|
How the Select Exam Plus Plan Works
Avesis' primary purpose is to provide covered employees and eligible dependents
with periodic professional vision examinations and materials. The examination
is a complete analysis of the visual functions, including the prescription of
corrective lenses where indicated.
Vision Examination
After the applicable co-payment is met, every Avesis member is entitled to a covered
in full vision examination by a qualified Avesis provider. If a patient has no specific
complaint but wants a brief, routine check-up, the provider may perform a limited or
intermediate exam. The followings a summary of what is included in the examination:
- Case History
- Health Status of the Visual System Evaluations which must include:
- External and Internal Examination - to include direct and/or indirect ophthalmoscope
- Neurological Integrity - papillary reflexes and extra ocular muscle assessment (versions)
- Biomicroscopy
- Tonometry
- Retinoscopy
- Refractive Status Evaluation Procedures
- Binocular Function Tests
- Diagnosis/Treatment Plan
Frames
Frame selection from network providers is unlimited. Traditional, fashionand even designer
styles are available at discounts according to fixed formulas. Because retail prices for
frames may be as much as wholesale plus 300%, the unique Avesis pricing formula represents
substantial savings.
Lenses
Eyeglass lens purchases are unrestricted and unlimited. Network providers guarantee the accurate
filling of all prescriptions as written - their own as well as those of providers who are not
Participants of the network. Virtually all types of lenses, from traditional glass to space
age polycarbonate are available at fixed, discounted fees. Options such as tints, gradients,
photogray and UV 400 (filters ultraviolet light) are also available at fixed, discounted fees.
Contact Lenses
Premium contact lenses, comprehensive contact lens care and complete contact lens supplies - from
solutions to replacement lenses - are available at fixed, discounted fees. The Avesis contact
lens program provides unlimited follow-up care and visits for 12 months after the initial fitting.
Schedule of Benefits
| Benefit Frequency |
| |
In-Network |
Out-of-Network |
| Vision Examination |
12 Months |
12 Months |
| Standard Lenses (pair) |
Unlimited |
N/A |
| Frame |
Unlimited |
N/A |
| Contact Lenses |
Unlimited |
N/A |
| Benefit Allowance and Reimbursement |
| |
In-Network |
Out-of-Network |
| Vision Examination* |
100% after applicable $10 copayment |
$35 Allowance |
| Standard Lenses - Single Vision* |
Member will pay no more than $35 |
N/A |
| Standard Lenses - Bifocal |
Member will pay no more than $50 |
N/A |
| Standard Lenses - Trifocal |
Member will pay no more than $65 |
N/A |
| Frame* |
Save 20% - 50% off the retail fees |
N/A |
| Contact Lenses* |
Save 5% - 20% off the retail fees |
N/A |
| Non-Standard Lenses* |
20% off the providers retail fees |
N/A |
| Tints, Scratch Coating, etc.* |
20% off the providers retail fees |
N/A |
|
*A $10 copayment is for the vision exam only.
- Rates are guaranteed for one (1) year.
- The vision plan requires a minimum participation of ten (10) eligible employees.
- Employer Paid rates need particpation of 100% of eligible employees, 10 lives minimum.
- Each employee enrolling in the Group Vision Plan must agree to remain enrolled during the designated plan period.
- Those employees who elect not to enroll during the initial plan enrollment period must wait until the next plan enrollment period to enroll. The plan enrollment period shall be the month prior to the beginning of the next plan year.
The exam benefit is underwritten by Fidelity Security Life Insurance Company, Kansas City, MO; VC-16, M-9004.
|
