 |
 |
 |
|
||
|
|
|||
|
|
|||||||||
| Main | About | News | Jobs | Members | Groups | Dentists | Contact | ||
|
|
|||||||||
|
 |
|
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:
|
|||||||||||||||||||||||||||||||||||||||||||||||||||
| Plan Frequencies |
Exam every 12 months Lenses every 12 months Frames every 24 months |
Copayment for each member at the time of service: $10
(covers both exam and materials)
 |
||
| Maximum Allowances | Network Doctor (After copayments/Up to plan limits) |
Non-network (copayments apply) |
|
|
||
| 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 | ||
| Elective (exam & lenses) | $105.00** | $105.00** |
| Medically necessary* | Paid in full | $210.00 |
| Frame | $45 wholesale | $45.00 retail |
| Lasik*** | Members will receive a discount if Services are rendered by a TLC Network provider and they will pay no more than $1800/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 2003.
|