Miami-Dade County Government
  OHS Overview
  OHS FAQ's

  OHS Standard Plan Schedule

  OHS Enriched Plan Schedule

  OHS Standard Plan Providers

  OHS Enriched Plan Providers

Vision Option

  Plan Overview
  How It Works
  Certificate of Benefits
  LASIK Benefits
  Vision Out-of-Network Claim Form
  Provider Directory
  MyCompBenefits
  HIPAA Privacy Notice
  Contact Information


Optix Plan Overview

The Optix Vision Plan provides access to independent eye care professionals who are committed to providing quality vision care.

What can you expect?

bulletImmediate savings.
bulletConvenient locations.
bulletNo long waits for rebates.
bulletNo complicated forms to fill out.
bulletQuality professional care and services.

Selecting Your Eye Care Professional

To receive panel benefits, you must receive vision services from a participating provider on the Optix Plan network. Refer to the provider listing in the back of this booklet for the eye care professional nearest you. Family members are welcome to choose different providers. However, prior to receiving care, remember to verify that the provider is still participating as listings are subject to change.

Making An Appointment

You may schedule an appointment by calling the eye care professional you have selected. Remember to identify yourself as a member of the Optix Vision Plan and give the office the social security number of the main insured. You don't need authorization numbers or forms. Your provider will simply verify your eligibility.

Day of Appointment

Identify yourself as a member of the Optix Plan. This will ensure that you receive the proper savings. All discounts and allowances will be applied at the time services are rendered. You will be responsible to pay the provider's office for any applicable co-payments or balances due above the plan allowance at the time services are rendered.

Dependent Eligibility

Who is eligible:

bulletYour spouse (unless also an eligible Optix Vision Plan member);
bulletYour unmarried dependent child to the end of the calendar year in which the child reaches age 25, if the child depends upon you for support and is living in your household, or the child is a full- or part-time student (this includes your natural children, legally adopted children, stepchildren who reside in your household, and any child supported by you and permanently residing in your household);
bulletAn unmarried dependent child beyond age 25 if physically or mentally handicapped.

Terms of Enrollment

Enrollment in the Optix Vision Plan is for a minimum of 12 consecutive months while employed by your current employer. Enrollment in the plan will be allowed during open enrollment periods as determined by your employer and OHS.

Cancelling Appointments

The time set aside for a patient is very valuable to your eye care professional. Therefore, if you cannot keep an appointment, notify the office at least 24 hours in advance. If you do not notify the office, you may be charged for a broken appointment.

Effective Date of Coverage

The effective date of coverage is established between your employer and OHS. Upon enrollment you will be notified of your effective date of coverage.

Member Support

If you have an inquiry or grievance, OHS encourages you to contact:

For Miami-Dade County Government:

Optix Vision Plan
(800) EYE-CURE   (800) 393-2873
Monday through Friday
8:00 a.m. to 6:00 p.m.

For Jackson Health System employees: Optix Vision Hotline
Fringe Benefits Management Co. (800) 342-8017
Monday through Friday
8:00 a.m. to 10:00 p.m.

or submit it in writing to:
Optix Vision Plan
P.O. Box 14729
Lexington, KY 40512-4729

How to use the OPTIX vision panel plan benefits

  1. A list of participating optometrists and ophthalmologists is on the following pages. Benefits listed are valid at all participating eye doctors.
  2. Identification cards are not needed. Your eligibility for service is verified by identifying yourself as an Optix Panel Plan participant when you make an appointment with a participating eye doctor.
  3. The eye doctor's office will handle all claim forms.

Important notes to remember:

  1. The eye exam, contact lens (new or replacement), and lenses are provided once every plan year regardless of prescription change. Frames are provided once a year through a network provider or once every two years if using a non-panel provider.
  2. Your out-of-pocket cost for the service rendered is paid by you upon receipt of services. Oversize lenses, tinted lenses, sunglasses, nonstandard and photo chromatic lenses may be purchased with an additional charge. Contact lenses are in lieu of frames and lenses. Fitting fees for contact lenses are not included.
  3. Certain therapeutic and diagnostic procedures are available to the participants of Optix Vision Plan on a co-payment basis. See you certificate of insurance for a list of these procedures. There is no annual deductible with this plan.

How to use the OPTIX vision non-panel plan benefits

  1. Optix Vision Non-Panel Plan benefits are valid at any licensed ophthalmologist, optometrist or optician, who is not an Optix plan provider.
  2. Vision care claim forms are available at your worksite or will be provided upon request by calling Optix Vision Plan For Miami-Dade County Government: (800) EYE-CURE   (800) 393-2873
    For Jackson Health System employees: (800) 342-8017

Important notes to remember:

  1. You are responsible for payment of the entire fee. There will be a reimbursement by the Optix Vision Non-Panel Plan up to the amounts listed on the previous page.
  2. The vision exam is provided once every plan year: maximum $40 reimbursement.
  3. Lenses are provided once every plan year, if needed as determined by your optometrist or ophthalmologist.
  4. Frames are provided every two years if needed. Frames are limited to a maximum of a $40 reimbursement.
  5. Contact lenses will be provided once every plan year* under the plan if needed, as determined by your optometrist or ophthalmologist. Payment will be made for only one pair of lenses, either single, bifocal, trifocal, or contacts during a plan year. Benefits are not payable for contact lens fitting charges. No frame or lens benefits are available during the plan year that contact lenses are elected.

Exclusions & Limitations

bulletCosmetic contact lenses;
bulletMedical or surgical treatment of the eyes (covered by medical plan);
bulletAny services or material under preferred panel when the plan procedures are not followed;
bulletServices and materials for orthoptics or vision training, subnormal vision aids, aniseikonic lenses, two pair of glasses in lieu of bifocals, nonprescription glasses;
bulletLost or broken lens replacement or repair, unless it is time for your annual exam;
bulletAny services and material that Worker's Compensation, another plan, or a government agency provides; and
bulletAny employer-required exam as a condition for employment.

 


© Copyright CompBenefits 2012.