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?

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:

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 Jackson Memorial Hospital employees:

Optix Vision Plan
(800) EYE-CURE � (800) 393-2873
Monday through Friday
8:00 a.m. to 5:00 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 30349
Tampa, FL 33630-3349

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 Jackson Memorial Hospital employees: (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

Plan Provider: Oral Health Services has subcontracted with Vision Care, Inc. to provide vision benefits.

This product description does not constitute an insurance certificate or policy. The information provided is intended only to assist in the selection of benefits. Final determination of benefits, exact terms and exclusion of coverage for each benefit plan are contained in certificates of insurance issued by the participating insurance companies.

Underwritten and administered by Vision Care, Inc. Out of Network Benefits underwritten by CompBenefits Insurance Company. Upon request, Vision Care, Inc. shall provide written information about the terms and conditions of the plan to prospective enrollees.

To submit comments or questions, please visit our Contact Center.

© Copyright CompBenefits 2004.