Why should I have my eyes examined regularly?
Comprehensive eye exams are essential not just for detecting vision problems but are also important as a preventive measure for maintaining overall health and wellness and can detect medical eye conditions.Your vision benefit is designed to protect and enhance your eyesight – your most important sense. Caring for your eyes should always be a part of your regular healthcare routine.
What is a comprehensive examination?
Network providers are contracted to perform comprehensive examinations as detailed in the EyeMed Professional Provider Manual. These exams not only evaluate a member’s vision but can lead to the detection of many medical conditions that should be treated by the patient’s medical doctor, such as hypertension, arteriosclerosis, glaucoma, macular degeneration, and diabetes. Ultimately, comprehensive eye exams contribute to an overall wellness program.
Some of the tests and procedures performed with these exams include:
- Case History
- Evaluation of visual system’s status
- Refractive Status
- Binocular Function
- Assessment, diagnosis, and treatment plan
The tests performed during examinations may vary according to age, type, and severity of the conditions present or other contributing factors.
Is dilation included in the comprehensive examination?
Dilation is covered by the comprehensive examination when the network provider determines it is appropriate for the member. The decision to dilate is left to the professional judgment of the provider, subject to state law requirements, and may be critical to the final diagnosis in a thorough eye examination. Dilation allows the doctor to better view the back of the eye, as well as important components and structures – such as blood vessels, nerves, and other related tissues. In fact, it is dilation that makes an eye exam a key part of an overall wellness program because it allows doctors to detect early signs of serious illnesses such as diabetes, hypertension, and heart disease.
What is the difference between a routine eye exam and a contact lens exam?
Routine eye exams are designed to detect vision problems and determine overall wellness.
Contact lens exams are designed to evaluate your vision and comfort wearing contacts lenses. Although your vision may be clear and you feel no discomfort from your lenses, there are potential risk factors with improper wearing or fitting of contact lenses that can affect the overall health of your eyes. The contact lens exam assures proper fit of contact lenses.
How can I find out more about Laser Vision Correction?
Members can learn more at the GVS Member page.
What is the average turnaround time for eyeglass orders?
Some of our providers have the ability to fabricate eyewear in “about an hour” or same day.
Turnaround time on materials may vary depending on the prescription level and the policies and procedures of a particular provider.
What lenses are covered under the plan?
Standard lenses include basic plastic single vision, bifocal, and trifocal lenses. All lenses must meet ANSI standards for quality.
Are Safety Glasses covered?
Safety glasses are excluded under the funded vision program, however GVS offers a discount program. See Member page for more details.
What frames are covered by my plan?
Members have a plan retail frame allowance which may be applied to the frame of their choice. If the member chooses a frame costing greater than the plan allowance the member will receive a 20% discount off the balance over the plan allowance.
Do you use frame tower?
We allow members to apply their frame allowance to any available frame at a provider location. This true choice results in increased member satisfaction with the plan. If a member goes over the allowance, the member will receive 20% off the balance for even greater savings. Members can also apply their frame allowance toward the purchase of prescription sunglasses.
What type of contact lens coverage do you provide?
A plan allowance is provided toward the purchase of conventional or disposable contact lenses.
What is a contact lens fitting and evaluation?
It is extremely important to one’s health and comfort to be accurately measured and fitted for contact lenses. If a member decides to wear contact lenses for the first time, an evaluation will be performed to determine whether or not the member is a candidate for contact lenses. While most people can wear contact lenses, there are some instances where they are not recommended. After the determination is made that the member can wear contact lenses, or if the member is currently a contact lens wearer, measurements of the eye will be taken in order to prescribe lenses that will properly fit. The provider will then dispense the contact lenses with the proper prescription and fitting parameters (i.e., overall diameter, base curvature, peripheral curves, thickness, etc.) to the member. If the member is a first-time wearer, the provider will instruct the member on the proper way to insert, remove, and care for contact lenses. At this time, the member will have the opportunity to ask any questions he or she may have.
Are discounts available for additional purchases?
The GVS product includes an Additional Saving Program through in network providers at no cost to members or employer groups. Additional pair purchases are available at a 40% discount. Other items include some non-prescription sunglasses, lens cleaning supplies, contact lens solutions and eyeglass cases, etc. are available at a 20% discount from in network providers.
Discounts are not insured benefits.
Is there a limit to the number of purchases a member can make utilizing the Additional Savings Program?
There is no limit to the number of purchases made under the Additional Saving Program.
Are Contact Lenses offered on a discount basis?
Yes, conventional/traditional lenses are offered with 15 percent discount over the contact lens allowance.
Will members receive a laser vision discount?
Yes, members can find more information regarding laser vision correction, network providers and discount pricing at the GVS member page.
Are there savings on mail-service contacts?
Yes, members can find more information regarding mail order contact lenses and pricing at the GVS member page..
Can I use a coupon or buy one get one free offer with my benefits?
Members often question the value of promotions i.e., coupons or buy one get one (BOGO) and how they can be used in conjunction with their vision care coverage. Members can use the benefit with some promotions by applying their Out-of-Network Reimbursement Schedule included in your vision plan. Promotions and coupons may not be used in conjunction with your in-network covered benefit.
Members will be responsible for all costs at the time of service and submit the receipts with an Out-of-Network claim form for reimbursement. An Out-of-Network claim form is available on the GVS members tab.
What is the Customer Service number?
Members may reach a customer service agent or the IVR at 866-265-4626
What are the Customer Service hours of operation?
Agents are available 7 days a week from 8:00 a.m. to 11:00 p.m. EST – Monday through Saturday and 11:00 a.m. to 8:00 p.m. EST – Sunday
Do I need to get preauthorization from my primary Doctor?
No preauthorization is required. However, you do need to make sure you are eligible for benefits at the time. You can check your benefit availability by logging on to the member portal.
Can I get the exam at one provider’s office and the hardware at another location.
Yes, but be certain to let each provider know you are a GVS/EyeMed member at the time of service. The provider will then verify your eligibility.
What is my benefit coverage?
You can check your benefit availability and level of coverage by logging on to the member portal on the member page.
Most plans cover a routine eye exam, frame, and lenses, or contact lenses, however the benefit frequencies will depend on the plan design selected by the group.
Are both eyeglasses and contacts covered by my plan?
Yes, both eyeglasses and contacts are covered benefits however you are eligible for one set of services during your benefit period. You may choose eyeglasses or contact lenses instead of eyeglasses. Neither benefit is not available at the same time. If you choose to purchase, contact lenses or eyeglasses in addition to your covered benefit you will receive a discount under the Additional Saving Program.
Do I have to visit a participating provider?
No, you can go to a non-network provider and submit the claim yourself for reimbursement according to the schedule located in your certificate of coverage. Maximum benefits are achieved when services and materials are obtained from a In Network Provider. An Out-of-Network claim form is located on the member page
Is there any kind of warranty on my eyeglasses?
That is determined by the manufacturer and provider however, additional warranties may be available from the provider at an additional cost.
How do I submit an out-of-network claim for reimbursement?
If you are eligible for services from an out-of-network provider, pay the entire bill directly to the provider directly at the time of services. Then send the following information:
- A copy of the itemized bill/receipt listing the services you received.
- The name, address, and phone number of the out-of-network provider
- The covered member’s Social Security number or member identification number
- The covered member’s name, phone number and address
- The name of the group that provides your benefit coverage.
- The patient’s name, date of birth, phone number and address
- The patient’s relationship to the covered member i.e., spouse, child, etc.
Return the completed form and your itemized paid receipts to: EyeMed Vision Care/GVS, Attn: OON Claims, P.O. Box 8504, Mason, OH 45040-7111
Is your network National?
Network providers are located in all fifty states including Puerto Rico.
How can members find network providers?
Customers may locate network providers by calling the customer service number at 866-265-4626 or on the provider page.
Do you offer a provider directory?
The most updated and current information network listing is located on the web site at provider page.
Providers do not often leave the network but many join and the electronic directory is automatically updated on a weekly basis. Customer Service representatives can provide members with a list of the ten closest providers to the members location, but we do not provide hard copy state directories for member distribution.
Will you add providers to the network at a member’s request?
Yes, members may request that their provider join the network. Providers can logon to the Provider site for more information about joining the network www.eyemedvisioncare.com
Do I need an I.D. card?
You do not need an I.D. card to visit a network provider. Simply call a network provider to schedule an appointment. Be sure to tell the provider you are a GVS/EyeMed member when making your appointment. The provider’s office will verify benefit levels and eligibility and we manage the rest!
Am I responsible for a copayment when I visit my network provider?
Yes, if your group’s plan coverage includes a copayment, you will need to pay that to the network provider during your visit. Copayments typically apply to both you and your covered dependents. Copayments typically apply to the examination and materials. Materials are identified as lenses and frames or contact lenses.
WHAT DOES THIS MEAN?
Anti-reflective coating – By allowing more light into your eye, anti-reflective (AR) coatings are designed to greatly reduce reflections on your lenses that can compromise visual clarity. This means you may see better. An AR coating can also help improve your night vision and make night driving safer. The reduced glare allows others to see your eyes more clearly, too.
Bifocal lenses – Bifocal lenses include two different areas of vision correction, which are divided by a distinct line that sits horizontally across the lens. The top portion of the lens is used for distance and the bottom portion of the lens is used for closer vision.
Claim – A request for payment of benefits; if you go to an in-network eye doctor, they will send this to EyeMed, so you do not have to.
Conventional contact lenses – Contact lenses designed for long-term use (up to one year); can be either daily or extended wear.
Copay – A fixed amount that you pay out-of-pocket at the time of your visit. Check your plan details for your specific copays and benefits.
Dependent – A member’s spouse or child who meets criteria outlined by your specific plan.
Digital lenses – Digital lenses, also sometimes referred to as high definition or HD lenses are digitally made for accuracy and designed to provide sharper vision, improved peripheral vision and increased clarity to help colors appear more defined and details more vivid. Often, these lenses require additional measurements to personalize the lens for you.
Disposable contact lenses – Contact lenses designed to be thrown away daily, weekly, bi-weekly, monthly, or quarterly.
Eligible – Approved to receive benefits.
High index – This super thin lens is best for those with a strong prescription. They are designed to bend light more efficiently and allow light to travel faster through them. Your eye doctor may want you to use a high-index lens depending on your prescription and the frame you choose.
Lens add-on – Any option that does not come with the basic lens, like polycarbonate, scratch-resistant coating, tint, and UV coating. You might hear it called an “option” or “upgrade.” Your EyeMed benefits cover most of the cost of these options, while you pay a copay.
Lenticular lens – Used only when a significant vision correction cannot be reached with a traditional lens. This technology involves bonding one lens to the center of another to reach the correct power.
Medically necessary contact lenses – Contact lenses are medically necessary if you are diagnosed with one of these conditions (ask your eye doctor for more info):
- Anisometropia of 3D in meridian powers
- High Ametropia exceeding – 10D or +10D in meridian powers.
- Keratoconus when vision is not correctable to 20/30 in either or both eyes using standard spectacle lenses.
- Vision improvement other than Keratoconus when vision can be corrected two lines of improvement on the visual acuity chart when compared to the best corrected standard spectacle lenses.
All requests for medically necessary contact lenses must be submitted by your eye doctor for review and approved by our Medical Director before a claim will be processed.
Network (In-network) – The group of professional providers that we contract with to provide vision care for our members. Our network includes opticians, credentialed optometrists, and ophthalmologists who can provide services, eyeglasses and contacts covered under the plan.
Out-of-network (OON) provider – A professional provider who is not in our network of approved, credentialed providers.
Photochromic lenses – Sometimes also referred to as variable tint or light-adaptive lenses, these lenses change color based on various levels of light. Transitions® lenses are the most popular photochromic lenses. They continuously adapt to changing light conditions and are virtually clear indoors and at night. Plus, they also block UV rays and filter blue light.
Plastic (basic lens material) – The most widely-used lens material because it is lighter than glass.
Polarized lenses – A common lens add-on that cuts down on glare from the sun. Ideal for driving or outdoor activities, especially water and snow sports.
Polycarbonate – A commonly-used lighter, thinner material that helps your lenses resist impact.
Progressive lenses – Bifocal or trifocal lenses with no lines; available in both standard and premium brands.
Provider – An optician, optometrist or ophthalmologist who offers eye care or eyewear to EyeMed members.
Scratch-resistant coating – A common lens coating that helps reduce lens scratches.
Single vision lenses – Lenses prescribed for people who only need help seeing either far away or up close (not both).
Tint – A common lens add-on that reduces the light that enters your eyes; can be added because your eye doctor recommends it or because you simply like the style.
Trifocal lenses – Lenses prescribed for people who need help seeing far away, up close, and in between.
Ultra-Violet Coating (UV) – In addition to the UV protection provided by your lens material (think polycarbonate), a UV coating protects your eyes from UV light being reflected off the lens and back into your eye. Over time, prolonged exposure to these rays can be damaging to your eyes.