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MMCP Vision Plan Overview
Dual Choice Coverage
More than 92% of our plan members choose a network doctor from our List
of Member Doctors.
Doing so means getting the greatest value from the plan at the least
out-of-pocket expense. Services and materials are provided on a prepaid
basis, and the plan pays network doctors directly.
Plan members may use non-network doctors if they wish. In this case, they
pay their doctor at the time of the visit and submit receipts to us for
reimbursement. Benefits are paid according to a reimbursement schedule. The
following shows the maximum allowances for services and materials depending
on whether or not a plan member uses a network doctor:
|
Copayment for each member at the time of service |
Exam: $15
Lenses and/or frames: $20 |
 |
| |
Network Doctor
(after copayments/
up to plan limits) |
Non-network
(copayments apply) |
|
|
| |
|
|
|
Eye Exam |
Paid in full |
$35 |
|
Lenses (per pair) |
|
|
| Single |
Paid in full |
$20 |
| Bifocal |
Paid in full |
$40 |
| Trifocal |
Paid in full |
$60 |
| Lenticular |
Paid in full |
$100 |
|
Contact Lenses |
|
|
| Elective (exam & lenses)** |
$105 |
$105 |
| Medically necessary* |
Paid in full |
$150 |
| Frame |
Paid in full |
$45 |
* 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. |
The amounts shown are maximum benefits. The actual benefit amount the
plan will reimburse to a plan member for non-network doctors will be the
least of: the maximum shown in the schedule; the amount actually charged;
or the amount a doctor usually charges a private patient.
The availability of services under the non-network reimbursement
schedule is subject to the same time limits and copayments as those for
network services. The plan pays non-network benefits in place of services
from a network doctor.
Out-of-State Services
In-network services are available through a nationwide network of
participating doctors. If plan members travel or move to another state,
their plan goes with them. They simply request a List of Member Doctors for
that area along with the benefit form, and as long as they remain eligible,
they will receive the same benefits as they would in their home state.
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