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VisionCare Plan OverviewVisionCare 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:
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| Plan Frequencies |
Exam every 12 months Lenses every 12 months Frames every 24 months |
Copayment for each member at the time of service
Exam: $10.00
Lenses and/or frames: $15.00
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| Maximum Allowances | Network Doctor Non-network (After copayments/Up to plan limits) |
Non-network (copayments apply) |
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| Eye Exam | Paid in full | $35.00 |
| Lenses (per pair) | ||
| Single | Paid in full | $25.00 |
| Bifocal | Paid in full | $40.00 |
| Trifocal | Paid in full | $60.00 |
| Lenticular | Paid in full | $100.00 |
| Contact Lenses | ||
| Exam | Paid in full | $35.00 |
| Elective (exam & lenses) | $120.00** | $120.00 |
| Medically necessary* | Paid in full | Up to $210.00 |
| Frame | $60.00 wholesale | $60.00 |
| Lasik*** | Members will receive a discount if Services are rendered by a TLC Network provider and they will pay no more than $1800 per eye. | No benefit |
* 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.
To submit comments or questions, please visit our Contact Center. © Copyright CompBenefits 2004.
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