SurgeryPlus (Surgeons of Excellence)
The State Employee Benefits Committee (SEBC) believes in providing high quality care to members at an affordable cost. Effective July 1, 2023, bariatric surgery coverage will be available exclusively through the SurgeryPlus benefit. 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.
The SurgeryPlus benefit is a comprehensive surgical program that provides a personalized concierge experience from dedicated Care Advocates and access to excellent health care through a network of credentialed Surgeons of Excellence for planned, non-emergent surgeries. Enrollment in the SurgeryPlus benefit is automatic for individuals enrolled in a State of Delaware Aetna or Highmark Delaware non-Medicare health plan.
Their goal, in partnership with the State of Delaware, is to simplify the surgical process from start to finish - from helping schedule appointments to eliminating medical bills related to your care. The credentialed surgeons undergo a rigorous evaluation process to assure that you receive high-quality care from specialists who excel in the area related to your needs. SurgeryPlus negotiates a single cost (bundled rate) for the entire surgical procedure, resulting in savings for the State of Delaware.
Using the SurgeryPlus benefit for your planned, non-emergent surgeries saves you money by reducing your financial responsibility and removing deductibles, copays and coinsurance amounts. Some surgeries and procedures may even include a financial incentive and travel benefits, when applicable.
I WANT TO...
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. The requirements needed for surgery, including any pre-operative tests, screenings, evaluations, and post-operative care will continue to be covered under your Aetna or Highmark Delaware non-Medicare health plan. The surgery and any facility costs will be 100% covered under your SurgeryPlus benefit. Pre-authorization will still need to be submitted by your provider to SurgeryPlus before the surgery is scheduled. Members will pay nothing out of pocket for bariatric surgery; however, financial incentives do not apply.
Please note: If you are covered under the State of Delaware Group Health Insurance Plan as secondary, refer to the SurgeryPlus plan booklet for details on bariatric coverage.