life events

Major Surgery

If you are facing major surgery, you should become fully informed of your benefits covering hospitals and surgery.

Also, if you have not already done so, you should make arrangements for financial matters such as power of attorney for health care, general power of attorney, a will, and designations of beneficiaries.

Checklist

  • Use a network (PPO) hospital and doctor. You save money and paperwork using healthcare providers in the Aetna Choice POS II network.
    • The $200 copayment for inpatient hospital services is waived when a participating hospital and doctor.
    • Your out-of-pocket share of a covered service will not exceed 10% of the billed amount.
    • Covered services are paid at 100% once you've satisfied the annual coinsurance maximum ($2,300 individual/$4,600 family).
    • Your provider files your claim. As part of their contract, Aetna physicians, hospitals and providers handle the paperwork.
    • Your provider handles preadmission certification required by the health plan (see next).
  • Review the precertification requirements. All inpatient admissions, as well as many surgical procedures, must be precertified with the medical review agency. If precertification is not obtained and it is determined that the service was not medically necessary, then no benefits will be provided and you will be financially responsible for 100 percent of the related services. When you use a network provider, the precertification is handled by your provider. If a non-network provider is used, then you, the patient, or the provider must request precertification. (Learn more)
  • Review beneficiary designations. To change a life insurance beneficiary, complete a new health plan Enrollment Form. If you are legally married and die before retirement, your spouse is automatically the beneficiary of your vested preretirement death benefit. This is true for the Carpenters Retirement Plan as well as the Carpenters Individual Account Pension Plan. If you are not legally married, you may designate any person or persons as your beneficiary on your pension Enrollment Application.

Other Considerations

There is a certain risk involved in walking out your front door and driving to work. There is undeniably higher risk in having a major surgery. While it is not beneficial to exaggerate the risks involved, it is recommended that prior to surgery, you prepare and/or review documents which would come into play in the event you die or become incapacitated. Here are the items which you may wish to update, revise, or consider prior to surgery: