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Bargaining Unit Employees,
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Information provided below is for current Exempt Vision benefits (July 1, 2012).


Click here to see Vision information in effect July 1, 2013.

The State of Ohio provides exempt employees who have more than one year of continuous state service with vision care benefits at no cost. Employees may choose between two vision plans:

1. Vision Service Plan (VSP), Group Number: 12022518; and
2. EyeMed Vision Care (EyeMed), Group Number: 9676008.

Both plans offer large, statewide provider networks and similar benefit levels for in-network services. Employees and their family members who choose to receive services outside of the vision plan networks are subject to a substantial reduction in benefits. Routine vision benefits include:

  • An annual eye exam
  • Glasses or contact lenses
    • Lenses - Once every 12 months
    • Frames - Once every 12 months, or
    • Eyeglass frames are covered up to $120 and lens options include standard polycarbonate and standard progressive (no-line) bifocals at no additional cost.
    • Contact Lenses - In place of spectacle lenses and frames
      • Both plans also offer discounts on laser vision surgery, but do not provide surgical benefits.

Click the links below to access the information you need quickly.

Eligibility
Enrollment
Comparing Your Vision Options
What Are My Vision Benefit Copayments?
What's Covered?
Plan Discounts
How Do I Use My Vision Benefits?
Claim Process
Continuation Coverage (COBRA)
Exclusions and Limitations
Low Vision Benefits
Questions

Eligibility

You are eligible for vision coverage after you have completed one year of continuous state service and you are a permanent full-time or permanent part-time employee. County service time does not count towards eligibility time. You must enroll within 31 days of your one-year anniversary or wait until the next open enrollment period.

Service time for employees classified as student help, college interns or whose appointments are temporary, seasonal or intermittent may count toward one year of continuous state service if such employees are hired on a permanent, full-time basis or permanent part-time basis with no break in service. Please contact your payroll/personnel officer to confirm your eligibility.

Dependents

  • If you are eligible for vision benefits, some of your dependents also may be eligible for vision benefits through your plan. Your dependents eligible for vision benefits are:
  • Your spouse;
  • Your unmarried, dependent children who are dependent upon you for primary support. Your children are only eligible:
  • Through the end of the month in which they turn age 19; or
  • Through the end of the month in which they turn 23 if the child is residing with you or attending an accredited school (proof of attendance may be required).

Enrollment

If you are an eligible employee, you will be able to enroll in one of the two vision plans, Vision Service Plan (VSP) or EyeMed Vision Care (EyeMed), after one year of continuous state service. Prior to the end of your first year of service, you should receive notification that you soon will become eligible for vision coverage.

To enroll, you must complete a Benefit Enrollment/Change Form (ADM 4717), available online and from your payroll/personnel officer. Your vision coverage will be effective the first day of your 13th month of state service, as long as you have completed an enrollment form at least 31 days before your anniversary date.

You may enroll up to 31 days after your anniversary date; however, your effective date of benefits may be delayed.

Comparing Your Vision Options

*Employees who choose to receive services outside of the vision plan networks are subject to a substantial reduction in benefits.

A primary difference between vision plans is the provider network. Be sure to check with your vision provider to determine whether he/she belongs to the "VSP Signature" or EyeMed "Select" network. Check with each plan for a complete provider list.

What Are My Vision Benefit Copayments?

Member Doctor

When you receive an examination, spectacle lenses and/or frames from a member doctor, the doctor accepts the payment as payment in full (provided you stay within the limitations of the program), except for your plan copayment of $5 (EyeMed) or $10 (VSP) payable at the time of the examination, and an additional copayment of $15 (if you are in VSP) toward the cost of lenses and/or frames. Only the exam copayment applies toward contact lenses.

Non-Member Doctor

When you receive services from a non-member doctor, you will be reimbursed directly according to the Non-Member Reimbursement Schedule.



What's Covered?

The vision benefits provided through VSP and EyeMed Vision Care Plan include:

Vision Examination - A complete analysis of the eyes and related structures to determine the presence of vision problems. Contact lens evaluation and fitting and additional supplemental tests are not covered under the vision examination.

Lenses - The member doctor will order the proper lenses. The doctor also will verify the accuracy of the finished lenses. (Note: progressive lenses (no-line bifocal and trifocal lenses are a covered benefit).

Frames - Frames within the plan allowance are covered in full. If you select a frame that costs more than the wholesale allowance (or a large frame that requires oversized lenses) there will be an additional charge. More expensive frames are available at a controlled cost, by agreement between the member doctor and VSP or EyeMed. To minimize your out-of-pocket expenses, ask your provider to show you frames priced within the benefit allowance.

Necessary Contact Lenses - If you use an out-of-network doctor, the necessary contact lens benefit maximum is $210. Contact lenses and the necessary opthalmic materials are covered in full, less the applicable $15 copayment, when a member doctor receives prior approval to:

  • Correct problems not correctable with spectacle lenses;
  • Correct significant anisometropia;
  • Treat keratoconus; or
  • Provide treatment following cataract surgery.

Elective (Cosmetic) Contact Lenses - When contact lenses are chosen for reasons other than those above, they are considered elective. An allowance of $125 with no copayment will be made toward their cost in place of spectacle lenses and frames for the benefit period.

Plan Discounts

Patients may obtain additional pairs of prescription glasses at a 20 percent discount off usual and customary charges. In addition there is a 15 percent discount off contact lens professional services (materials provided at usual and customary fees). These discounts are available for 12 months following the patient's last covered eye examination from the member doctor who provided that examination.

Laser VisionCare Program

Through VSP's Laser VisionCare Program, patients may obtain a 20 to 25 percent discount on PRK and LASIK surgery up to a maximum charge of $1,500 and $1,800, respectively, per eye. Details about VSP's Laser VisionCare Program, as well as comprehensive information about laser vision correction surgery, can be found in the WellVision Learning Source area of VSP's Web site or by contacting VSP at 1.800.877.7195 or TDD for the hearing impaired at 1.800.428.4833.

EyeMed Vision Care also offers special incentives for Lasik services. Call 1.877.5LASER6 to obtain information about participating surgeons in your area and the savings you can receive as an EyeMed Vision Care member.


How Do I Use My Vision Benefits?

To receive vision care benefits, follow the procedure for one of the three options below.

Option 1: Choose A Member Doctor/Provider

Step 1 - Choose a doctor from the list of member doctors and make an appointment for an examination and tell him/her that you have VSP or EyeMed Vision Care coverage.

Step 2 - The doctor will take care of all paperwork for payment. VSP or EyeMed Vision Care will pay the doctor for the services you received according to their agreement with that doctor.

Option 2: Choose A Non-Member Provider

Step 1 - Make an appointment and receive the necessary services from the provider. Pay the provider his/her full fee and obtain an itemized bill which must contain:
1. The patient’s name;
2. The date services began;
3. The service and materials received;
4. The type of lenses received (single, bifocal, trifocal, etc.); and
5. The subscriber’s name, address and Social Security Number.

Step 2 - Mail the itemized bill to your provider. Claims must be filed within six months from the date of service.

 

Vision Service Plan EyeMed Vision Care
Out-of-Network Claims Out-of-Network Claims
P.O. Box 997100 P.O. Box 8504
Sacramento, CA 95899-7100 Mason, OH 45040-7111

Option 3: See A Non-Member Provider and Have A Member Doctor Fill Your Prescription

Step 1 - After receiving an examination from the provider, pay the provider his/her exam fee. Obtain an itemized bill for the exam and the prescription for your lenses/contacts. Send the exam bill to VSP or EyeMed Vision Care. You will be paid directly according to the Non-Member Provider Reimbursement Schedule for your exam. (See the Member Benefits and Non-Member Reimbursement Schedule for more information.)

Step 2 - Contact the member doctor to see if he/she will fill a prescription from another doctor.

Step 3 - Take your prescription to the member doctor on your first visit.

Step 4 - The member doctor will fit you with your new glasses/contacts and take care of any paperwork for payment. The doctor will be paid by VSP or EyeMed Vision Care for dispensing your glasses/contacts according to their agreement with the doctor. You are responsible for any applicable copayments.

Claim Process

Claim Review Procedures
If a claim for benefits is denied, a written request may be submitted to VSP or EyeMed Vision Care for a full review of the denial. This request must be made within 60 days of the denial. To exercise this option, call VSP or EyeMed Vision Care at the toll-free number listed below to obtain details on procedures to follow.

You are guilty of insurance fraud if you submit an application or file a claim containing a false or deceptive statement, and have intent to defraud or know that you are facilitating a fraud against an insurer.
If you have questions about your vision care coverage or the filing of your claim, please contact the VSP at 1.800.877.7195 or EyeMed Vision Care at 1.800.334.7591.

Continuation Coverage (COBRA)
If you or one of your dependents become ineligible for employer-paid vision coverage, you may be eligible to continue your coverage under the federal COBRA program. Contact your agency for more details.

Exclusions and Limitations

The vision benefit is designed to cover your vision needs rather than elective materials. There will be extra costs involved if you select materials or services which are elective in nature, such as:

  • Oversized frames;
  • A frame that costs more than the plan allowance;
  • Elective contact lenses costing more than $125;
  • Tinted or coated lenses;
  • Supplemental tests in addition to the standard vision exam;
  • Sunglasses; or
  • Materials or services not necessary for visual welfare.

Items not covered include:

  • Orthoptics, vision training or non-prescription lenses;
  • Lenses and frames under this program which are lost, stolen or broken. These will not be replaced unless you are eligible for frames or lenses at that time;
  • two pairs of glasses in place of bifocals;
  • Medical or surgical treatment of the eyes;
  • Services or materials as a result of any Workers’ Compensation law or similar legislation;
  • Any eye exam required by an employer as a condition of employment; or
  • Any services or materials provided by any other vision care plan or group benefit plan containing benefits for vision care.

Low Vision Benefits

If you are not legally blind, but your eyesight cannot be corrected to 20/70 with the use of optical lenses, you may be eligible to receive low vision benefits. Here is how the low vision benefit works:

  • If your participating doctor finds that you have a low vision condition, the provider requests authorization from VSP or EyeMed Vision Care to do more tests, gather information and propose a treatment plan for you.
  • If VSP or EyeMed Vision Care approves you for low vision benefits, you may be covered for additional prescription services and vision aids.
  • You will have to pay 25 percent of the low vision benefits; VSP or EyeMed Vision Care will pay the remaining 75 percent. Low vision benefits are only available to a maximum of $1,000 (excluding the copayment) for every two years.
  • If you think you or a family member might have a need for these services, talk with your participating doctor about low vision benefits.

For questions about vision benefits, claims or participating doctors:


 

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