1.

The VisionCare Plan brochure tells you about the plan's benefits.

2.

You can request a benefit form through this website
or by calling 800-865-3676.

3.

We verify your eligiblity and mail you a benefit form along with a list of
Vision Care Plan doctors in your area.

4.

Select a doctor from the list and make an appointment.

5.

Present the form when you visit the doctor and sign the form before leaving.
You'll pay any copayments and/or the cost of any upgrades at that time.

6.

The doctor provides you with a complete eye exam, and where necessary,
orders prescribed eyeglasses or contact lenses from a
VisionCare Plan approved lab.
The doctor also verifies their accuracy and fits them on you.

7.

VisionCare Plan pays the doctor directly for his or her
professional services. It is that easy.

P.O. BOX 30349 | TAMPA, FL 33630-3349 | 800.749.5855 | 813.289.2020
http://www.visioncare.com/
Underwritten by CompBenefits Insurance Company and administered by Vision Care, Inc.
In Florida, underwritten and administered by Vision Care, Inc./Out of Network Benefits underwritten by CompBenefits Insurance Company.

VisionCare Plan Overview

VisionCare Plan offers you and your family a benefit that covers all routine eye care, including eye exams and eyeglasses (lenses and frames) or contacts. The plan features:

	In-network and out-of-network benefits
	Enhanced benefits in-network
	National panel of optometrists and ophthalmologists

Frequently Asked Questions

How does the plan work?

The plan is easy to use!

Obtain a Benefit Form from CompBenefits by calling our Member Services Department (number listed below) or from our website at http://www.visioncare.com/.
CompBenefits will send you a personalized Benefit Form that outlines your benefits, along with a list of providers. Then schedule your appointment.
Give the Benefit Form to the doctor during your first visit. You'll pay any copayments at that time as well.

You have nothing more to do! The doctor provides you with services and bills CompBenefits directly for the balance of your bill.

Since the plan is designed to meet your eye care needs, optional upgrades (like frames costing more than the plan limits, progressive lenses, or contacts that are not medically necessary) will cost extra. However, since all upgrades are on a wholesale basis, your cost will be lower than what you would pay on your own.

What are the advantages of using a network provider?

Our national network of providers can provide you with one-stop shopping. You get your eye exam and materials with nothing more than your copayment (cosmetic options will include additional charges).

What if I want to see a provider not in your network?

If you prefer, you can visit a non-network doctor. If you do, you will pay the doctor's regular charges and CompBenefits will reimburse you according to the plan's non-network benefit schedule.

How can I get further questions answered?

You may contact the CompBenefits Member Services Department with any questions or concerns at 1-800-865-3676, M-F 8am – 6pm EST. Locate us on the web at http://www.visioncare.com/.

Annual rates for PracticeSource members
Effective date: 10/1/03

Member	$100.00
Family	$280.00

Plan
Frequencies

Exam every 12 months
Lenses every 12 months
Frames every 24 months

Copayment for each member at the time of service
Exam	$20
Lenses and/or frames	$20

Maximum Allowances	Network Doctor (After copayments / Up to plan limits)
Eye Exam	Paid in full
Lenses (per pair)
Single	Paid in full
Bifocal	Paid in full
Trifocal	Paid in full
Lenticular	Paid in full
Contact Lenses
Elective (exam & lenses)	$105.00**
Medically necessary*	Paid in full
Frame	Covered in full up to plan allowances
Lasik***	Members will receive a discount if Services are rendered by a TLC Network provider and they will pay no more than $1800/eye.

*Medically necessary (prior authorization required) is defined as 1) following cataract surgery w/o intraocular lens; 2) correction of extreme visual acuity problems not correctable with glasses; 3) anisometropia greater than 5.00 diopters and asthenopia or diplopia, with spectacles; 4) Keratoconus; or 5) monocular aphakia and/or binocular aphakia where the doctor certifies contact lenses are medically necessary for safety and rehabilitation to a productive life.

**This allowance is paid with the same frequency as lenses, in place of all other benefits.

***Plan members must first contact CompBenefits for a list of providers and to receive a Refractive Care ID card.

This schedule shows only a few of the covered procedures. Please see your Benefit Administrator for a complete schedule. This schedule is intended for comparison purposes only. The benefits of each plan will be determined by the contract. For a complete listing of benefits and exclusions and limitations, please reference your certificate of coverage.

The CompBenefits Family of Companies

CompBenefits Insurance Company
VisionCare, Inc. • VisionCare Plan

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