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Web Content Viewer (JSR 286)

Got questions?

We've got answers to your frequently asked questions.

FAQ

How do I use my benefits?

Follow the clear path to your benefits! Just locate a provider, schedule an appointment and receive services. We'll handle all the paperwork, when you visit an in-network provider. You can also create an account at EyeMed.com or download our mobile app through the App Store or Google Play to view your benefits, find an eye doctor near you or check the status of your claims.

 

Can I view my EyeMed benefits online?

Yes, you can view your benefits and do a lot more on our secure website. You can also print an ID card, check the status of a claim, locate a provider and download an Explanation of Benefits. You can even download the EyeMed Members App through the App Store or Google Play to get access on the go. 

 

How do I submit a claim?

When you visit one of our in-network providers we take care of all of the paperwork.  If you see an out-of-network provider AND you have out-of-network benefits as part of your plan, you’ll need to pay at the time of service and submit a claim form  online for reimbursement.  You will need to upload an itemized paid receipt with your name included.  

 

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

Yes, we provide 2 ID cards in the subscriber’s name, but you aren’t required to have it at the time of service.  If you lose your card or need extras for your family, you can print a replacement by creating an account at EyeMed.com or download the EyeMed Members App through the App Store or Google Play to pull up a digital version anytime, anywhere.

 

How do I find a provider in your network?

EyeMed makes it easy to find an eye doctor and schedule an exam online. Visit our enhanced provider search to choose from nearly 82,000 in-network providers*. You can even filter your search by your frame preferences, provider hours and much more.

*On the access network

 

Does EyeMed offer any additional discounts? 

We sure do! At participating in-network providers, members eyeing additional pairs receive 40% off a full pair or 20% off a partial pair (lenses only or frames only).  You can also receive 20% off non-prescription sunglasses and accessories.  If that’s not enough, you can create an account at EyeMed.com and login anytime to view additional special offers just for being an EyeMed member.

 

Don’t like wearing glasses or contacts? No problem. We also offer discounts on LASIK laser vision correction.  Contact the US Laser Network online or by phone at 877-5laser6 to find a provider.

 

When I register, I am not able to see any of my dependents or not all of my dependents.  Why?

Due to privacy guidelines, we only show family members who are under the age of 18 under the subscriber.  Anyone 18 or older will need to register for his or her own account.

 

Does EyeMed sell individual plans?

EyeMed currently sells individual vision insurance plans in 42 states. Visit http://individual.eyemed.com to see if an individual plan is offered in your state. EyeMed Individual and Family plans start at just $5.00 per month.

 

Can I use my benefits online?

Absolutely! You can utilize your in-network EyeMed benefits online by visiting  www.contactsdirect.com , www.lenscrafterscontacts.com or Target Optical to purchase contact lenses online.  To purchases glasses online visit www.glasses.com or Target Optical.

 

Can I apply FSA funds to out-of-pocket costs after my EyeMed benefit is applied?

Yes. You can use your Flexible Spending Account (FSA) to pay for a variety of health-related out-of pocket expenses, including those associated with supplementary benefits like an EyeMed plan. Money from the FSA can be applied toward the eye exam copay, out-of-pocket costs for prescription glasses or contact lenses (including upgrades) and supplies such as contact lens solution. Employees can even use FSA funds for LASIK surgery.

Vision care out-of-pocket costs are also eligible for Health Savings Account reimbursement, although these expenses do not count toward your annual deductible.

 

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

Getting an eye exam is not just about finding out if you need glasses. It’s about your health! An eye exam can detect eye health problems like glaucoma or cataracts, but it can also help identify early signs of diseases that impact your whole body- high blood pressure, diabetes and high cholesterol – just to name a few. To learn more about vision wellness, visit www.eyesiteonwellness.com.

 

At what age should my child first visit the eye doctor?

The American Optometric Association recommends that your child should have his or her first eye exam with an optometrist or ophthalmologist between 6 months of age and 1 year. The doctor will check for nearsightedness, farsightedness, astigmatism, amblyopia (or "lazy eye"), proper eye movement and eye alignment, how the eye reacts to light and darkness, and other eye health problems.

They also recommend that your child's next eye exam should take place sometime between the ages of 3 and 5, and then every year after that. During these exams, the doctor will conduct a comprehensive eye exam as well as vision screening tests. To learn more about your child’s vision, visit www.eyesiteonwellness.com.

 

My child gets a vision screening at school, so there is no need for an eye exam, right?

A vision screening does not take the place of an eye exam. They generally check a child’s ability to see far away and check for color blindness, but a comprehensive eye exam will evaluate the entire structure of the eye and also allow the doctor to view nerves and blood vessels, providing a glimpse into a child’s overall health. Eye doctors will also check for farsightedness, which is more common in younger children.

 

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 unless otherwise directed by your doctor. To learn more about eye exams, visit www.eyesiteonwellness.com.

 

Can I get the same quality of care at a retail provider as I can at an independent doctor?

Absolutely! In fact, many of the optometrists who practice in retail settings share space with an optical store but operate separately. All optometrists, regardless of the setting of their practice, must meet the same state licensing and credentialing requirements. In addition, due to the finite number of optometry schools in the United States, optometrists are trained consistently regardless of the practice model they eventually choose.   

 

Where can I find a list of tiers for progressive lenses and anti-reflective coatings?

You can download a pdf copy of our tier classifications here.

 

How can I find out what my appeal rights are?

It’s easy. View your appeal rights by state listed below.

State of California

Your request for a review of an adverse benefit determination must be submitted within 180 days of the date of your Explanation of Payment.

A copy of the specific rule, guideline, or protocol relied upon in the adverse benefit determination will be provided free of charge upon request by you or your authorized representative. You may also review the documents relevant to your claim.

You may seek review by the California Department of Insurance of a claim that an insurer has contested or denied by contacting the California Department of Insurance Consumer Communications Bureau, 300 South Spring Street, South Tower, Los Angeles, CA 90013, or call the Consumer Hotline at 800.927.HELP (4357), 213.897.8921 for out-of-state callers, TDD at 800.482.4TDD (4833) or online at www.insurance.ca.gov.

You have a right to enter into the dispute resolution process described in Section 10123.13 of Article 1. General Provisions – California Insurance Code.

You may have other alternative dispute resolution options, such as mediation. One way to find out what may be available is to contact your local U.S. Department of Labor office and the California Department of Insurance.

State of Delaware

You have the right to seek review of our decision regarding the amount of your reimbursement. The Delaware Insurance Department provides claim arbitration services which are in addition to, but do not replace, any other legal or equitable right you may have to review of this decision or any right of review based on your contract with us. You can contact the Delaware Insurance Department for information about arbitration by calling the Arbitration Secretary at 302-674-7322 or by sending an email to: DOIarbitration@state.de.us. All requests for arbitration must be filed within 60 days from the date you receive this notice; otherwise, this decision will be final.

State of Illinois

If you are not satisfied with a coverage decision, you are entitled to a review (appeal) of the benefit determination.  To obtain a review, you or your authorized representative should submit your request in writing to:

Member Appeals Coordinator
EyeMed Vision Care
4000 Luxottica Place
Mason, OH  45040

Your request for a review of an adverse benefit determination must be submitted within 180 days of the date of your Explanation of Payment.

A copy of the specific rule, guideline, or protocol relied upon in the adverse benefit determination will be provided free of charge upon request by you or your authorized representative.  You may also review the documents relevant to your claim.

Notice of Availability:  Part 919 of the Rules of the Illinois Department of Insurance requires that our company advise you that, if you wish to take this matter up with the Illinois Department of Insurance, it maintains a Consumer Division in Chicago at 122 S. Michigan Ave., 19th Floor, Chicago, Illinois 60603 (312-814-2420) and in Springfield at 320 West Washington Street, Springfield, Illinois 62767 (217-782-4515) or contact the Illinois Department of Insurance at http://insurance.illinois.gov/.

You may have other alternative dispute resolution options, such as mediation.  One way to find out what may be available is to contact your local U.S. Department of Labor office and the Illinois Department of Insurance.

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Glossary of Vision Terms

Anti-Reflective Coating - A common lens coating that allows more light to pass through the lens, cutting down on glare and distracting reflections.  This coating is good for night driving and is also cosmetically appealing because it allows others to see your eyes rather than the light reflection off the lenses.

Benefits - Specific dollar amounts reimbursed or specific discounts for each covered product or service.

Bifocal Lenses - Lenses prescribed for those who need correction for both far away and up close.

Claim - A request for payment of benefits.

Conventional Contact Lenses - Contact lenses designed for long-term use (up to one year); can be either daily or extended wear.

Copay - A specified dollar amount a member must pay out-of-pocket for a specified service at the time of service.

Dependent - A member’s spouse and/or child who meets the dependent criteria outlined by your employer/plan sponsor.

Disposable Contact Lenses - Contact lenses designed to be thrown away daily, weekly, bi-weekly, monthly or quarterly.

Eligible – qualified to receive benefits during a specified date range

High Index - A lighter, thinner lens material offered to those with very high prescriptions.

Lens Add-on/Option - Any option that does not come with the basic lens. This includes, but is not limited to, polycarbonate, scratch-resistant coating, tint and UV coating. May also be referred to as an “option” or “upgrade.” Add-ons listed on a plan are considered standard. Most add-ons also have premium options available.

Lenticular Lens - An infrequently-used technology needed in situations that require a high plus power that cannot be achieved 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 defined as medically necessary if the individual is diagnosed with one of the following specific conditions:

  • Anisometropia of 3D in meridian powers
  • High Ametropia exceeding –10D or +10D in meridian powers
  • Keratoconus when the member’s vision is not correctable to 20/25 in either or both eyes using standard spectacle lenses.
  • Vision improvement other than Keratoconus for members whose 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 network provider for review and approval by our Medical Director before a claim will be processed for the service.


Network (In-Network) - The doctors, clinics, health centers, medical group practices, facilities and other professional providers that a managed care organization has selected and contracted with to provide health care for its members. In the case of EyeMed, our network includes opticians, credentialed optometrists, and ophthalmologists who can provide services and/or prove glasses and contacts covered under the plan.

Out-of-Network (OON) Provider - A professional provider who is not in the network of approved/credentialed providers.

Patient Allowance - A fixed amount of dollars that may be applied toward the payment for a professional service and/or material as specified by the benefit.

Photochromic Lenses - Lenses that change color based on different levels of light. When the lenses are exposed to sunlight they darken; when exposed to lower light (indoors), they lighten.

Plastic (Basic Lens Material) - The most widely used lens material because it is lighter in weight 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 lens material that helps create a more impact-resistant lens.

Progressive Lenses - Multifocal lenses with no lines. Available in both standard and premium brands.

Provider - An optician, optometrist or ophthalmologist who is able to provide services or materials to someone with EyeMed benefits.

Scratch-Resistant Coating - A common lens coating that helps reduce scratches on the lenses.

Single Vision Lenses - Lenses prescribed for those who only need correction for one field of vision: either far away or up-close.

Tint - A common lens add-on that reduces the light that enters the eyes; can be doctor recommended or for fashion purposes.

Trifocal Lenses - Lenses prescribed for those who need correction for three fields of vision: far away, up-close and intermediate.

UV Coating - A common eyeglass lens coating that protects eyes from harmful ultraviolet light.
 

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Web Content Viewer (JSR 286)
  • 46

    million members

  • 14.2

    seconds for us to answer your call

  • 102

    hours of live-agent assistance each week

Web Content Viewer (JSR 286)

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Web Content Viewer (JSR 286)

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