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General vision plan questions

I don’t wear glasses and can see fine! Why do I need an eye exam?

Getting an eye exam is part of a healthy person’s regular routine, whether your vision is 20/20 or requires correction, in addition to detecting glaucoma or cataracts, an eye exam may detect other health issues such as high blood pressure, diabetes and high cholesterol – just to name a few.EyeMed Individual and Family Vision Plans offer all members an eye exam to ‘keep an eye’ on your health.

How often should I get an eye exam?

As with any type of ongoing health care, annual eye exams are a good rule of thumb useless otherwise directed by your doctor.

How long does an eye exam typically take?

We recommend that you plan for about one hour, to be on the safe side. Most appointments start and end within 30 minutes to one hour. If your eyesight requires multiple tests or if your have a more complex problem, the exam may run longer or require subsequent visits.

Why does the eye doctor perform so many tests?

Eye doctors perform various tests to examine all parts of the eye, as well as to gauge your overall health. Some procedures are designed to evaluate your vision, others allow the doctor to look at the structure of the eye, and still others help detect specific diseases. Visit www.EyeSiteOnWellness.com for additional information and videos about what to expect during an eye exam.

Product & benefit questions

Will I get an ID card? How do I order replacements or extra cards?

Yes, we provide ID cards upon enrollment in the EyeMed Individual and Family Vision Plan, but you are not required to have the ID card at the time of service. If you lose your card or need extras for your family, you can get them anytime online at customer.sasid.com/eyemed or contact us at (844) 225-3107.

Is there a waiting period?

There are no waiting periods. Your benefits can be used on the first day of your effective date. For example, if you purchase on EyeMed plan on March 12, you can begin to use your benefits on April 1, you effective date.

Where can I go to use my benefits?

Find addresses and contact information for our independent, and retail providers via the Provider Locator or by calling our Customer Care Center at (844) 225-3107. Go online, and you can access turn-by-turn directions.

Does EyeMed offer any additional discounts?

We sure do. At in-network providers, members receive 40% discount off complete pair eyeglass purchases, 15% discount off conventional contacts, and 20% discount off non-prescription sunglasses and accessories. Don’t like wearing glasses or contacts? No problem. We also offer discounts on LASIK laser vision correction. We’re committed to saving our members money by offering additional discounts on non-covered items. However, recent state mandates allow providers in some areas to choose how they administer discounts on non-covered services. The good news is, we have found that nearly all of our providers have chosen to continue to administer our stated discounts consistently. To make it easy to find a provider who honors our discounts, our Provider Locator clearly indicates locations that have chosen not to honor our discounts on non-covered services. And just to be safe, you should always call ahead to confirm a provider’s participation in your plan. Discounts are not insured benefits. ­

What are the exclusions and limitations?

No Benefits will be paid for services or materials connected with or charges arising from: Orthopic or vision training, subnormal vision aids and any associated supplemental testing; Aniseikonic lenses, Medical, pathological, and/or surgical treatment of the eye, eyes or supporting structures; Any Vision Materials (Healthy Plan only); Any Vision Examination, or any corrective eyewear required as a condition of employment; Safety eyewear; Services provided as a result of any workers’ compensation law, or similar legislation, or required by any governmental agency or program whether federal, state or subdivisions thereof; Plano (non-prescription) lenses; Non-prescription sunglasses; or Two pair of glasses in lieu of bifocals (Bold & Bright Plans only). Any sales tax charged by the Provider as part of the transaction for covered services are not covered under this Policy. Fees charged by a Provider for services other than those covered under the Policy must be paid in full by the insured person to the Provider. Such fees or materials are not covered under this policy. Out-of-Network Provider expenses do not apply toward In-Network Provider expenses and In-Network Provider expenses do not apply toward Out-of-network Provider expenses. All providers are not required to carry all brands at all levels. Not available in all states. Some provisions, benefits, exclusions or limitations may vary by state.

What are the termination of coverage provisions?

Your vision coverage will continue until the last day for which you paid premium, subject to the grace period. Coverage will end on any premium due date the Company elects to non-renew the policy or on any date you provide a written request to cancel coverage. Any dependents covered will terminate on the same date your coverage ends; at the end of the policy year in which your dependent ceases to be eligible; or on the last day for which premium was paid, subject to the grace period. If an act of fraud is committed against the insurance company, all coverage will end on the date such determination is made by a court of law.

Are out-of-network benefits covered?

Out-of-network benefit coverage is provided, but members must pay for services first. Rather than use of out-of-network providers, EyeMed Individual and Family Vision Plan members already have access to a very large network of independent providers and retail locations. In fact, we have over 44,000 providers at thousands of locations. Independent providers are providers affiliated with LensCrafters, Pearle Vision, Sears Optical, Target Optical, and JC Penney Optical and are all represented on the EyeMed network. (Please note: out-of-pocket expenses at the time of purchase.)

How do I submit a claim?

When you visit one of our in-network providers, we take care of all the paperwork. If you see an out-of-network provider, you will need to pay at the time of service. Download a claim form and send to us for reimbursement, address listed on claim form.

What is covered under my plan1?

Depending on the plan selected, your plan may include an eye exam and discounts on glasses (lenses and frames) and lens options, or an eye exam, glasses (lenses and frames or contact lenses. Please refer to your summary of benefits for coverage details, or view your benefits online.

Can I get both glasses and contacts?

Depending on the plan selected, the policies will only cover glasses or contacts; however members can receive 40% off another complete pair of eyeglasses and a 15% discount off conventional contact lenses once the covered benefit has been used. Discounts are not insured benefits. Some in-network providers may exclude some discounts. Please ask your provider for an out-of-pocket amount for your purchase.

Can I get LASIK vision correction?

LASIK is offered at a 15% discount off the retail price or 5% off the promotional price for LASIK or PRK from the U.S. Laser Network, owned and operated by LCA Vision. It is just an additional discount you receive as an EyeMed Individual and Family Plan member. Please refer to your summary or benefits for additional discounts. Contact the U.S. Laser Network online or by phone at 877-5-LASER-6 [(877) 552-7376] to find an in-network provider.

Network questions

How do I find an in-network provider in your network?

Our directory of more than 44,000 independent and retail providers and the locations where they practice can be accessed via EyeMed’s user-friendly Provider Locator or by calling the Customer Care Center at (844) 225-3107. Choose providers based on location, special services like languages spoken by employees, technology available and designer frame line available. You can even schedule an appointment online with many in-network providers. How’s that for a one-stop shop?

Customer service questions

Who can I contact for help?

For benefit and provider information call (844) 225-3107 during these hours:
Monday – Saturday: 7:30 am to 11:00 pm EST
Sunday: 11:00 am to 8:00 pm EST

For billing, address, dependent or cancellation questions call (844) 225-3107 during these hours:
Monday – Thursday: 8:00 am to 8:00 pm EST
Friday: 8:00 am to 6:00 pm EST

1 2015 EyeMed Vision Care. All Rights Reserved.

-About High Blood Pressure,” American Heart Association, http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/About-High-Blood-Pressure_UCM_002050_Article.jsp
  -Lloyd-Jones D, Adams RJ, Brown TM, et al., Heart Disease and Stroke Statistics-2010 Update, A Report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee, Circulation, 2010, 121:e1-e170.
  -Hypertension and Your Eyes,” Transitions Optical Inc. – See more at: http://www.eyesightonwellness.com/open-your-eyes-to-high-blood-pressure/#sthash.Kj6KLxEa.dpuf

Marketed by EyeMed Vision Care, LLC, underwritten by Fidelity Security Life Insurance Company,and administered by First American Administrators and Insurance TPA.com and serviced by EyeMed. EyeMed is licensed in California as EyeMed Vision Care & Insurance Services, LLC. Telephone selling performed by SASid, Inc.
Policy for Covered California marketplace only: Policy number VC-134; form number M-9172CA/M-9174CA.
All frame brands not available at all locations. Discounts are not insured benefits.