral to a local dentist by calling +1-312-356-5970 (collect) when outside the U.S. to receive immediate care until you can see your dentist. Always err on the side of caution! 250 0 obj <> endobj This website and phone number are for use by dental professionals only. Confirm your coverage before you commit to a procedure you're unsure about. Some links on this page may take you to Humana non-Medicare product or service pages or to a different website. Weight-Loss (Bariatric) Surgery. 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. Pre-/postnatal professional care: 35% of our allowance . Before undergoing surgery, youll want to be connected with the highest-quality providers and facilities. 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. Outpatient facility care: 35% of our allowance . Call a Care Advocate at 833.709.2444 for more information. Your general dentist or specialist usually sends MetLife a plan for your care and requests an estimate of benefits. Delaware Courts 0000019224 00000 n What happens with my health information? SurgeryPlus negotiates a single cost (bundled rate) for the entire surgical procedure, resulting in savings to the State of Delaware. It also doesnt cover help for whats called activities of daily living, like bathing, getting dressed, using the toilet, eating or moving from place to place within your home.9. L0920007743[exp0922][All States][DC,GU,MP,PR,VI] 2020 MSS, Florida office (headquarters) He or she hasnt agreed to accept negotiated fees. hb```f`` vAX,Xf000Z\ q1=nIc /( Negotiated fees may extend to services not covered under your plan and services received after your plan maximum has been met, where permitted by applicable state law.
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