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Optix Vision Plan Questions and Answers
Can you explain the new wholesale allowance in greater detail?
Employees now have two ways to get frames covered under their Optix
vision plan. They may continue to choose from the select group of frames
that are covered in full under their co-payment or they may choose a frame
that is not part of the select group. If a frame is going to be purchased
that is not part of the select group, you will receive an allowance of $25
toward the wholesale cost of the frame through your Participating Provider.
The $25 wholesale allowance will purchase, in full, (minus your copayment) frames with an average retail cost of $50 to $75. Approximately
6,000 frames manufactured today fall under the $25 wholesale frame
allowance. If you select a frame that exceeds the $25 wholesale allowance,
you will only be responsible for paying two times the wholesale difference of the cost of the frame and your applicable co-
payment.
For example, if the frame you select has a wholesale
cost of $35, you will pay an additional $20 (two times the
wholesale difference of $10) to purchase the upgraded
frame. The new wholesale frame allowance benefit could
save you more than 60 percent over the old plan, if you
choose a frame that is not part of the select group.
What services and materials does the plan
exclude?
 | Cosmetic contact lenses. |
| Medical or surgical treatment of the eyes. |
| Any services or material under Preferred Panel when the plan procedures are
not followed. |
| Services and materials replacement for orthoptics or vision training, subnormal
vision aids, aniseikonic lenses, two pair of glasses in lieu of bifocals, and
nonprescription glasses. |
| Lost or broken lens or repair, unless it is time for your annual exam. |
| Any services and material that Workers' Compensation, another plan or a government
agency provides. |
| Any employer-required exam as a condition for employment. |
Who is an eligible dependent for this coverage?
Eligible dependents covered under this plan include:
| Spouse/Domestic Partner |
| Unmarried children under age 19 |
| Children (including children of a Domestic Partner, as
long as the Domestic Partner is also covered) will be
covered under this plan until the end of the calendar
year in which he/she reaches age 25 provided the child
is a full-time or part-time student or is residing in an
eligible employee's home. Coverage for eligible children
will also extended beyond age 19 if the child is
incapable of self-care due to a mental or physical
handicap and is predominantly dependent upon the
covered employee for support and maintenance. |
How to select Optix Vision Plan benefits:
- You may cover yourself by selecting the "Employee
Only" benefit.
- You may cover yourself and your eligible dependent(s)
by selecting the "Employee and Family" benefit.
- You may select "Family Only" if your coverage is
included in a Flex Plan Option.
Plan Provider:
This plan is offered by Vision Care, Inc., through its
parent company CompBenefits Corporation.
Upon request, Vision Care, Inc. shall provide written
information about the terms and conditions of the plan
to prospective enrollees. Vision Care, Inc. is a prepaid
limited health service organization licensed under Chapter
636, Florida Statutes.
Note:
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.
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