Vision Benefit Plan Member Handbook. Vision Benefit Web Site: UNIVERSITY OF DETROIT MERCY

Transcription

1 Vision Benefit Plan Member Handbook Vision Benefit Web Site: UNIVERSITY OF DETROIT MERCY

2 WELCOME TO HERITAGE VISION PLANS page 2 SECTION I TRUST PLAN BENEFITS Table of Contents WELCOME TO Scope HERITAGE of Coverage VISION PLANS page 32 What's Not Covered page 4 WELCOME TO HERITAGE VISION PLANS page 2 SECTION I TRUST PLAN WELCOME TO BENEFITS HERITAGE VISION PLANS page 2 SECTION WELCOME I TO Scope TRUST HERITAGE of PLAN Coverage VISION PLANS page 3 2 BENEFITS SECTION What's UNIVERSITY Not Covered OF DETROIT page 4 WELCOME SECTION I TO Scope MERCY TRUST HERITAGE of PLAN Coverage VISION PLANS page 32 BENEFITS What's BENEFITS Not Covered page 4 Scope of Coverage page 3 SECTION WELCOME I TO Scope TRUST HERITAGE of PLAN Coverage VISION PLANS page 32 What's Not Covered page 4 What's BENEFITS Not Covered page 4 SECTION I Scope TRUST of PLAN Coverage page 3 SECTION II What's BENEFITS USING Not YOUR Covered BENEFIT PLAN page 4 FREQUENTLY Using a Network Provider page 5 Scope ASKED of Coverage QUESTIONS page What's Claims Appeals Not Covered page 6 page 4 GLOSSARY Unresolved OF EYEWEAR Concerns TERMS page 6 Different Types of Prescription Lenses page 10 FREQUENTLY ASKED QUESTIONS page Eyeglass Lens Materials page 11 FREQUENTLY Eyeglass ASKED Lens QUESTIONS Coatings and Options page GLOSSARY WEB SITE: HOW OF EYEWEAR TO USE TERMS page 9 GLOSSARY FREQUENTLY MEMBER RIGHTS/PRIVACY OF Different ASKED EYEWEAR Types QUESTIONS of TERMS Prescription PRACTICES Lenses page SECTION III PROVIDER DIRECTORY page Eyeglass Lens Materials page 11 Different Types of Prescription Lenses page 10 GLOSSARY FREQUENTLY NOTES/APPOINTMENTS Eyeglass ASKED Lens QUESTIONS Coatings and Options page MEMBER RIGHTS/PRIVACY OF EYEWEAR TERMS Eyeglass Lens Materials PRACTICES page 115 Eyeglass Different Types Lens Coatings of Prescription and Options Lenses page GLOSSARY FREQUENTLY MEMBER RIGHTS/PRIVACY OF ASKED EYEWEAR QUESTIONS TERMS PRACTICES page GLOSSARY OF Eyeglass EYEWEAR Lens Materials TERMS page 11 MEMBER RIGHTS/PRIVACY Different Types of Prescription PRACTICES Lenses NOTES/APPOINTMENTS Eyeglass Lens Coatings and Options page GLOSSARY OF Different EYEWEAR Types of TERMS Prescription Lenses page 16 Eyeglass Lens Materials page 11 Eyeglass Lens Materials page 17 NOTES/APPOINTMENTS MEMBER RIGHTS/PRIVACY Eyeglass Different Types Lens Coatings of Prescription PRACTICES and Options Lenses page Eyeglass Lens Coatings and Options page 18 Eyeglass Lens Materials page 11 MEMBER NOTES/APPOINTMENTS RIGHTS/PRIVACY Eyeglass Lens Coatings PRACTICES and Options page NOTES/APPOINTMENTS MEMBER RIGHTS/PRIVACY PRACTICES NOTES/APPOINTMENTS page page page 14 Heritage Vision Plans 1

3 Introduction WELCOME University of Detroit Mercy Employees! We are glad to have you as members of the Heritage Vision Plans family. Heritage is a vision benefit management company that is dedicated to providing exceptional service, world-class quality and an extensive provider network. Heritage is committed to the quality, reliability and service excellence that have made us successful since Our goal is to provide you with the best in eye care and service. We are providing this booklet to enable you and covered dependents to make the best possible use of valuable vision care benefit. If you have questions that are not answered here, please call us toll-free at , or us at corporate@heritagevisionplans.com. Cordially, George P. Barnes, Jr. President Heritage Vision Plans Heritage Vision Plans has developed this guide to help you receive maximum value from vision benefit. This handbook covers important topics such as: what services are covered, accessing a provider, filing a claim, and member rights and privacy practices. Heritage Vision OpticalPlans 2

4 Section I UNIVERSITY OF DETROIT MERCY BENEFIT PLAN Scope of Coverage Your Scope of Coverage is determined by University of Detroit Mercy. This section of the Vision Benefit Handbook will explain plan benefit. The following chart indicates what services are covered, how often each covered service can be used, what you can expect to pay when receiving services from an in-network provider. SERVICES Comprehensive Eye Exam For Eyeglasses (Does not apply to Contact Lens Exam) Frames Lenses: (Choice of One) Single Vision Bifocal Trifocal Lenticular Lens Options: Tint (Therapeutic Rose Tint #1 or #2) COVERAGE FREQUENCY Once every 24 months (from date of last exam) Once every 24 months (from date of last purchase) Once every 24 months (from date of last purchase) Once every 24 months (from date of last purchase) Once every 24 months (from date of last purchase) Once every 24 months (from date of last purchase) Once every 24 months (from date of last purchase) IN-NETWORK: COVERAGE Fully Covered, No Co-pay Covered up to a $125 maximum Fully Covered, No Co-pay Fully Covered, No Co-pay Fully Covered, No Co-pay Fully Covered, No Co-pay Fully Covered, No Co-pay Frame Warranty (1 year manufacturer s) Once every 24 months (from date of last purchase) OR Fully Covered, No Co-pay Contact Lenses - $ Allowance towards Exam and Contact Lenses Comprehensive Eye Exam Contact Exam and Fitting: For Contact Lenses 1 Once every 24 months (from date of last purchase) Covered up to a ritage Optical (Applies to Contact Lens Exam and Fitting) $64.50 maximum 3 Contacts Lenses 1 Contact Lenses: Once every 24 months Heritage Vision Plans (includes disposables) (from date of last purchase) Covered up to a 3 $64.50 maximum 1 You are eligible for contact lenses OR glasses, not both, in any 24 Month Consecutive Period. Heritage Vision Plans 3

5 What s Not Covered Products and services not covered under the plan include: Non-prescription lenses Two pairs of glasses instead of bifocals Lenses and frames furnished under a plan, that are lost or destroyed Parts or repair of frame not covered under manufacturers' warranty Medical or surgical treatment of the eyes Drugs or medications Corrective vision services, treatments, and materials of an experimental nature Services not visually necessary Industrial (3mm) safety lenses and safety frames with side shields Any services not specified in University of Detroit Mercy's Scope of Coverage Heritage Optical Vision Plans 4

6 Section II USING YOUR BENEFIT PLAN Using a Network Provider Here are the steps to take: 1. Select a doctor from the list of network providers. The list can be accessed on our Web site: or by calling our Interactive Voice Response (IVR) System toll-free at: The Interactive Voice Response System is available seven days a week, 24 hours a day. 2. Make an appointment with the doctor of choice. When calling to make an appointment, identify self as a University of Detroit Mercy Member and a Heritage Vision Plans Member. The Doctor/ Provider will ask for ID number (Member's S SN). As a Heritage Vision Plans member, you will maximize benefits and reduce out-of-pocket costs by choosing to visit an In-Network Provider. 3. The Doctor / Provider will verify eligibility and/or eligibility of dependents. 4. When the examination is complete and you and/or dependents have been fitted for any necessary glasses or contact lenses, the doctor will explain any additional charges that you may have to pay. 5. The Doctor / Provider will take care of all the paperwork. There are no claim forms for you to complete. Heritage Vision OpticalPlans 5

7 continued Section II continued Claims Appeals If a claim is denied, in whole or in part, Heritage will Claims notify you Appeals of the reasons for denial. Within 60 days after the date of the denial notice, you may make a If a claim is denied, in whole or in part, Heritage will written request for review of the denial. The request notify you of the reasons for denial. Within 60 days must include any and all supporting documentation. after the date of the denial notice, you may make a The claim will be reviewed and you will be notified of written request for review of the denial. The request the decision. Submit claim appeals to: must include any and all supporting documentation. The claim will be reviewed and you will be notified of Heritage Vision Plans the decision. Submit claim appeals to: ATTN: Claims Appeal Manager Livernois Avenue, Suite B Heritage Vision Plans Detroit, MI ATTN: Claims Appeal Manager Livernois Avenue, Suite B Unresolved Concerns Detroit, MI If you are not satisfied with the Heritage Vision Unresolved Plans' resolution Concerns of any customer service issue you may have, please contact Human Resources Dept. If you are not satisfied with Heritage Vision Plans' representative. After exhausting all avenues to have resolution of any customer service issue you may have, concerns satisfactorily addressed, you may contact: please contact Human Resources Department representative. After exhausting all avenues to have Customer concerns Services/Benefit satisfactorily Inquiry addressed, Section you may contact: Michigan Division of Insurance Customer P.O. Box Services/Benefit Inquiry Section Michigan Lansing, MI Division of Insurance P.O. Box Lansing, MI Heritage Vision Plans 6

8 FAQ FREQUENTLY FREQUENTLY ASKED ASKED QUESTIONS QUESTIONS Q: Q: Do Do I need need an an ID ID card? card? A: A: Yes, No, you you do will not use need an Blue ID Cross card. Blue When Shield you of call Michigan for an appointment ID card. When with a you provider, call f or the an provider appointment will verify with a provider, eligibility. the The providerwill provider v will erify ask for eligibility. Member The provider ID number will which ask for is Member Social ID Security number Number. and (Patient's) Date of Birth. Q: Q: How How can can I obtain obtain a list list of of vision vision care care providers providers in in network? network? A: A: Heritage Heritage Vision Vision Plans Plans offers offers a provider provider locator locator on on our our Web Web site: site: and and by by calling calling our our toll-free toll-free number: number: Q: Q: Where Where do do I get get a claim claim form form to to submit submit for for reimbursement? reimbursement? A: A: If There you is visit no an claim in-network form to provider, submit. When there you is no visit claim the form Heritage to submit. network The provider, provider the will provider handle will all of handle the paperwork all of the paper and work will submit and will the submit claim. the If you claim. visit an out-of-network provider, you must get an itemized Q: receipt Do all from optical the provider locations and submit have that the receipt same to Heritage frames Vision to choose Plans from? for reimbursement. The A: No, receipt the will frames serve will as differ the claim by location, form. Please but each see location will 6 have for a a complete wide variety description of styles of to choose what the from. Page itemized receipt must contain. Q: Where do I send my itemized receipt for reimbursement? A: Send the itemized receipt to: Heritage Vision Plans ATTN: Vision Claims Reimbursement Livernois Avenue, Suite B Detroit, MI Heritage Vision Plans 7

9 Q: Do all optical locations have the same frames to choose from? A: No, the frames will differ by location, but each location will have a wide variety of styles to choose from. FAQ continued Q: How can my current doctor join the network? A: You may refer doctor to us for inclusion in our Q: Do network. all optical Request locations that doctor have contact the same our frames Director of to Provider choose from? Relations at A: No, ext. the 1506 frames for will an differ application by location, packet, but each or location will have us at a corporate@heritagevisionplans.com wide variety of styles to choose from. Q: How Can I get can both my contact current lenses doctor and glasses? join the A: You network? are eligible to receive contact lenses OR glasses, You not may both, refer in the doctor same Plan to us Year for inclusion as a covered in our A: benefit. network. Request that doctor contact our Director of Provider Relations at Q: Is Lasik a covered or partially covered benefit? ext for an application packet, or A: Lasik is not a covered or partially covered benefit us at corporate@heritagevisionplans.com under the University of Detroit Mercy's Scope of Q: Can Coverage. I get both contact lenses and glasses? A: You are eligible to receive contact lenses OR glasses How in the do same I know Plan which Year as of a the covered toll-free benefit. If Q: you numbers wish to listed purchase in this both book in the to same use? Plan Year, A: you If you may need receive information a preferred regarding pricing discount eligibility on the or non-covered provider locations, item. use the toll free number. This will connect you to the Customer Q: Is Lasik a covered or partially covered benefit? Service Center or IVR system. A: Lasik is not a covered or partially covered benefit under the MPS Group's Scope of Coverage. For all other member service needs, please use the Q: How do I know toll which free number. of the toll-free This will connect you numbers to Heritage listed Vision in this Plans' book administrative to use? offices. A: If you need information regarding eligibility or provider locations, use the toll free number. This will connect you to the Customer Service Center or IVR system. For all other member service needs, please use the toll free number. This will connect you to Heritage Vision Plans' administrative offices. Heritage Vision OpticalPlans 89

10 Heritage Web Site: How To Use Step 1: Go to the Heritage Vision Plans Website The Heritage Vision Plans Web site is Step 2: Select Member Login Click the "member login" button in the upper right corner of the web page (see example below). Step 3: Login At the login screen, enter the Primary Member's I.D. (Social Security Number), and the Primary Member's Date of Birth. After logging in, you will have full member access to eligibility information, The Provider Search Engine, and the MPS Group University of vision Detroitbenefit Mercyinformation. vision benefit information. Click the member login Button (Snapshot of Home Page) C Click the member login Button Heritage Vision Plans 9 Heritage Vision ptical Plans H 0 erita ge O

11 Section III Instaset University Plastic of Detroit Corporation Mercy Provider Directory Participating Provider information is subject to change without notice. Please call Providers, listed in this Directory, to verify their continued participation in the Heritage Provider Network, prior to scheduling appointment or receiving services. The Heritage Vision Plans Web site ( or toll-free Automated Provider Locator ( ) will always be source for the most up-to-date Participating Provider Directory for vision care plan Heritage Optical Vision Plans

12 AUBURN HILLS Fortney Eyecare Associates William J. Fortney O.D. Christine A. Jack O.D. Alicia T. Zimnicki O.D Walton Boulevard Auburn Hills, MI (248) BATTLE CREEK Gerald E. Hanna O.D. 65 E. Columbia Avenue Battle Creek, MI (269) BELLEVILLE Belleville Vision Center Barry K. Lesnick O.D. Michael R. Sandles O.D Belleville Road Belleville, MI (734) BENTON HARBOR Karl K. Damm O.D. Kristina R. Swartz O.D S. M-139 Benton Harbor, MI (269) BRIGHTON D.O.C Randy Watsky O.D W. Grandriver Brighton, MI (810) BROWNSTOWN Redford Optical Jennifer A. Ciak O.D West Road Brownstown, MI (734) CANTON D.O.C Jeffrey S. Hagan O.D Ford Road Canton, MI (734) Visionpro Eyecare Barry K. Lesnick O.D N. Canton Center Road Canton, MI (734) Sharper Vision Jacquelyn Blakey O.D Canton Center Road Canton, MI (734) Elite Eyecare Center Daniel J. Trainor O.D. Andrew H. Schmitzer O.D Ford Road Canton, MI (734) CHARLOTTE Steven McMurry O.D Lansing Road Suite B Charlotte, MI (517) CHESTERFIELD D.O.C Arlene Barton O.D. Michael Weisberger O.D Mile Road Chesterfield, MI (586) CLAWSON House Of Optical Mark J. Simard O.D. Robert R. Feldman O.D. 329 W. 14 Mile Road Clawson, MI (248) CLINTON TOWNSHIP Metro Vision II Gerald J. Blazius O.D Garfield Road Clinton Township, MI (586) COLDWATER Joseph M. Hibler O.D. Linda L. Goeman-Stahl O.D. 755 E. Chicago Street Coldwater, MI (517) DEARBORN Fortney Eyecare Associates William J. Fortney O.D. Christine A. Jack O.D. Alicia T. Zimnicki O.D Michigan Avenue Dearborn, MI (313) Margaret M. Kuznicki O.D. Henry Ford Medical Center Hubbard Drive, 2 nd Floor Dearborn, MI (313) Anna Marie Santillan O.D Michigan Avenue Dearborn, MI (313) Midwestern Vision Center Roman Goldvecht O.D Schaefer Road Dearborn, MI (313) DEARBORN HEIGHTS Redford Optical Jennifer A. Ciak O.D Ford Road Dearborn Heights, MI (313) DETROIT Heritage Optical Center Maurice D. Valentini O.D. Robert Kocembo O.D Livernois Avenue Detroit, MI (313) Heritage Optical Center Maurice D. Valentini O.D. 87 Monroe Street Detroit, MI (313) Heritage Optical Center Robert Kocembo O.D E. Jefferson Avenue Detroit, MI (313) Black & White Look Optical Myron J. Gerber O.D E. Jefferson Suite A Detroit, MI (313) Beverley J. Katz O.D. Henry Ford Medical Center 7800 W. Outer Drive, 1 st Floor Detroit, MI (313) William K. Carter O.D. Henry Ford Hospital 2799 W. Grand Blvd, 1 st Floor Detroit, MI (313) Health Center Optical Robert F. Lee O.D Saint Antoine Street Detroit, MI (313) Belmont Vision Lowell Ressler O.D E. 8 Mile Road Detroit, MI (313) Optical World Michael Weishaus O.D. Randall M. Weishaus O.D. Max Gottesman O.D. Lorne M. Gottesman O.D Grand River Ave Detroit, MI (313) Rosedale Eye Care Seymour R. Rosen O.D Grand River Avenue Detroit, MI (313) EASTPOINTE Normandy Optical Gerald J. Blazius O.D. Mark J. Simard O.D Gratiot Avenue Eastpointe, MI (586) W. Fraser Vipond M.D. & Oxford Optical Gratiot Avenue Eastpointe, MI (586) FARMINGTON HILLS Barry A. Bell O.D. Rovetta M. Qashat O.D W. 10 Mile Road Farmington Hills, MI (248) Heritage Vision Plans 11

13 FLINT Riverfront Optical Scott McDowell O.D. Marla Hayden O.D. G-4325 Miller Road Flint, MI (810) Riverfront Optical Francis Stone O.D. Marla Hayden O.D Davison Road Flint, MI (810) FORT GRATIOT Charles G. Shermetaro O.D. Kimberly A. Sebok O.D th Avenue, Suite 5 Fort Gratiot, MI (810) FRASER Fraser Optical Inc. Aimee K. Gray O.D. James G. Miller O.D. Mark A. Stefani O.D. Michael J. Sistick O.D Groesbeck Hwy. Fraser, MI (586) GARDEN CITY Elite Eyecare Centers Andrew H. Schmitzer O.D. Daniel J. Trainor O.D Inkster Road Suite 303 Garden City, MI (734) GRAND HAVEN Christine I Vandeweghe OD 1125 S. Beacon Boulevard Grand Haven, MI (616) GRAND RAPIDS Anthony W. Danko O.D Northland Drive NE Grand Rapids, MI (616) Rebecca A. Dignum O.D. Steven McMurry O.D. David G. Higley O.D Plainfield Avenue NE Grand Rapids, MI (616) Michael P. Jacquemin O.D. Steven McMurry O.D th Street SE Grand Rapids, MI (616) Martha Romanyk O.D Cascade Road Grand Rapids, MI (616) GROSSE POINTE MM AAT TERR E IIAAL I LLS S OO NNL LLY Y Henry Ford Medical Center E. Jefferson, 1 st Floor Grosse Pointe Park, MI (313) HASTINGS Heidi M. Gordon O.D. 803 W. State Street Hastings, MI (269) HOLLAND Christine Haloda O.D S. Washington Avenue Holland, MI (616) Michael P. Jacquemin O.D. Aaron D. Miller O.D Riley Street Holland, MI (616) IONIA Clifford J. Frazho O.D S. State Street Ionia, MI (616) JACKSON David C. McClintic O.D E. Michigan Avenue Jackson, MI (517) JENISON Stacy L. Maier O.D. 304 Baldwin Avenue Jenison, MI (616) JONESVILLE Joseph M. Hibler O.D. Natalie Sorce O.D. Linda L. Goeman-Stahl O.D. 855 Olds Street Jonesville, MI (517) KALAMAZOO Gerald E. Hanna O.D S. Park Street Kalamazoo, MI (269) Ronald McClatchey O.D Gull Road Kalamazoo, MI (269) Heidi M. Gordon O.D. 125 S. Kalamazoo Mall Kalamazoo, MI (616) Leslie K. Delemester O.D W. Main Street Kalamazoo, MI (269) Gerald E. Hanna O.D. Bronson Hospital 601 John Street Suite 261 Kalamazoo, MI (269) KENTWOOD David Szczepanski O.D th Street SE Kentwood, MI (616) LAKE ORION Stephanie B. Turpen O.D. 684 S. Lapeer Road Lake Orion, MI (248) LANSING D.O.C Marvin Matson O.D S. Cedar Street Lansing, MI (517) Clifford J. Frazho O.D W. Saginaw Hwy. Lansing, MI (517) Optiview Vision Center Jack Adkins O.D. 635 S. Waverly Road Suite B Lansing, MI (517) LIVONIA D.O.C Howard J. Rosner O.D. Newburgh Plaza Six Mile Road Livonia, MI (734) Fortney Eyecare Associates William J. Fortney O.D. Christine A. Jack O.D. Alicia T. Zimnicki O.D W. 5 Mile Road Livonia, MI (734) Royal Optics Gary S. Yee O.D Plymouth Road Livonia, MI (734) Heritage Vision Plans 12

14 Michigan Eyecare Institute Kevin J. Trapp O.D Levan Livonia, MI (734) MADISON HEIGHTS Kurt M. Schulz O.D John R Road Madison Heights, MI (248) MILFORD Bruce R. Wolffis O.D. Fariba M. Hickinson O.D. 516 Highland Avenue Milford, MI (248) MONROE Best Vision / Eyecare One Douglas W. Baltrip O.D. 504 N. Telegraph Road Monroe, MI (734) MUSKEGON Aaron D. Miller O.D E. Apple Avenue Muskegon, MI (231) NILES Karl K. Damm O.D S. 11th Street Niles, MI (269) OKEMOS Clifford J. Frazho O.D W. Grand River Avenue Okemos, MI (517) OSCODA Fraser Optical Inc. Aimee K. Gray O.D. James G. Miller O.D. Mark A. Stefani O.D. Michael J. Sistick O.D. 211 N. State Street Oscoda, MI (989) OWOSSO Robert C. Hagemann O.D E. Main Street Owosso, MI (989) PLAINWELL David G. Higley O.D West M-89 Plainwell, MI (269) PONTIAC Lynn Optical Associates Samuel M. Wapner O.D. 22 N. Telegraph Road Pontiac, MI (248) Pontiac Eye Clinic Michael Weishaus O.D. Randall M. Weishaus O.D. Max Gottesman O.D. Lorne M. Gottesman O.D. 294 E. Walton Boulevard Pontiac, MI (248) Optiview Vision Center Angela Iceberg O.D. Frank Kozin O.D. 41 E. Walton Boulevard Pontiac, MI (248) PORTAGE David C. McClintic O.D S. Westnedge Avenue Portage, MI (269) RICHMOND Fraser Optical Inc. Aimee K. Gray O.D. James G. Miller O.D. Mark A. Stefani O.D. Michael J. Sistick O.D Gratiot Richmond, MI (586) ROCHESTER HILLS D.O.C Eyeworld John Gedda O.D. Spring Hill Plaza 2915 Walton Boulevard Rochester Hills, MI (248) ROCKFORD Anthony W. Danko O.D. 507 E. Division Street Rockford, MI (616) ROMEO Fraser Optical Inc. Aimee K. Gray O.D. James G. Miller O.D. Mark A. Stefani O.D. Michael J. Sistick O.D N. Van Dyke Road Romeo, MI (586) ROSEVILLE Amy F. Jones O.D. Ann Marie Spadofora O.D. Kristi A. Watchorn O.D. Gregory C. Herbart O.D. Ranald F. Mackenzie O.D. Xanthi Tuchowski O.D Gratiot Avenue Roseville, MI (586) SAGINAW Riverfront Optical Raymond Lalonde O.D. Paul Golsch O.D. Melissa David O.D S. Cabaret Trail Saginaw, MI (989) SHELBY TOWNSHIP D.O.C Eyeworld Jerry Lebeau O.D Van Dyke Avenue Shelby Township, MI (586) Fraser Optical Inc. Aimee K. Gray O.D. James G. Miller O.D. Mark A. Stefani O.D. Michael J. Sistick O.D Van Dyke Ave Shelby Township, MI (586) SOUTH LYON Oakland Vision Fred E. Weiser O.D. 608 N. Lafayette Street South Lyon, MI (248) SOUTHFIELD D.O.C Eyeworld Kenneth Foon O.D. Northland Mall Northwestern Hwy. Southfield, MI (248) Black & White Look Optical Myron J. Gerber O.D W. Ten Mile Road Southfield, MI (248) Benjamin H Stein O.D. Edward F. Stein O.D Northwestern Hwy #635 Southield, MI (248) Michigan Eyecare Institute Kevin J. Trapp O.D Telegraph Road Ste 100 Southfield, MI Advance Eye Care M.D. Lanny Green M.D Greenfield Road Ste 144 Southfield, MI (248) Heritage Vision Plans 13

15 SOUTHGATE Lesnick Optical Barry K. Lesnick O.D Fort Street Southgate, MI (734) Sally Hoey O.D. Matthew S. Haubert O.D Eureka Road Southgate, MI (734) Nathan D. Harris O.D. Timothy J. Guthrie O.D Eureka Road Southgate, MI (734) ST. CLAIR Distinctive Eyewear Gary Kendrick O.D. 201 N. Riverside Avenue Saint Clair, MI (810) ST. CLAIR SHORES Shore Optical Mark Lavine O.D Harper Avenue St Clair Shores, MI (586) ST. JOSEPH Kristina R. Swartz O.D Washington Avenue St Joseph, MI (269) STERLING HEIGHTS Gregory C. Herbart O.D. Robert E. Brinker O.D. William K. Carter O.D. Daniel L. Flick O.D. Henry Ford Medical Center Schoenherr Rd, 2 nd Floor Sterling Heights, MI (586) Larry T. Olson O.D. Henry Ford Medical Center Mile Road, 2 nd Floor Sterling Heights, MI (586) Fraser Optical Inc. Aimee K. Gray O.D. James G. Miller O.D. Mark A. Stefani O.D. Michael J. Sistick O.D Mile Road Sterling Heights, MI (586) Feeder Optical Robert E. Brinker O.D Dequindre Sterling Heights, MI (586) STURGIS Mark Prieur O.D. 500 S. Centerville Road Sturgis, MI (269) TAYLOR Optiview Vision Center Frank Kozin O.D S. Telegraph Road Taylor, MI (313) Oakland Eyewear MM AAT TERR E IIAAL I LLS S OO NNL LLY Y Plaza South Drive Taylor, MI (734) THREE RIVERS Mark Prieur O.D. 111 S. US Hwy-131 Three Rivers, MI (269) TRENTON D.O.C Gary Kendrick O.D. West Grange Plaza 3420 West Road Trenton, MI (734) TROY Golden Gate Optical Asher L. Weisman O.D E. Big Beaver Road Troy, MI (248) Optometry On The Mall Thomas T. Casey O.D W. South Boulevard Troy, MI (248) WALKER Steven McMurry O.D. Christine Haloda O.D. Christine I Vandeweghe OD 4335 Lake Michigan Drive Walker, MI (616) Rebecca A. Dignum O.D. David G. Higley O.D Alpine Avenue NW Walker, MI (616) WALLED LAKE Oakland Vision Centers Fred E. Weiser O.D. 519 N. Pontiac Trail Walled Lake, MI (248) WARREN D.O.C Anthony D. Spitler O.D Dequindre Road Warren, MI (586) Fortney Eyecare Associates William J. Fortney O.D. Christine A. Jack O.D. Alicia T. Zimnicki O.D Mile Road Warren, MI (586) WATERFORD D.O.C Eyeworld Bradley D. Goldberg O.D Highland Road Waterford, MI (248) WEST BLOOMFIELD Admiral Optical Inc. Paul S. Keller O.D Haggerty Road West Bloomfield, MI (248) Shanna M. Voss O.D. Robert V. Finlay O.D. Barry A. Bell O.D. Curtis E. Wee O.D. Rovetta Mattia O.D Farmington West Bloomfield, MI (248) WESTLAND Fortney Eyecare Associates William J. Fortney O.D. Christine A. Jack O.D. Alicia T. Zimnicki O.D Warren Avenue Westland, MI (734) Jay P. Lizyness O.D. Emily S. Michalik O.D. Curtis E. Wee O.D. James M. Flynn O.D. Robert C. Hagemann O.D. William C. McIntyre O.D Central City Parkway Westland, MI (734) WOODHAVEN Matthew S. Haubert O.D Allen Road Woodhaven, MI (734) WYANDOTTE Wyandotte Optical Dan Stein O.D Biddle Avenue Wyandotte, MI (734) WYOMING Stacy L. Maier O.D th Street SW Wyoming, MI (616) YPSILANTI Fortney Eyecare Associates William J. Fortney O.D. Christine A. Jack O.D. Alicia T. Zimnicki O.D. 2 N. Huron Street Ypsilanti, MI (734) Heritage Vision Plans 14

16 Member Rights/Privacy Practices If you would like to request a copy of our Member Rights and/or Notice of Privacy Practices, please contact us at: Plan Administrator Heritage Vision Plans Livernois Avenue, Suite B Detroit, MI Phone: (888) Fax: (313) corporate@heritagevisionplans.com Provider Information Information about any participating provider is available from Heritage Vision Plans at the above listed address. Heritage Vision OpticalPlans 15

17 Glossary of Eyewear Terms The The Eyewear Eyewear Terms Terms in in this this Glossary Glossary are are provided provided for for informational informational purposes purposes only. only. They They are are not not meant meant to to reflect reflect actual actual covered covered benefits benefits under under vision vision plan. plan. Please Please refer refer to to page page 3, 3 of of this this Handbook, Handbook for for covered covered benefits. benefits. DIFFERENT TYPES OF PRESCRIPTION LENSES Based upon the particular eyesight disorder, different types of corrective lenses are prescribed. As a rule, there are 4 types of prescription lenses: Single Vision, Bifocal, Trifocal, and Progressive. Single Vision Lenses Single Vision lenses have only one viewing area throughout the lens. This corrected area can be for far distance, near distance, or reading. Bifocal Lenses Bifocals (meaning a lens with two points of focus, usually one for distance and one for near) are some of the most commonly prescribed multi-focal lenses. A small portion of the bifocal eyeglass lens is reserved for the near-vision correction. The rest of the lens is usually a distance correction, but may have no correction at all if the wearer has good distance vision. Trifocal Lenses Trifocal lenses are lenses with three points of focus: usually for distance, intermediate and near. Trifocals have an added segment above the bifocal for viewing things in the intermediate zone: about an arm's length away. Computer terminals are typically in the intermediate zone. Progressive Lenses Progressive lenses correct vision for multiple distances without the visible segment lines seen in bifocal or trifocal lenses. Instead they have a graduated section in which the power of the lens progresses smoothly from one prescription to the other, allowing the wearer to see clearly at all distances. Heritage Vision Plans 28 Heritage Vision Plans 168

18 Glossary of Eyewear Terms (continued) EYEGLASS LENS MATERIALS Choosing the right lens material for eyeglasses is an important decision, and there are several options. Plastic Lenses Plastic remains the most popular lens material for eyeglasses in the United States, accounting for nearly 50% of all lenses sold. Plastic is generally regarded as the economy choice in lenses. It offers good optical clarity at a lower price point. Due to thickness, it is not typically recommended for higher prescription powers. Polycarbonate Lenses Polycarbonate Lenses are the most durable of all lenses. These lenses are over ten times more impact resistant than regular plastic. They are also one of the lightest, thinnest lens materials used in eyewear (up to 40% thinner and 30% lighter than standard plastic lenses). Polycarbonate remains a good choice if you want the safest and/or lightest lenses possible. It is also an excellent material choice for children. Hi Index Lenses Hi Index lenses are an excellent alternative for patients with higher prescriptions that want the thinnest, most attractive lenses possible. Hi Index lenses range from 20% to 65% thinner than plastic lenses (depending on the refractive index). The higher the refractive index, the thinner the lens (and typically the higher the cost). Trivex Lenses The Trivex lens is a lightweight, impact resistant material much like polycarbonate. It offers the added benefits of lower visual distortion, better optics, and inherent U.V. Protection. Trivex is a great substitute for polycarbonate lenses in prescription sunglasses because Trivex can be easily tinted, whereas polycarbonate cannot. Heritage Vision Plans 17

19 Glossary of Eyewear Terms Glossary of Eyewear (continued) Terms EYEGLASS LENS COATINGS AND OPTIONS There are many different choices in eyeglass lens coatings and other optical options. These coatings and options can enhance the performance and appearance of eyeglass lenses. Scratch Resistant Coating The material in plastic lenses is relatively soft and is easily scratched if it is not coated with scratch-resistant coating. This coating, a much harder plastic compound, is applied to the lens surface. The " Scratch Coat " greatly increases the lens' resistance to scratches and abrasions, however it too can be scratched. Anti-Reflective or AR Coating Anti-Reflective Coatings help reduce the reflection on the lenses. When driving (day or night), or using the computer, they reduce the glare and lessen strain on the eyes. What you see is both clearer and sharper. AR Coating also cosmetically enhances the lens, making the lens almost invisible. Your eyes, not the glasses, become the focus of attention. Ultra-Violet or UV Coating UV Coating helps protect the eyes from the harmful damage caused by the sun. This protection helps the eyes tolerate bright sunlight and softens harsh light without making the glasses seem darker. (Note: Both Polycarbonate and Trivex lenses have builtin Ultra-Violet protective properties.) Photochromic or Transitions Lenses Photochromic lenses change from light to dark through changing levels of sunlight. " Transitions " is the most well-known brand in the category of Photochromic lenses. When worn indoors they are virtually clear. When worn outside they change to a dark color. Polarized Lenses Polarized Lenses block out virtually all Ultra-Violet Rays. These lenses help to eliminate haze and glare, while increasing visibility. Heritage Vision Plans 18

20 Member Services Center Livernois Avenue, Suite B Detroit, MI corporate@heritagevisionplans.com