Network vs Out- of- Network
The benefit levels of both vision plans are for care received in network or out-of-network.
Network Providers
Network providers are licensed vision care providers participating in the network. You generally
receive higher benefits from a network provider; this means less out-of-pocket expense for you. Another benefit of using a network provider is that the
provider checks with the plan to make sure the services you want to receive will be covered.
Network providers also submit claims for you. You just pay your deductible or copayment at the
time of service, along with fees for any options you choose over and above the covered benefits, such as tints or anti-reflective coating.
To obtain a network directory, contact the plan:
VSP
EyeMed
Out-of-Network Providers
Your plan will reimburse you directly within the limits listed.
You typically have more out-of-pocket costs with out-of-network providers.
You will also be responsible for filing claims. See the vision comparison
chart below for more information about your coverage choices.
Vision Comparision Chart
Materials and exams in both plans are covered once every 12 months.
You pay the copays; all other amounts in the vision comparison chart (below) are what the plan pays after copayments are made (for in-network care and materials).
| |
|
VSP
|
EyeMed
|
| |
|
Network
|
Out-of-Network
|
Network
|
Out-of-Network
|
| |
|
|
|
| Professional
Fees |
|
|
|
|
|
Standard
Spectacle Exam*
|
$10 copay
|
plan pays up to $25, you pay remainder
|
$5 copay
|
plan pays up to $25, you pay remainder
|
Contact Lens Exam* |
$10 copay plus amount over standard spectacle exam |
plan pays up to $25, you pay remainder |
$5 copay plus amount over standard spectacle exam |
plan pays up to $25, you pay remainder |
Materials |
|
|
|
|
|
| |
Single
Vision Lenses |
$15 copay
|
$25
maximum
|
Covered
in full
|
$25
maximum
|
| |
Bifocal
Lenses |
$15 copay
|
$35
maximum
|
Covered
in full
|
$35
maximum
|
| |
Trifocal
Lenses |
$15 copay
|
$52
maximum
|
Covered
in full
|
$52
maximum
|
| |
Lenticular
Lenses |
$15 copay
|
$62
maximum
|
Covered
in full
|
|
| |
Progressive Lenses |
$15 copay |
$52 maximum |
Covered up to $120 |
$55 maximum |
| |
Frames |
Covered
in full
(any frame up to $120 retail)
|
$18
maximum
|
Covered
in full
(any frame up to $120 retail)
|
$18
maximum
|
| |
|
|
|
|
|
|
Contact Lenses |
Elective
(instead of lenses and frames)
|
$125 maximum
|
$105 maximum
|
$125 maximum
|
$105 maximum
|
|
|
Medically
Necessary (as defined by the plan must have prior approval)
|
Covered
in full
|
$210 maximum
|
Covered
in full
|
$210
maximum
|
| *
Within plan limits; contact the Trust if you need more information. Lenses listed in chart are plastic or polycarbonate, other options will add cost for which you are responsible, e.g., photochromic or tints. New plan booklets will be available in late summer. |
Special
Vision Benefits
Early
Coverage
If a second eye exam reveals an axis change of 20 degrees or .50 diopter sphere or cylinder
change and improved vision acuity by at least one line on the standard chart, an exam and the lens or pair of lenses will be considered a covered
vision benefit. Copays apply to the covered exam and/or lenses.
Contact your plan for details.
Medically Necessary Contact Lenses
With prior approval, medically necessary contact lenses are covered when prescribed
- following cataract surgery
- to correct extreme visual acuity problems that cannot be corrected with spectacle lenses
- with certain conditions of anisometropia or keratoconus.
The network provider must secure prior approval from the plan for medically necessary contact
lenses.
Contact your plan for details.
Low Vision
If your vision cannot be corrected to 20/70 with lenses, but your sight is better than 20/200
(legally blind), you may qualify for low-vision benefits.
Contact your plan for details.
Updated August 2008
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