The State Employee Benefits Committee (SEBC) believes in providing high quality care to members at an affordable cost. Many Medicare Advantage plans, however, do include coverage for routine dental, vision and hearing care, including glasses and hearing aids. A reminder that the SBC is only a summary. (Based on internal analysis by MetLife. TE 6Uz A$& &`5= X7"yH: wd`^+H(`q] DF9qt 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. However, Medicare doesnt cover routine hearing exams, hearing aids or fittings.7. 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. 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. 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. Metlife will not pay Dental Insurance benefits for charges incurred for: Alternate Benefits 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. To provide and maintain this valuable membership benefit, MetLife reimburses the association and/or the plan administrator for these costs. Transparency startxref 0000001266 00000 n 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. 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. Assign you a personal care coordinator to offer one-on-one guidance and support as you prepare for, undergo and recover from surgery. 0000006640 00000 n %%EOF A class is a group of people defined in the group policy. 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. A dental plan may cover routine office visits, fillings, crowns, root canals, oral surgery, periodontics, orthodontics, or bridges and dentures. Vision benefits are underwritten by Metropolitan Life Insurance Company, New York, NY (MetLife). Hospice care, Medicare.gov, last accessed June 10, 2022. Gross Receipts Tax Help Center State Employees The surgery and any facility costs will be 100% covered under your SurgeryPlus benefit. L0920007743[exp0922][All States][DC,GU,MP,PR,VI] 2020 MSS, Florida office (headquarters) The documentation requirements outlined below are used to assess whether the member meets the clinical criteria for coverage but do not guarantee coverage of the service requested. Adjusting to the physical changes post-surgery can be difficult, and finding the right mastectomy bra is one of the most important steps in the process. This group plan is made available to through membership in the American Association of Business Networking (ABN). This Coverage Policy addresses breast reduction for symptomatic macromastia and breast reduction surgery on Some links on this page may take you to Humana non-Medicare product or service pages or to a different website. endobj Inpatient (Precertification is required): $350 per admission. Durable medical equipment (DME) coverage, Medicare.gov, last accessed June 10, 2022. Alternatively, a Medicare Advantage plan often provides comprehensive vision coverage, plus cataract surgery without out-of-pocket coinsurance costs.". 12 Always err on the side of caution! lbSy 1 Sturti / Getty Images Coverage Varies by Insurer Each health plan is different. <<7C167570AC52504DB41418C8CABC0A04>]/Prev 422895/XRefStm 1266>> To get one, contact us. 0000010311 00000 n However, some UnitedHealthcare policies charge lower deductibles . Do your homework. 0000016018 00000 n POWER Up to HIP Plus! However, this depends on the specific type of surgery you need, your dental plan, and your level of coverage. Delaware Marketplace Remember that Medicare Advantage plans are required by law to offer all the benefits of Original Medicare, but most plans offer much more. In some cases, your association and/or the plan administrator may incur costs in connection with providing oversight and administrative support for this sponsored plan. Consult your doctor before beginning any new diet or exercise regimen. Rest easy knowing you can afford the surgery you need, HDHP Plans will require a reduced deductible to be met first. "Original Medicare may cover 80% of a traditional cataract surgery. But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary.12. hbbd```b``+@$}D Outpatient: 15% of our allowance . But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary. Coverage terminates when your membership ceases, insurance ceases for your class, when your dental contributions cease or upon termination of the group policy by the Policyholder or MetLife. 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. 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. "_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 startxref 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. 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. To check to see if you may already have SurgeryPlus, begin to type the name of your employer in the space below. Members will pay nothing out of pocket for bariatric surgery; however, financial incentives do not apply. endstream endobj startxref The group policy terminates for non-payment of premium and may terminate if participation requirements are not met or if the Policyholder fails to perform any obligations under the policy. Agent tip: "Original Medicare may cover 80% of a traditional cataract surgery. %%EOF Medicare Advantage plans are provided by private companies with approval from Medicare. Hearing & balance exams, Medicare.gov, last accessed June 10, 2022. You'll also pay a deductible of $233. Bigger. Privacy Policy }4Q2L_L 0fI\l!AN7za|*_)2:lU2_kciTX*R:N%` c8B=3 Although most cosmetic surgery is not covered by insurance, certain operations are typically deemed medically necessary when they're done in conjunction with other medical treatments. Please fill out the contact form so the right person can be in touch quickly. What Part B covers, Medicare.gov, last accessed June 10, 2022. Mobile Apps 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. 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. For example, rather than paying separately for the surgeon, facility, anesthesiologist, and radiologist, SurgeryPlus negotiates one bundled rate. <. Copyright 2022 Employer Direct HealthcareAll Rights Reserved. This symbol denotes a PDF Document. cost of cataract surgery with medicare. By packaging surgical expenses into one simple, bundled rate, SurgeryPlus is able save money for you and the State of Florida. Benefits are subject to change upon agreement between Metropolitan Life Insurance Company and the participating organization. Coverage is provided under a group insurance policy (Policy form GPNP99) issued by MetLife. 0000007939 00000 n xref 0000401803 00000 n Adjustable straps allow for a better, customized fit. endstream . What is the SurgeryPlus benefit? 0000023776 00000 n The service categories and plan limitations shown below represent an overview of the plan benefits. Connect you with a top-ranked, board-certified and fellowship-trained surgeon near you. The effective date of coverage for newly added dependent(s) will depend on when we receive notice and required premium. 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 0 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. 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. 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. SurgeryPlus offers a variety of medical procedures, including the following: Terms and Conditions | Privacy Statement | Accessibility Statement | Sitemap, Monthly Webinars / Educational YouTube Videos, Making plan changes with a Qualifying Status Change (QSC) Event. Malini Ghoshal, What You Need to Know About Medicare Prescription Drug Plans (Part D), Healthline, last accessed June 10, 2022. Confirm your coverage before you commit to a procedure youre unsure about. 0000381088 00000 n What Part A covers, Medicare.gov, last accessed June 10, 2022. 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. Effective July 1, 2023, bariatric surgery coverage will be available exclusively through the SurgeryPlus benefit. Your doctor certifies that you are terminally ill, meaning that your life expectancy is 6 months or less. You can use the SBC to compare prices, benefits and other health plan options and features that might be important to you. Weight-Loss (Bariatric) Surgery. Guided Support hbbd```b``f+A$S$d@$&},L`1]`*z3`] rO o bHHj@&{:.a`$ S Medicare will not pay for 24-hour in-home care or meals delivered to you at home. endstream 89 37 Your SurgeryPlus Care Advocate will provide you one-on-one, personalized help each step of the way. Because its all in the same format, its easier to make apples-to-apples comparisons when youre deciding which plan is best for you. Certain claim and network administration services are provided through Vision Service Plan (VSP), Rancho Cordova, CA. This program utilizes the MetLife PDP Plus Network of participating dentists. Rates are subject to change and depend on geographic area. 89 0 obj <> endobj 0000015692 00000 n endstream endobj 124 0 obj <>/Filter/FlateDecode/Index[5 84]/Length 22/Size 89/Type/XRef/W[1 1 1]>>stream 0000024943 00000 n We cover the most expensive costs associated with your surgery so youll pay less for your procedure. 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.