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Vision Care Plan

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General Information The Vision Care Plan is a County self-funded plan administered by Vision Service Plan (VSP). Eligible Employees All regular and probationary employees who work 20 or more hours a week. Eligible dependents are your lawful spouse, dependent unmarried children to age 19, or young adult dependents to age 30 (if you provide more than 50% of his/her livelihood), domestic partners and children of domestic partners - (the County's contribution for domestic partners and children of domestic partners are considered taxable income). Benefits Vision Examination A complete analysis of the eyes and related structures to determine the presence of vision problems or other abnormalities. Examination benefits are available every 12 months. A $10 co-payment is required. Lenses The panel doctor will order the proper lenses only if needed. The doctor also verifies the accuracy of the finished lenses. Lenses are covered every 12 months if necessary. $10 co-payment is required. Frames The plan offers a wide selection of frames. However, if you select a frame which costs more than the amount allowed by your plan, there will be an additional charge. Frames are covered every 24 months if necessary. Contact Lenses An eligible member may obtain contact lenses in lieu of all other benefits - examination, lenses and frames - for the calendar year. Necessary contact lenses are furnished under the plan when the panel doctor secures prior approval for the following conditions: Following cataract surgery; to correct extreme visual acuity problems that cannot be corrected with spectacle lenses; certain conditions of Anisometropia; Keratoconus. When the panel doctors receive approval for such cases, the cost is fully covered by the plan. Cosmetic contact lenses, when chosen by patients for other reasons, will have an allowance of $150 made toward their cost by the plan. Laser Surgery An eligible member may obtain discounted fees (between 20-25%) for laser surgery services from over 70 laser centers, and 1,800 VSP participating doctors throughout the state. Receiving Benefits If you select a panel doctor, he or she will obtain payment directly from the plan and there after you only need to contact the doctor. The verification process is automated for panel doctors. If you select a non-panel provider, you must pay for services and file an itemized bill for reimbursement. The benefits for a non-panel provider are significantly reduced. Policies and Procedures Limitations Extra Cost This plan is designed to cover your visual needs rather than cosmetic materials. There will be an extra charge if you select any of the following: blended lenses; except as noted above; oversize lenses; progressive multi-focal lenses; photochromic lenses; laminated lenses; or a frame that costs more than the plan allowance. Not Covered There is no benefit for professional services or materials connected with: Orthoptics or vision training and any associated supplemental testing. Plano lenses. Two pairs of glasses in lieu of bi-focals. Lenses and frames furnished under the program which are lost or broken. They will not be replaced except at the normal intervals when services are otherwise available. Medical or surgical treatment of the eyes. Any eye examination, or any corrective eye wear, required by an employer as condition of employment. If the covered person does not obtain the VSP benefit form in advance, but visits the panel doctor as a private patient, the panel doctor is not obligated to accept VSP fees as full payment for these services, but may elect to charge his usual and customary fees. Frequency of Certain Benefits Vision examination. Once each calendar year. Lenses. Once each calendar year only if necessary. Frames. Once each two calendar years. VSP's 2003 CA Grievance System