new in 2020: enhanced vision network · 27-11-2018  · adult vision care begins on the first day...

2
Vision and Dental All Blue Option plans include our routine pediatric and adult vision coverage through an independent company, Physicians Eyecare Network (PEN). PEN provides vision services through the Physician Eyecare Plan (PEP) on behalf of BlueChoice HealthPlan. You have access to these retail providers: Walmart Vision Center, Pearle Vision, Sam’s Club Optical, LensCrafters, Target Optical, Sear’s Optical, Eyeglass World and America’s Best. Pediatric Vision Care * For children (ages 0-18), this includes: • $15 copay for one annual routine eye exam • $49 copay for one standard contact lens fitting or 15% discount off the provider’s non-standard contact lens fitting fee. • $150 material allowance with a $25 copay every benefit year for glasses and contacts that can be spent on frames, lenses and lens upgrades with no limits on frame or lens selection. • Discounts of 20% on glasses and 15% on contacts on any amounts spent over the material allowance (at most providers). • For members outside the South Carolina service area, up to $40 will be allowed toward the routine eye exam and up to 65% of the material allowance that is used, less material copay. The member must file claims. *For dependent children until the age of 18. Adult vision care begins on the first day of the month following their 19th birthday. Please note: For pediatric vision, you must visit an in-network provider to receive this benefit. Costs incurred from these services count toward maximum out-of-pocket (MOOP) expenses. These benefits are essential. Adult Vision For adult vision care (ages 19 and over), this includes: • $0 copay for one annual routine eye exam. • $49 copay for one standard contact lens fitting or 15% discount off the provider’s non-standard contact lens fitting fee. • $150 material allowance with $0 copay every benefit year for glasses and contacts that can be spent on frames, lens and lenses upgrades with no limits on frame or lens selection. • Discounts of 20% on glasses and 15% on contacts on any amounts spent over the material allowance (at most providers). • For members outside the South Carolina service area, up to $40 will be allowed toward the routine eye exam and up to 65% of the material allowance that is used, less material copay. The member must file claims. Please note that you must visit an in-network provider to receive this benefit. Costs incurred from these services do not count toward MOOP expenses. Consult your PEP provider for information on discounts for which you may be eligible if you elect to receive eyewear/contact lenses outside the standard designated selection. These benefits are non-essential. NEW IN 2020: Enhanced Vision Network

Upload: others

Post on 16-Oct-2020

1 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: NEW IN 2020: Enhanced Vision Network · 27-11-2018  · Adult vision care begins on the first day of the month following their 19th birthday. Please note: For pediatric vision, you

Vision and Dental

Please note: There should be a white line on top and bottom of this pattern strip the same width as the white lines in the graphic when used on a color background or photo. They are present in this vector image.

QuickEnroll

QuickBill

FOCUSfwd GreatExpectations

Hearing Aids

Biometric Screening

Learning Management System

TobaccoCessationBlueChoice

HealthPlan WireMy Health

ToolkitRewards

2018 Icons - Cumulative

Bases

Storefront

REV: 11/27/2018

Education Center

Laboratory Benefits Mgmt

Physician’s Office Manual

News

BlueOption

Blues Flash

ProducersGuide

Discounts andAdded Values

Business ADV Core ServicesCore ServicesHealth Care Reform

Video Carolina ADVAdvantage Plus MyChoice ADV Primary Choice Medical PoliciesFlexible Savings

AccountHealth

Reimbursement Account

EmployeeAssistanceProgram

Mobile App

QuickEnroll

QuickBill

FOCUSfwd GreatExpectations

Hearing Aids

Biometric Screening

Learning Management System

TobaccoCessationBlueChoice

HealthPlan WireMy Health

ToolkitRewards

2018 Icons - Cumulative

Bases

Storefront

REV: 11/27/2018

Education Center

Laboratory Benefits Mgmt

Physician’s Office Manual

News

BlueOption

Blues Flash

ProducersGuide

Discounts andAdded Values

Business ADV Core ServicesCore ServicesHealth Care Reform

Video Carolina ADVAdvantage Plus MyChoice ADV Primary Choice Medical PoliciesFlexible Savings

AccountHealth

Reimbursement Account

EmployeeAssistanceProgram

Mobile App

AllBlueOptionplansincludeourroutinepediatricandadultvisioncoveragethroughanindependentcompany,

PhysiciansEyecareNetwork(PEN).PENprovidesvisionservicesthroughthePhysicianEyecarePlan(PEP)onbehalfof

BlueChoiceHealthPlan.

Youhaveaccesstotheseretailproviders:WalmartVisionCenter,PearleVision,Sam’sClubOptical,LensCrafters,Target

Optical,Sear’sOptical,EyeglassWorldandAmerica’sBest.

Pediatric Vision Care*

For children (ages 0-18), this includes:

• $15 copay for one annual routine eye exam

•$49copayforonestandardcontactlensfittingor15%discountofftheprovider’snon-standardcontactlensfittingfee.

•$150materialallowancewitha$25copayeverybenefityearforglassesandcontactsthatcanbespentonframes,lenses

andlensupgradeswithnolimitsonframeorlensselection.

•Discountsof20%onglassesand15%oncontactsonanyamountsspentoverthematerialallowance(atmostproviders).

•FormembersoutsidetheSouthCarolinaservicearea,upto$40willbeallowedtowardtheroutineeyeexamandupto

65%ofthematerialallowancethatisused,lessmaterialcopay.Themembermustfileclaims.*Fordependentchildrenuntiltheageof18.Adultvisioncarebeginsonthefirstdayofthemonthfollowingtheir19thbirthday.

Please note: For pediatric vision, you must visit an in-network provider to receive this benefit. Costs incurred from these services count toward maximum out-of-pocket (MOOP) expenses. These benefits are essential.

Adult VisionForadultvisioncare(ages19andover),thisincludes:

•$0copayforoneannualroutineeyeexam.

•$49copayforonestandardcontactlensfittingor15%discountofftheprovider’snon-standardcontactlensfittingfee.

•$150materialallowancewith$0copayeverybenefityearforglassesandcontactsthatcanbespentonframes,lensand

lensesupgradeswithnolimitsonframeorlensselection.

•Discountsof20%onglassesand15%oncontactsonanyamountsspentoverthematerialallowance(atmostproviders).

•FormembersoutsidetheSouthCarolinaservicearea,upto$40willbeallowedtowardtheroutineeyeexamandupto

65%ofthematerialallowancethatisused,lessmaterialcopay.Themembermustfileclaims.

Please note that you must visit an in-network provider to receive this benefit. Costs incurred from these services do not count toward MOOP expenses. Consult your PEP provider for information on discounts for which you may be eligible if you elect to receive eyewear/contact lenses outside the standard designated selection. These benefits are non-essential.

NEW IN 2020:Enhanced

Vision Network

Page 2: NEW IN 2020: Enhanced Vision Network · 27-11-2018  · Adult vision care begins on the first day of the month following their 19th birthday. Please note: For pediatric vision, you

Please note: There should be a white line on top and bottom of this pattern strip the same width as the white lines in the graphic when used on a color background or photo. They are present in this vector image.

Dental CarePlansincludeadentalallowanceforadultsandchildrenforexamsandcleanings.Thisbenefitcoversanallowed

amountperbenefitperiodforexamsandcleaningsatanylicenseddentist.

For Adults:•Oneexameverysixmonths:$50allowanceforinitial/$50allowanceforperiodic.

•Onecleaningeverysixmonths:$50allowance.

For Children:•Oneexameverysixmonths:$50allowanceforinitial/$50allowanceforperiodic.

•Onecleaningeverysixmonths:$50allowance.

Memberswillberesponsibleforpayinganyadditionalbalanceabovewhatcopaywecover.Youwillneedtosubmita

dentalreimbursementformtoBlueChoice®forreimbursement.

Forexample,ifyourdentistchargesyou$80foraninitialexam,youwillpayyourdentist$80atthetimeofservice.Wewill

reimburseyou$50oncewereceiveyourreimbursementform.

Costs incurred from these services do not count toward MOOP expenses.

BlueChoiceHealthPlanofSouthCarolinaisanindependentlicenseeoftheBlueCrossandBlueShieldAssociation.

Focus on life. Focus on health. Stay focused.

2110

32-9

-201

9

QuickEnroll

QuickBill

FOCUSfwd GreatExpectations

Hearing Aids

Biometric Screening

Learning Management System

TobaccoCessationBlueChoice

HealthPlan WireMy Health

ToolkitRewards

2018 Icons - Cumulative

Bases

Storefront

REV: 11/27/2018

Education Center

Laboratory Benefits Mgmt

Physician’s Office Manual

News

BlueOption

Blues Flash

ProducersGuide

Discounts andAdded Values

Business ADV Core ServicesCore ServicesHealth Care Reform

Video Carolina ADVAdvantage Plus MyChoice ADV Primary Choice Medical PoliciesFlexible Savings

AccountHealth

Reimbursement Account

EmployeeAssistanceProgram

Mobile App