For specific LCDs/LCAs, refer to the table for Administrative services provided by United HealthCare Services, Inc. or their affiliates. 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. This information is provided for educational purposes only. Continuous Glucose Monitors (CGMs)examples include Dexcom and Libre. Prescription drug planscalled Medicare Part Dare only available through private companies like Humana. All services defined in your group dental benefits plan certificate are covered. Please review the plan summaries for summarized information and your certificate of insurance for detailed information about your plan benefits. SurgeryPlus notifies that you or your dependent earned the reward. Board Certification, Specialty Training Requirements, Procedure Volume Requirements, State Sanctions Check, Medical Malpractice Claims Review, Criminal Background Checks, CMS Quality Requirements (Hospital Only), Monthly Network Monitoring. SurgeryPlus is a supplemental benefit for non-emergency surgeries that provides high-quality care, The complete provisions of the plans are set forth in the Plan Documents and Summary Plan Description. The inclusion of a code does not imply any right to . Or Reach Us at 855-200-2099 " *" indicates required fields If you and your dentist have agreed on a treatment that is more costly than the treatment upon which the plan benefit is based, you will be responsible for any additional payment responsibility. Your medical insurance may also pick up the cost in full or part for medically-related . (Due to contractual requirements, MetLife is prevented from soliciting certain providers.) Learn more about the ABN. Please use this access code on website: surgeryplus. Do your homework. 1. Your general dentist or specialist usually sends MetLife a plan for your care and requests an estimate of benefits. By receiving services through SurgeryPlus, you and your dependents can earn financial rewards. What's not covered by Part A & Part B? Medicare.gov, last accessed June 10, 2022. Some examples of comorbidities include high blood pressure, high cholesterol, obstructive sleep apnea, Type II Diabetes, angina or stroke. This symbol denotes a Web Page. Hospital Care. 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. 285 0 obj <>stream Child(ren)s eligibility for dental coverage is from birth up to age 26. Your SurgeryPlus benefit will also help pay for necessary travel associated with the covered procedure. The Plan Sponsor(s) reserve the right to amend or terminate each plan at any time. E-mail / Text Alerts Will Medicare Cover LASIK Eye Surgery? Medicare.org, last accessed June 10, 2022. 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. You can make monthly payments by monthly bank draft (ACH) or pay for the entire year via credit card payment. Only travel arrangements made through your Care Advocate are eligible for coverage under the SurgeryPlus benefit. An estimated cost of cataract surgery may be*: In a surgery center or clinic, the average total cost is $977. For example, breast augmentation for cosmetic reasons isnt covered by Medicare, but reconstructive surgery after a mastectomy is covered.11, Medicare wont cover Lasik surgery just to avoid the need for glasses. Franchise Tax Medicare pays 80% of the treatment costs, and the beneficiary contributes 20%. What is Medicare Part C? U.S. Department of Health & Human Services, last accessed June 10, 2022. Fair and simple terms We pay a fair, transparent rate for cases and streamline reimbursement, decreasing your administrative burden. Overview . If it contains a form, you can fill it out online and submit it. There are no simple answers, but you can start here to find general answers to some of the most common questions about Medicare coverage. Disclaimer hbbd```b``f+A$S$d@$&},L`1]`*z3`] rO o bHHj@&{:.a`$ S It has less visits to physical, speech and occupational therapies than HIP Plus. A mastectomy bra can provide comfort, support, and security to an individual as they become accustomed to their new normal. 0000379543 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. 0000001266 00000 n 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. 988 0 obj <>stream Because its all in the same format, its easier to make apples-to-apples comparisons when youre deciding which plan is best for you. Please contact MetLife or Member Benefits, your plan administrator at 1-800-282-8626 for costs and complete details. HVn7}Wt)A87HPV$(YXF;3as=sfj'O&y>=zF_Gmlr:v1z5`:A1suhMFY}r0_&o^w]vw%'o':~u>)|]!6nRBki;L}h0y^'#cCmJJc A class is a group of people defined in the group policy. 0000418667 00000 n Please fill out the contact form so the right person can be in touch quickly. Locations Directory Medicare will not pay for 24-hour in-home care or meals delivered to you at home. search a list of these participating dentists online, https://www.metlife.com/support-and-manage/forms-library/, One fluoride treatment per 12-month period for dependent children up to their 14th birthday, Total number of periodontal maintenance treatments and prophylaxis cannot exceed two treatments in a calendar year, For dependent children up to 14th birthday, once per lifetime per tooth area, One application of sealant material every 60 months for each non-restored, non-decayed 1st and 2nd molar of a dependent child up to their 16th birthday, Crown, Denture, and Bridge Repair / Recementations, Initial placement to replace one or more natural teeth, which are lost while covered by the plan, Root canal treatment limited to once per tooth per lifetime, When dentally necessary in connection with oral surgery, extractions or other covered dental services, Except as mentioned elsewhere in certificate, Periodontal scaling and root planning once per quadrant, every 24 months, Your Children, up to age 19, are covered while Dental Insurance is in effect. 866-855-1212 to request a claim form. Hospice care, Medicare.gov, last accessed June 10, 2022. To see if your procedure is covered, contact us. All rights reserved. On average, cataract surgery costs about $5,000 per eye; however, in some places, this price can move up to over $10,000. SurgeryPlus Frequently Asked Questions General Questions . Medicare Advantage plans are provided by private companies with approval from Medicare. startxref You'll be more confident on the beach with an extensive selection of plus-size swimwear. 0000015692 00000 n We suggest you discuss treatment options with your dentist before services are rendered, and obtain a pre-treatment estimate of benefits prior to receiving certain high cost services such as crowns, bridges or dentures. Its also possible to get an SBC in another language. 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. 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. 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. %PDF-1.6 % 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. (Based on internal analysis by MetLife. Text Size Smaler, Make Text Size Weather & Travel, Contact Us Weight-Loss (Bariatric) Surgery. Austin, TX 78735 POWER Up to HIP Plus! %%EOF You sign a consent form to receive hospice care instead of other Medicare-covered treatments for your terminal condition. To provide and maintain this valuable membership benefit, MetLife reimburses the association and/or the plan administrator for these costs. The amount of benefits payable by MetLife may be reduced due to the benefits paid under the primary plan. Some links on this page may take you to Humana non-Medicare product or service pages or to a different website. This program utilizes the MetLife PDP Plus Network of participating dentists. It is not to be used for medical advice, diagnosis or treatment. Filing a health claim. SurgeryPlus is included in your medical benefits at no additional cost to you. Your SurgeryPlus Care Advocate will provide you one-on-one, personalized help each step of the way. Know your options. Cities & Towns When enrolling you may choose to also cover your spouse, domestic partner, and/or children up to age 26. SurgeryPlus provides an alternative to using your health plan for a planned surgical procedure that is not an emergency. 89 0 obj <> endobj endstream Medicare Advantage plans may offer coverage for vision, hearing, dental and wellness services. Privacy Policy You can obtain an updated procedure charge schedule for your area via fax by dialing 1-800-942-0854 and using the MetLife Dental Automated Information Service. 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. 0 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. 0000025231 00000 n 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. 00k` !" State Agencies 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. Pre-authorization will still need to be submitted by your provider to SurgeryPlus before the surgery is scheduled. About SurgeryPlus SurgeryPlus is a supplemental benefit for non-emergency surgeries which provides high-quality care, concierge-level member service and lower costs. Members of HumanaVision can receive deeper discounts on LASIK services, especially when using a specific in-network provider. 0000377893 00000 n Negotiated fees are subject to change. References to UnitedHealthcare pertain to each individual company or other UnitedHealthcare affiliated companies. 0000005180 00000 n 0000401803 00000 n Policy number TS 05343606-G (High plan) It requires doctors and facilities to meet strict credential guidelines leading to the highest quality care possible. Mon-Fri, 8:30am-5:00pm (ET), Texas office Confirm your coverage before you commit to a procedure youre unsure about. A dental plan may cover routine office visits, fillings, crowns, root canals, oral surgery, periodontics, orthodontics, or bridges and dentures. This surgery makes the stomach smaller. Some general conditions to receive coverage from United Healthcare requires that you meet the following criteria: Have a body mass index over 40 OR. . 0000004536 00000 n You are always free to select the dentist of your choice. 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. This communication does not guarantee benefits and does not indicate all services received will be covered by your plan. Most plans cover the entire cost of preventive care, plus a portion of the cost after you meet your deductible for other procedures. Whats especially helpful is that every health plan has to use the same outline to show the costs and coverage for each of the plans they offer. Malini Ghoshal, What You Need to Know About Medicare Prescription Drug Plans (Part D), Healthline, last accessed June 10, 2022. 0000016018 00000 n Before undergoing surgery, youll want to be connected with the highest-quality providers and facilities. Please fill out the contact form so the right person can be in touch quickly. You can choose whether or not to use SurgeryPlus for your surgical procedures. This exclusion will apply whether or not the person receiving the services is enrolled for the government plan. Assign you a personal care coordinator to offer one-on-one guidance and support as you prepare for, undergo and recover from surgery. This program will be available on January 1, 2020. Gross Receipts Tax Rest easy knowing you can afford the surgery you need, HDHP Plans will require a reduced deductible to be met first. 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. xref Each company is a separate entity and is not responsible for another's financial or contractual obligations.
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