OptiCare Vision Plan for Employees of Lexington City Schools
The Vision of Health
OptiCare's extensive provider panels are contracted to provide substantial discounts for optical products and services. No paperwork is required when utilizing in-network providers. Out-of-network benefits are available at reduced benefit levels.
OptiCare Vision Plan - Low Option (Hardware Only)
Member Benefits Include:
- Frames any frame up to the retail allowance and if the frame exceeds plan limits, one simply pays the difference less a 20% discount.
- Lenses plastic single vision, flat top bifocal, and flat top trifocal lenses are covered in full. Lens upgrades are available at deep discounts.
- Elective Contact Lenses In lieu of spectacles, benefits may be used for the fitting, follow-up and/or purchase of contact lenses.
- Medically Necessary Contact Lenses Covered in full, in lieu of spectacles.
- LASIK Surgery 15% off LASIK procedures via LasikPlus Vision Centers - www.lasikplus.com/opticare/opticare.html or 866-293-1414.
- 1st Pair Discounts 20% off usual & customary hardware fees over and above plan allowance on first pair of eyeglasses and contacts.
- 2nd Pair Discounts 30% off frames & lenses, 25% off sunglasses & 20% off contact lenses for additional pairs of eyeglasses and contacts.
- Online Discounts discounts on contacts, sunglasses and spectacles are available to OptiCare members at http://opticare.framesdirect.com/.
| Tier | 10 Month Rate | 12 Month Rate |
|---|---|---|
| Employee Only | $7.00 | $5.83 |
| Employee + 1 | $10.14 | $8.45 |
| Employee + Family | $18.19 | $15.16 |
Utilizing Your Benefits
- Locate a network provider by calling (877) 615-7732 or visiting www.myvisionplan.com.
- Make an appointment with an OptiCare provider and provide your OptiCare Member ID.
- The OptiCare network provider takes care of the rest
| Member Maximum Ophthalmic Lens Add-On Liabilities (per pair) | |
|---|---|
| Polycarbonate (V2784) | $35.00 |
| UV Treatment (V2755) | $15.00 |
| Progressive Lens (V2781) | $85.00 |
| High Index (V2782, V2783) | $50.00 |
| Photochromatic/Transition (V2744) | $40.00 |
| Scratch Resistance (V2760) | $15.00 |
| Anti-Reflective Treatment (V2750) | $40.00 |
| Tint (Solid or Gradient) (V2745) | $15.00 |
| 80% of Usual and Customary for miscellaneous add-ons. | |
Copay
- Hardware $10.00
Plan Frequencies
- Lenses every 12 months
- Frames every 24 months
- Contacts every 12 months
| Benefits | Network Doctor (after copay) |
Non-Network (copays apply) |
|---|---|---|
| Eye Exam | Not Covered | Not Covered |
| Lenses (per pair) | ||
| Single | Paid in Full | $37.50 |
| Bifocal | Paid in Full | $55.00 |
| Trifocal | Paid in Full | $90.00 |
| Lenticular | Paid in Full | $90.00 |
| Contact Lenses | ||
| Fitting, follow up & lenses (in lieu of spectacles) | $125.00 | $87.50 |
| Frame - Retail Value | $175.00 | $122.50 |
| LASIK | 15% off at LasikPlus | No benefit |
Limitations
Vision Exam and Vision Materials - Fees charged by a provider for services other than Vision Exam or Covered Vision Materials must be paid in full by the Covered Person to the provider. Such fees or materials are not covered under this policy.
Exclusions
- No benefits will be paid for services or materials connected with or charges arising from orthoptic or vision training, subnormal vision aids, and any associated supplemental testing.
- Medical and/or surgical treatment of the eye(s) or supporting structures.
- Any eye or Vision Examination, or any corrective eye wear, required by an employer as a condition of employment.
- Services provided as a result of Worker's Compensation law, or similar legislation, or required by any governmental agency or program whether Federal, state or subdivisions thereof.
- Plano (non-prescription) lenses, non-prescription sunglasses or two pair of glasses in lieu of bifocals.
- Lost or broken lenses, frames, glasses or contact lenses will not be replaced except in the next benefit period when vision materials next become available.
OptiCare Vision Plan - High Option
Member Benefits Include:
- Vision Exam comprehensive eye exam from our network of opticians, optometrists & ophthalmologists at independent and retail locations.
- Frames any frame up to the retail allowance and if the frame exceeds plan limits, one simply pays the difference less a 20% discount.
- Lenses plastic single vision, flat top bifocal, and flat top trifocal lenses are covered in full. Lens upgrades are available at deep discounts.
- Elective Contact Lenses In lieu of spectacles, benefits may be used for the fitting, follow-up and/or purchase of contact lenses.
- Medically Necessary Contact Lenses Covered in full, in lieu of spectacles.
- LASIK Surgery 15% off LASIK procedures via LasikPlus Vision Centers - www.lasikplus.com/opticare/opticare.html or 866-293-1414.
- 1st Pair Discounts 20% off usual & customary hardware fees over and above plan allowance on first pair of eyeglasses and contacts.
- 2nd Pair Discounts 30% off frames & lenses, 25% off sunglasses & 20% off contact lenses for additional pairs of eyeglasses and contacts.
- Online Discounts discounts on contacts, sunglasses and spectacles are available to OptiCare members at http://opticare.framesdirect.com/.
| Tier | 10 Month Rate | 12 Month Rate |
|---|---|---|
| Employee Only | $11.36 | $9.47 |
| Employee + 1 | $16.48 | $13.73 |
| Employee + Family | $29.54 | $24.62 |
Utilizing Your Benefits
- Locate a network provider by calling (877) 615-7732 or visiting www.myvisionplan.com.
- Make an appointment with an OptiCare provider and provide your OptiCare Member ID.
- The OptiCare network provider takes care of the rest
| Member Maximum Ophthalmic Lens Add-On Liabilities (per pair) | |
|---|---|
| Polycarbonate (V2784) | $35.00 |
| UV Treatment (V2755) | $15.00 |
| Progressive Lens (V2781) | $85.00 |
| High Index (V2782, V2783) | $50.00 |
| Photochromatic/Transition (V2744) | $40.00 |
| Scratch Resistance (V2760) | $15.00 |
| Anti-Reflective Treatment (V2750) | $40.00 |
| Tint (Solid or Gradient) (V2745) | $15.00 |
| 80% of Usual and Customary for miscellaneous add-ons. | |
Copay
- Exam $10.00
- Hardware $10.00
Plan Frequencies
- Exam every 12 months
- Lenses every 12 months
- Frames every 24 months
- Contacts every 12 months
| Benefits | Network Doctor (after copay) |
Non-Network (copays apply) |
|---|---|---|
| Eye Exam | Paid in Full | Up to $38.50 |
| Lenses (per pair) | ||
| Single | Paid in Full | $37.50 |
| Bifocal | Paid in Full | $55.00 |
| Trifocal | Paid in Full | $90.00 |
| Lenticular | Paid in Full | $90.00 |
| Contact Lenses | ||
| Fitting, follow up & lenses (in lieu of spectacles) | $125.00 | $87.50 |
| Frame - Retail Value | $175.00 | $122.50 |
| LASIK | 15% off at LasikPlus | No benefit |
Limitations
Vision Exam and Vision Materials - Fees charged by a provider for services other than Vision Exam or Covered Vision Materials must be paid in full by the Covered Person to the provider. Such fees or materials are not covered under this policy.
Exclusions
- No benefits will be paid for services or materials connected with or charges arising from orthoptic or vision training, subnormal vision aids, and any associated supplemental testing.
- Medical and/or surgical treatment of the eye(s) or supporting structures.
- Any eye or Vision Examination, or any corrective eye wear, required by an employer as a condition of employment.
- Services provided as a result of Worker's Compensation law, or similar legislation, or required by any governmental agency or program whether Federal, state or subdivisions thereof.
- Plano (non-prescription) lenses, non-prescription sunglasses or two pair of glasses in lieu of bifocals.
- Lost or broken lenses, frames, glasses or contact lenses will not be replaced except in the next benefit period when vision materials next become available.