HRD > Benefits Administration Services > Vision

Vision Benefits

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), and
   
2. EyeMed Vision Care (EyeMed).

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:

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

Non-Member Doctor
When you receive services from a non-member doctor, you will be reimbursed directly according to the Non-Member Reimbursement Schedule, minus a copayment of $10 on the exam and an additional copayment of $15 (if you are in VSP) toward the cost of lenses and/or frames. The copayment will be taken prior to applying the schedule. These copayments apply toward contact lenses.

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 1-888-705-2020 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.
Step 2 -	Make an appointment with your doctor and tell him/her that you have VSP or EyeMed Vision Care coverage.
Step 3 -	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: The patient’s name; The date services began; The service and materials received; The type of lenses received (single, bifocal, trifocal, etc.); and 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 Out-of-Network Claims P.O. Box 997100 Sacramento, CA 95899-7100 EyeMed Vision Care Out-of-Network Claims 4000 Luxottica Place Mason, OH 45005

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.