DeltaVision. Insured vision plans from Delta Dental of Arizona

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1 DeltaVision Insured vision plans from Delta Dental of Arizona

2 DeltaVision DeltaVision is offered through Canyon Insurances Services, a wholly owned subsidiary of Delta Dental of Arizona, in partnership with EyeMed Vision Care, LLC. About EyeMed EyeMed Vision Care is a leading vision benefits company providing vision care programs to more than 150 million members. As a vision care administrator to more than 24 million funded members, EyeMed Vision Care has extensive experience with many of the nation s leading health plans, as well as, several national and many regional dental and ancillary plans. Members have the choice of thousands of private practitioners and leading optical retailers including, LensCrafters, Target Optical, Sears Optical, JCPenney Optical and most Pearle Vision locations. EyeMed s unique approach to vision benefits offers substantial savings to employers and employees, equating to a value unmatched in the industry. Help your employees ensure a lifetime of eye wellness and overall health care through EyeMed Vision Care. Distinguishing Features Commitment to Vision Wellness EyeMed s integration with a company devoted to vision allows us to promote our members usage of the benefit. Comprehensive eye exams do more than manage patients vision needs they contribute to overall health as the first line of defense against illness such as diabetes, hypertension and heart disease. Proactive communication and innovative plan designs make an EyeMed plan an essential part of any employer group s health and wellness program. Freedom of Choice EyeMed promotes choice throughout our plans. For employers, we provide many choices in plan designs. For our members, we offer a diverse network that includes both private practice and retail providers. And materials benefits can be applied to any type or brand without restrictive eyeglass frame towers or formularies. Quality of Care and Service All providers must meet National Committee for Quality Assurance guidelines and are monitored by a Quality Assurance Program. Internally we measure performance against organizational performance standards. Service Excellence EyeMed delivers top-notch service to members and clients through the industry s longest hours of call center support and automation through our Web site and voice response system. Easing Administrative Burden With EyeMed your administrative burden for vision plans is minimal. DeltaVision to Perform Sales / Marketing Eligibility Exchange, Billing and Receiving A/R Account Management EyeMed to Perform Provider Network and Maintenance Member and Provider Service Claims Payment Communication Support (Wellness/Disease Management Materials) Service / Sales Support / Training

3 History of EyeMed Throughout the last two decades, EyeMed has earned its place among the top vision benefits providers in the nation. We grew from a LensCrafters discount program to one of the largest vision benefits organizations in the country. EyeMed delivers vision wellness with professional passion and convenient accessibility to care. As a business unit of international vision leader Luxottica Group, S.p.A., EyeMed has experienced tremendous growth as described below: About Luxottica Group Luxottica Group is the world s leading designer, manufacturer and distributor of premium and luxury prescription frames and sunglasses. It is a global leader in eyewear, with nearly 5,700 optical and sun retail stores located primarily in North America, Asia-Pacific, China and the UK; a wholesale distribution network that covers over 130 countries; and a strong brand portfolio that includes eight owned and 19 licensed brands, including the world s best-selling eyewear brands: The EyeMed Network Consists of: Network Also Includes: Private Practice Opticians Ophthalmologists Optometrists To Locate Benefit Information or a Provider Call Discounts Available Directly at Retailer No Claims Forms to File No Referrals Required National Coverage

4 Quality Assurance All network providers must adhere to our Quality Assurance Program as outlined in the Professional Provider Manual. The program monitors the overall quality of care delivered by providers. The foundation of the Quality Assurance program is the Quality Assurance Committee and associated subcommittees, which include independent optometrists, ophthalmologists, opticians and the Medical Director. The results of the Quality Assurance evaluations are tracked and logged for review. The Quality Assurance Committee assesses the results of the analyses and comments or provides recommendations based on the reports to monitor and improve the Quality Assurance process. Member and Provider Service - Customer Care Support Our Customer Care Center and Web site, provide exceptional service to members. The EyeMed combination of extensive customer service representative availability, the automated features of our Interactive Voice Response (IVR) system and state-of-the-art Web site allow us to provide members with convenient options to address questions at almost any time of day or night. Your members may contact our Customer Care Center and the IVR by calling EYEMED. We also provide translation in more than 150 languages. The chart below describes the services available via our toll-free phone lines, IVR and the Web site. Member Services (CCC) Service Customer Care Center IVR Web site Multilingual Capabilities Provider Locator Plan Benefit Information Next Eligible Date of Service Out-of-Network Claim Form Requests (if applicable) ID Card Requests Laser Benefit Information Laser Provider Locator Claims and Claims Status Educational Information about Vision Member Grievance Resolution Order Replacement Contact Lenses Provider Services (CCC) Service Customer Care Center Web Site Plan Benefit Information Eligibility Verification Automated Claims Submission Claims Status Provider Inquiries Forms and Materials Requests EyeMed s Customer Care Center is one of our most unique features. Below is more information about how our call center distinguishes itself in the industry. EyeMed s Hours of Live Operation Monday through Saturday: 8:00 a.m. to 11:00 p.m. (EST) Sunday: 11:00 a.m. to 8:00 p.m. (EST) Differentiating Features Access to live agent 99 hours per week Closed only three days a year: Easter, Thanksgiving and Christmas

5 Claims Payment Member Submission (In Network Claims) The in network process is paperless for members. As such, they do not need to submit any claim paperwork. To access their in-network benefits members should follow the steps below: 1. Locate the Nearest EyeMed Provider: Members can locate providers by: a. Calling our Customer Care Center to use our Interactive Voice Response system; b. Calling our Customer Care Center to speak with a representative; c. Referring to their member brochure; d. Accessing the provider locator via a link at 2. Schedule an Appointment: Many in-network provider locations have evening and weekend hours; some locations even have walk-in appointments available to accommodate patients' busy schedules. Members should identify themselves as having EyeMed benefits when making an appointment. 3. Receive Services: Members should present their ID card at the time of service to help expedite the process. Once eligibility is verified, members may access their benefits and are only responsible for paying the designated plan copays and any other incurred charges. The provider arranges eyewear fabrication and delivery. Member Submission* (Out-of-Network Claims) 1. Request an Out-of-Network Claim Form: Members should call our Customer Care Center or go to the EyeMed website to request/print an out-of-network claim form before receiving services. Out-of-network claim forms can be mailed, faxed or ed to the member. 2. Receive Services: Member can receive services from the out-of-network provider of their choice and should request an itemized paid receipt. 3. Submit Claim Form: Members should fill-out their out-of-network claim form and mail it with a copy of their paid receipts for reimbursement at the out-of-network reimbursement level. 4. Scan and Review of Claim: Once received, the claim is sent to our mailroom where it is reviewed for completeness and the hard copy is scanned into our system. If the claim is complete, it will go on to the next stage. If incomplete, it will be sent or called back to the member for additional information. 5. Entering of Data and Passing through Matrix: All complete claims entered into our system by the Pre-Staging Department will run through our automated claims matrix where all benefit levels will be reviewed to ensure that they were applied correctly and the correct reimbursement is made. 6. Reimbursement Check mailed to Subscriber: Once complete, claims process through our system and a reimbursement check, including remittance advice will be mailed directly to the subscriber. Benefits of the Plan Vision Exams Our plans provide for a complete eye examination rather than just a vision screening. Additionally network providers are credentialed in accordance with NCQA guidelines; and we have QA/QI programs in place. Vision examinations may include Case History, Evaluation of the Visual System, Refractive Status, Binocular Function as well as Assessment, Diagnosis and Treatment Plans. Some tests may vary depending on the age of the member. Frames The retail frame allowance provides members with a real choice in their eyewear selection. Members who opt for a more expensive frame will receive a 20% discount off the balance of a higher priced frame. Our program is designed to eliminate member confusion, due to predetermined frame collections, reduced benefits for higher priced frames and wholesale markups offered by other vision carriers. Spectacle Lenses Standard coverage includes single vision; bifocal and tri-focal plastic lenses but many options may also be included at the sponsor s request. The plan covers basic plastic eye glass lenses. (There are plastic lenses designed for greater cosmetic appeal that are available at a discount when members obtain benefits from a Network Provider). Contact Lenses A benefit allowance is provided for members who may choose contact lenses instead of eye glasses. The allowance provided applies to the selection of the lenses only.