For questions about your vision benefits through June 30, 2018, contact Vision Service Plan (VSP) at 1-800-877-7195. 

Effective July 1, 2018
The State of Ohio provides exempt employees who have more than one year of continuous state service with vision care benefits through EyeMed Vision Care at no cost to the employee. The Insight network encompasses a large number of providers. Employees and their family members who choose to receive services outside of the vision plan network may be subject to a reduction in benefits. 

About Exempt Vision Coverage

Vision Coverage

What's Covered?

Vision Plan Chart

For information regarding the vision plan for exempt employees, see the EyeMed Vision Care Plan chart below. 


Click chart to enlarge.

How Does the Contact Lens Benefit Work?

Low Vision Benefits

Laser Vision Correction Discount

EyeMed Vision Care, in connection with the U.S. Laser Network, owned and operated by LCA Vision, offers discounts to you for LASIK and PRK.  You receive a discount when using a network provider in the U.S. Laser Network. The U.S. Laser Network offers many locations nationwide. For additional information or to locate a network provider, visit eyemedlasik.com or call 1-877-5LASER6.

After you have located a U.S. Laser Network provider, you should contact the provider, identify yourself as an EyeMed member and schedule a consultation to determine if you are a good candidate for laser vision correction. If you are a good candidate and schedule treatment, you must call the U.S. Laser Network again at 1-877-5LASER6 to activate the discount.

At the time treatment is scheduled, you will be responsible for an initial refundable deposit to the U.S. Laser Network.  Upon receipt of the deposit, and prior to treatment, the U.S. Laser Network will issue an authorization number to your provider.  Once you receive treatment, the deposit will be deducted from the total cost of the treatment. On the day of treatment, you must pay or arrange to pay the remaining balance of the fee. Should you decide against the treatment, the deposit will be refunded.

You are responsible for scheduling any required follow-up visits with the U.S. Laser network provider to ensure the best results from your laser vision correction procedure.

Hearing Discount Benefit

EyeMed partnered with Amplifon – the world’s largest distributor of hearing aids and services – to add affordable hearing care to your EyeMed vision benefits package.

Members receive a 40% discount off hearing exams and a low price guarantee on discounted hearing aids. For additional information, call 1-844-526-5432.
 

How Do I Use My Vision Benefits?

To receive vision care benefits, follow the procedure for one of the two options below:

Choose an In-Network Provider 

When making an appointment with the provider of your choice, identify yourself as an EyeMed member and provide your name and the name of your organization or Benefit number, located on the front of your ID card. Confirm the provider is an in-network provider for the Insight Network. While your ID card is not necessary to receive services, it is helpful to present your EyeMed Vision Care ID card to identify you as a Plan member. 

When you receive services at a participating EyeMed Insight Network Provider, the provider will file your claim.  You will have to pay the cost of any services or eyewear that exceeds any allowances, and any applicable co-payments. You will also owe state tax, if applicable, and the cost of non-covered expenses (for example, vision perception training). 

Using an Out-of-Network Provider (Out-of-network charges will apply)

If you receive services from an out-of-network Provider, you will pay for the full cost at the point of service. You will be reimbursed up to the maximums as outlined in the Summary of Vision Care Services.  To receive your out-of-network reimbursement, complete and sign an out-of-network claim form, attach your itemized receipts and send to:  

FAA/EyeMed Vision Care
Attn:  OON Claims
P.O. Box 8504
Mason, OH 45040-7111

For your convenience, a FAA/EyeMed out-of-network claim form is available at eyemed.com or by calling EyeMed’s Customer Care Center at 1-888-838-4033.

Third-Party Administrator Information

For questions about vision benefits, claims or participating EyeMed Vision Care vision providers:

EyeMed Vision Care 
1-888-838-4033
eyemed.com

Group Number: 1016475

Enrollment

Eligibility

Exempt full-time and part-time permanent employees are eligible to enroll in vision coverage effective the first day of the month following the completion of one year of continuous state service or thereafter during open enrollment. 

Dependents

Dependent Eligibility

1. Spouse
• Your current legal spouse as recognized by Ohio law.

2. Children younger than age 19 including:
• Your unmarried biological children;
• Your legally adopted children. Adopted children have the same coverage as children born to you or your spouse, whether or not the adoption has been finalized. Coverage begins upon placement/custody for adoption;
• Your stepchildren;
• Non-emancipated foster children. Emancipation is defined as the age of 18 unless specifically stated in the court order;
• Non-emancipated children for whom either you or your spouse has been appointed legal guardian; and
• Children for whom the plan has received a Qualified Medical Child Support order. The child must be named as your alternate recipient in the order.

3. Children between the ages of 19 and 23 with approved student status
Dependents between the ages of 19 and 23 are eligible for continued coverage as long as they maintain their student status. Student coverage is not automatic. To initiate or continue coverage for your dependent, you are required to submit proof of eligibility within 31 days of the change in status/qualifying event.

If the proof of eligibility is provided timely, the dependent will remain on your vision coverage until he or she turns 23 or experiences a change in status/qualifying event, such as graduating from college or getting married.

4. Unmarried children incapable of self-care

Enrollment

If you are an eligible employee, you will be able to enroll in vision coverage through EyeMed Vision Care 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.

Enrollment in the state’s vision plan is not automatic. Instead, you may complete your vision plan enrollment in one of two ways:

Your vision coverage will be effective the first day of your 13th month of state service. If you do not enroll within 31 days of your anniversary date, you must wait until the annual Open Enrollment period or until you experience a change in status/qualifying event to obtain vision coverage.

Claims

Claim Process

Claims Complaint and Appeals

If you are dissatisfied with an EyeMed Provider’s quality of care, services, materials or facility or with EyeMed’s Benefit administration, you should first call EyeMed Customer Care Center at 1-888-838-4033 to request resolution. The EyeMed Customer Care Center will make every effort to resolve your matter informally.  

If you are not satisfied with the resolution from the Customer Care Center service representative, you may file a formal complaint with EyeMed’s Quality Assurance Department at the below address.  You may also include written comments or supporting documentation. 

The appeal should be mailed or faxed to the following address:

FAA/EyeMed Vision Care
Attn: Quality Assurance Dept.
4000 Luxottica Place
Mason, OH 45040

Fax: 1-513-492-3259

The EyeMed Quality Assurance Department will resolve your complaint within thirty days after receipt, unless special circumstances require an extension of time. In that case, resolution shall be achieved as soon as possible, but no later than one hundred twenty days after EyeMed’s receipt of your complaint. Upon final resolution, EyeMed will notify you in writing of its decision.

Coordination of Benefits (COB)

You and your family members may have coverage under more than one health vision plan, Coordination of Benefits (COB) is the procedure used to determine the amount of a claim that each plan should pay and to eliminate duplication of payment for services. 

EyeMed will always be the primary payer for your claims except in the instances where you have other coverage and another payer has already paid a portion of your claim.

In that case, you will submit your claim to EyeMed for reimbursement, and include a copy of the Explanation of Benefits (EOB) from the other payer. When EyeMed receives your claim with the EOB attached, we will reimburse you the balance of the claim, up to your available benefit amount with EyeMed.   

Termination

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.

General Contact

Ohio Department of Administrative Services
30 E. Broad St., 27th Floor
Columbus, Ohio 43215
Local: 614-466-8857 
Toll Free: 800-409-1205, option 2

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