Vision Coverage. Rochester Business Alliance

Transcription

1 Rochester Business Alliance Vision Coverage Here is your new vision coverage. Make sure you return the completed form, if applicable, to your plan administrator. If you miss the deadline, the coverage may be delayed or you may not be eligible for enrollment this year. Questions? Concerns? Helpline (888) Call weekdays, 7:00 AM to 8:30 PM, EST. And refer to your plan number: Find out if your doctor is in VSPs or Davis Visions network by using the Find A Doctor resource at

2 We re ready to get working for you If you re like most employees, finding enough time in the day to accomplish your lengthy to-do list can often be no easy task. As your Guardian coverage begins, we want you to know that we re here for you every step of the way and are committed to providing you with the resources to obtain fast, accurate answers to your benefits-related uestions. One way in which we do this is through our online member resource, Guardian Anytime sm, which allows you to manage your benefits when it works best for you day or night. Plus, it offers helpful resources to ensure you get access to the uality care you need. We encourage you to take a couple minutes to check out and register for Guardian Anytime sm at We promise it will be time well spent. Welcome to Guardian!

3 Prepared for Rochester Business Alliance Guardian Group Plan Number Vision Plans Option 1: Visit any doctor with your Full Feature plan, but save by visiting any of the 34,000 locations in the nation's largest vision network. Option 2: Significant out-of-pocket savings available with your Full Feature plan by visiting one of Davis Vision's network locations including retail centers such as Wal-Mart, JCPenney, Sears, Target, Sams Club, and Pearle. COMPARE THE PLANS Option 1: VSP Option 2: Davis Network VSP Choice Network Davis Vision Your premium $ $ You, spouse/domestic partner and child(ren) Copay $ $ Exams Copay $ 20 $ 20 Materials Copay (waived for non-formulary elective contact lenses) $ 20 $ 20 Service Freuencies Exams Every calendar year Every calendar year Lenses (for glasses or contact lenses) Every calendar year Every calendar year Frames Every calendar year Every calendar year Network discounts (cosmetic extras, glasses and contact lenses) Dependent Age Limits (Non-Student/ Student) Limitless within 12 months of exam. 20/26 20/26 Applies to first purchase & courtesy discount from most providers on subseuent purchases. 1 Benefit includes coverage for glasses or contact lenses, not both. With Dual Option a member can change the vendor elected during any open enrollment except if the plan has a 24 month or 2 calendar year materials freuency the member is locked into the vendor they choose for a benefit period of two years. YOUR GUARDIAN PLAN OFFERS: Reduced prices VSP and Davis Vision both offer discounts on an extensive list of cosmetic extras, including special lenses and scratch-resistant coatings. National network VSP offers a network of private practice providers, while Davis Vision offers both private practice and well-known retail centers. No claims submission for in-network services and supplies. Did you know? "Two-thirds of employees would rather trade a vacation day for eyecare benefits." Bests Review, 2006 Questions? Call the Guardian Helpline (888) Enrollment Kit , 0002, EN 1

4 PLAN DETAILS OPTION 1: VSP OPTION 2: DAVIS You pay (after copay if applicable): You pay (after copay if applicable): In-network Out-of-network In-network Out-of-network Eye Exams $0 Amount over $39 $0 Amount over $50 Single Vision Lenses $0 Amount over $23 $0 Amount over $48 Lined Bifocal Lenses $0 Amount over $37 $0 Amount over $67 Lined Trifocal Lenses $0 Amount over $49 $0 Amount over $86 Lenticular Lenses $0 Amount over $64 $0 Amount over $126 Frames 80% of amount over $130 Amount over $46 80% of amount over $130* Contact Lenses (Elective) Amount over $130 Amount over $100 N/A N/A Contact Lenses (Elective and conventional) N/A N/A 85% of amount over $130* Contact Lenses (Planned replacement and disposable) N/A N/A 85% of amount over $130* Amount over $48 Amount over $105 Amount over $105 Contact Lenses (Medically Necessary) $0 Amount over $210 $0 Amount over $210 Contact Lenses (Evaluation and fitting) 15% off UCR No discounts No discounts No discounts Cosmetic Extras Avg % off retail price No discounts Avg % off retail price Glasses (Additional pair of frames and lenses) 20% off retail price** No discounts Courtesy discount from most providers Laser Correction Surgery Discount Up to 15% off the usual charge or 5% off promotional price No discounts This is only a partial list of vision services. Your certificate of benefits will show exactly what is covered and excluded. ** For the discount to apply your purchase must be made within 12 months of the eye exam. Up to 25% off the usual charge or 5% off promotional price No discounts No discounts No discounts With the Davis Vision Designer plans, frames from the Fashion or Designer collections are covered in full in excess of the plans materials copay, if applicable. Frames from the Premier collection are covered in full in excess of a $25 copay applied in addition to the plans materials copay, if applicable. Frames from a network provider that are not in the collections are covered up to the plans retail allowance in excess of the plans materials copay, if applicable. Contact lenses from Davis Vision's Collection are available at most private practice locations with Full Feature and Materials Only plans. Contacts from the collection are covered in full including fitting and evaluation, in excess of the plan's materials copay. Elective contacts that are not part of the Collection are covered up to the plan's elective contact lens allowance and the materials copay is waived. *Due to lower prices available at Wal-mart and Sam's Club locations, discounts do not apply. Members will pay 100% of the amount over their allowance. 2

5 Most Popular Lens Options Guardian Vision featuring the VSP Choice Network For additional value, members covered under the Guardian Vision featuring the VSP Choice Network have nationwide access to competitive pricing on all lens options. Savings average 20-25%. Patient Option Single Vision 1 Multifocal 1 Solid Tints and Dyes (Pink I and II) $0 $0 Solid Plastic Dye (except Pink I and II) $15 $15 Plastic Gradient Dye $17 $17 UV Protection $16 $16 Factory Applied Scratch-resistant Coating $17 $17 Polycarbonate Lenses Polycarbonate lenses are covered in full for dependent children. $33 $37 Anti-reflective Coating $43 $43 Photochromic Lenses - Plastic $70 $82 1 Prices shown reflect the standard option price for each respective category. Premium options may vary. Prices are valid only through VSP Choice Preferred Providers and are subject to change without notice. Progressive Lenses Your members will get added value with newly priced standard and premium progressive lens option categories. Patient Option Multifocal 2 Custom Progressive - Plastic $150 - $175 Premium Progressive - Plastic $95 - $105 Solid Tints and Dyes Solid color tints and dyes are not only fashionable, they also reduce the amount of light coming through the lenses. Plastic Gradient Dyes Gradient dyes are usually dark at the top and gradually lighten toward the bottom of the lenses. UV Protection UV-treated lenses absorb the harmful portion of ultraviolet light in sunlight. Scratch-resistant Coating Scratch-resistant coatings can be applied to plastic lenses to increase their resistance to normal scratching and pitting. The result is longer-lasting, clearer lenses. Polycarbonate Lenses Polycarbonate lenses are one of the thinnest, lightest, and most impact-resistant materials available. They re great for active lifestyles. Plus, they provide UV protection and scratch resistance. Anti-reflective Coating Anti-reflective (AR) coatings reduce ghost images, glare from lights at night, light reflecting off of the back side of a lens, and eye strain caused by overhead lighting. Photochromic Lenses Photochromic lenses automatically darken when exposed to sunlight and lighten when out of sunlight. Progressive Lenses Unlike traditional bifocal and trifocal lenses that have lines, progressive lenses are line-free. Also, the power gradually changes with distance. Standard Progressive - Plastic $55 2 Prices shown reflect the range of prices for each respective category. Prices are valid only through VSP Choice Preferred Providers and are subject to change without notice. The Guardian Life Insurance Company of America, New York, NY VSP Choice Plan Effective January 1, Vision Service Plan. All rights reserved. VSP and VSP choice Plan are registered trademarks of Vision Service Plan. 5 JOB#5840CL 2/11

6 Find a Provider How to Look Up VSP Choice Network Plan Providers Online Guardian s innovative web technology lets you look up a provider right from your computer. Our Find a Provider Search function is simple and easy-to-use. Just follow these steps: Visit Guardian s web page at Click on Find A Provider at the top of the page Click on the box that says Find a Vision Provider On the next web page, do the following: Under Select Your Vision Plan Choose VSP Under Search by select Search by Location or Search by Name Under Your Location, enter Zip Code or Street Address information Under Distance select you mile radius, then Select your Vision Network Choose VSP Choice Network Note: You also have the option to include gender and foreign language spoken in your search. Click Continue to view the list of network providers You can also find a Vision provider on the go from your smart phone simply download our app at 7

7 Designer Plan Save on Eyewear Enhancements through Davis Network Members Discounts Spectacle Lenses Designer All ranges of prescriptions (single vision, bifocal, trifocal) Included Choice of glass or plastic lenses Included Oversize lenses Included Fashion or gradient tinting of plastic lenses Included Blended Segment Lenses $20 Coating - Scratch Resistant $20 Coating - Ultraviolet $12 Corning Photochromic Glass Lenses $20 Intermediate Vision Lenses $30 Polycarbonate Lenses $30* Progressive Lenses - Standard $50 Progressive Lenses (VarilexTM, etc.) - Premium $90 Coating Ultra Anti-Reflective $60 Coating - Premium Anti-Reflective $48 Coating - Standard Anti-Reflective $35 Hi-Index Lenses $55 Plastic Photosensitive Lenses $65 Polarized Lenses $75 Eyeglass Breakage Warranty Included Prices subject to change For standard eyeglass lenses, you will receive the lower of the Davis vision discounted charge or Walmart or Sam s Club everyday low price. *Polycarbonate lenses covered-in-full for monocular patients and patients with prescriptions 6.00 diopters or greater. or contact member services at for more information 9

8 Find a Provider How to Look Up Davis Vision Plan Providers Online Guardian s innovative web technology lets you look up a provider right from your computer. Our Find a Provider Search function is simple and easy-to-use. Just follow these steps: Visit Guardian s web page at Click on Find A Provider at the top of the page Click on the box that says Find a Vision Provider On the next web page, do the following: Under Select Your Vision Plan Choose Davis Vision Under Search by select Search by Location or Search by Name Under Your Location, enter Zip Code or Street Address information Under Distance select your mile radius Note: You also have the option to include gender, foreign language spoken and services available in your search. Click Continue to view the list of network providers You can also find a dentist on the go from your smart phone simply download our app at 11

9 Employee Benefits Hotline (EBH) Benefit specialists are available to answer uestions as you sign up for your Guardian benefits Monday-Friday 7:00 a.m. 8:30 p.m. EST 6:00 a.m. 7:30 p.m. CST 5:00 a.m. 6:30 p.m. MST 4:00 a.m. 5:30 p.m. PST Toll-free Phone STEP 1: Ask yourself these uestions to determine if you should call the Employee Benefits Hotline. If you answer yes to any of these uestions, prepare to contact the Hotline (go to STEP 2): Do I need help completing my enrollment forms? Do I have uestions about the benefits covered under the plans my employer is offering? Do I need to make my first vision appointment immediately following my enrollment? (If so, it s suggested you contact the Hotline at least 72 hours prior to your visit so you can ensure your provider has your coverage information. Coverage begins on your plan s effective date.) STEP 2: Prepare to contact the Hotline Name of the company you work for Your company s group number (Both can be found on the front of the enrollment materials) STEP 3: Call to get answers! Press #1 to identify yourself as an employee. At the next prompt: o Press #0 if your uestions relate to Vision Benefits Enter your company s group number IMPORTANT NOTE: The Employee Benefits Hotline provides pre-enrollment support in over 50 languages! Once you are enrolled in a plan, you will receive additional information and new toll-free phone numbers. If you are looking for a dentist or vision provider who participates in your plan, go to Anytime.com. 13

10 Thank You If applicable, return your completed form to your plan administrator. Please remember to: You chose... Vision: Option 1: VSP Check the coverage you want Include your social security number (and those of your dependents, if applicable) Include dates of birth Indicate the best way to reach you Include your name on each page of the form Sign and date form Option 2: Davis Date form submitted:

11 Make the most of your Guardian benefits at Enrolled members and their dependents can access helpful, secure information about their Guardian benefit(s) instantly at Review your benefits Look up amounts and services covered in your plan Check the status of a claim Receive alerts when a response to your dental* claim is available online Print forms and plan materials...and much more To register, go to Rochester Business Alliance Vision Benefits Plan 2005 The Guardian Life Insurance Company of America, 7 Hanover Suare, New York *Not available to members with Guardian pre-paid Dental/DHMO plans (including FirstCommonwealth and Managed DentalGuard plans). 0002