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You have significant choice in your vision options; eligible
Trust members can choose EyeMed or VSP for their vision care needs.
EyeMed provides high-quality eye care and materials to members through well-known locations that include: LensCrafters, Sears, Target Optical and participating Pearle Vision Centers. The EyeMed network also offers many independent private practice providers. The network is spread throughout Ohio.
The Vision Service Plan (VSP) has a national network of doctors who provide high-quality eye care and materials to members. The VSP network is spread throughout Ohio and is available in all 88 counties.
Selecting a Plan
As with any enrollment decision, make sure you take time to understand the benefit levels and networks before enrolling.
You can see in the Comparison Chart that the benefit levels of the plans are very similar; the primary difference between the plans is the network (where you prefer to receive your eye care), but there are also some costs differences to consider, especially when using the discount programs.
Discount Plans
Discount programs offer you a way to obtain lower costs on eye care after you have used your Union Benefits Trust coverage (see the Comparison Chart). Both EyeMed and VSP offer the following discount which may be used in
conjunction with your Trust benefits:
20% off the frame cost over the plan's frame allowance.
Other discounts vary between the plans. In some circumstances, certain brands may not be eligible for discounts listed in this booklet. Ask your provider at the time of purchase.
EyeMed's discount program:
- 40% off or promotional offer, whichever is less, for additional pair(s) of prescription glasses.
- 20% off lens options/extras when complete prescription glasses pairs are purchased.
- 10% off premium exam and fitting (standard lens fitting covered up to $40) for contact lens exam and fitting.
- Discounts on annual supplies of many popular brands of contacts.
For additional exams, or pairs of glasses or contacts other discounts may apply. The discount program may also be available on non-prescription sunglasses and materials.
VSP offers discounts on materials for members who use VSP network
providers and includes:
- 20% off the price for additional pair(s) of prescription glasses when the complete pairs are purchased within 12 months of the original
prescription and from the same
provider.
- Preferred pricing on lens options/extras when complete prescription glasses pairs are purchased.
- 15% off professional fees for contact lens exam and fitting.
- Discounts on annual supplies of many popular brands of contacts.
In either plan, you will find the best benefit by using in-network providers. You may occasionally see advertisements for special offers, sales, rebates, etc., for these same network providers;
however, our benefits are designed to stand alone. In some cases, you may be able to apply both deals;
in most instances you will need to choose your benefit plan or the coupon savings.
Coupon savings may be fully applied to second sets of materials purchased at the same time as your benefit-covered set.
Ask your provider for more information and read the fine print of the coupon/offer if you are uncertain.
Limits & Exclusions
There are additional charges under either plan if you select any of the following:
- frame costs beyond the plan allowance
- contact lens evaluation and fitting
- tinted or coated lenses (other than solid pink #1 or #2) unless necessary for your visual welfare
- additional supplemental tests outside the standard vision examination
- sunglasses
- any other materials or services not necessary for the patient's visual welfare.
If you select oversize lenses in VSP, there will be additional charges; EyeMed does not charge
extra for oversize lenses.
The following materials and services are not covered under VSP or EyeMed:
- orthoptics, vision training or non-prescription lenses and frames
- replacing lost or broken lenses and frames
- two pairs of glasses in place of bifocals
- medical or surgical treatment of the eyes (see your health plan for possible coverage)
- services or materials provided as a result of any Workers' Compensation law or similar legislation
- any eye examination required by an employer as a condition of employment or
- any services or materials provided by another vision care plan or group benefit plan containing benefits for vision care.
How To Use Your Benefits
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Select
a vision care provider. Contact your plan for
provider information.
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| 2. |
Schedule
your appointment. Make sure you tell your provider you have coverage under
the plan you have selected (if you've enrolled in EyeMed, you must also
tell the provider you are a State of Ohio employee covered by Union Benefits
Trust). Your provider will verify your eligibility, but needs the covered
member's Social Security number. |
You are responsible for
filing your claim if you receive vision care from a provider who does not
participate in your plan's network.
VSP
You pay the non-network
provider in full, then, submit itemized receipts in writing within six months
of service completion to:
Vision
Service Plan
ATTN: Out-of-Network Provider Claims
P.O. Box 997105
Sacramento, CA 95899-7105
Call 24-hour line 800-877-7195
(automated with option to reach customer service).
EyeMed
For vision care from a
non-network provider, you must call EyeMed first for a claim form. You must
pay the provider in full, then,
submit itemized receipts in writing within six months of service completion.
EyeMed Vision Care Plan
ATTN: Out-of-Network Provider Claims
P.O. Box 8504
Mason, OH 45040-7111
Call 866-723-0514 if you have questions.
If Your Claim Is Denied
You may appeal a benefits claim denied by your plan by writing to the plan.
You must request a full review within 180 days of the claim denial.
Updated July 2006
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