Routine Vision Coverage
CEC vision benefits are for routine eye care. Routine exams and contact lens fittings, as needed, and eyewear are covered by the CEC full-service benefit. CEC vision coverage does not include medical treatment or surgical treatment of the eyes. Examples that could necessitate your visit being filed, by your provider, to your medical insurance include diabetes mellitus, glaucoma, cataracts, and other medical conditions.
Routine Retinal Screening
A routine retinal screening is an enhancement to the member's annual eye exam when seeing a CEC provider.
Frequency - Once per year
Copay - Up to $39.00
Coverage - Covered after copay
Routine Retinal Screening discounts available through most CEC providers. Not applicable for out-of-network claims.
Most providers in the CEC network offer vision plan members a 20% overage discount on glasses and a 10% overage discount on contacts on amounts exceeding the eyewear allowance. However, by law, CEC providers are not required to offer the overage discounts. In addition, some providers will offer vision plan members a 20% discount on additional pairs of glasses. Note that not all plans include overage discounts in the benefit.
Non-Prescription Eyewear Policy
Most providers in the CEC network allow vision plan members to use their eyewear allowance for the purchase of non-prescription eyewear. However, CEC providers are not required to extend coverage to non-prescription items, and a few have opted to restrict coverage to prescription eyewear.
Before using your eyewear allowance to obtain non-prescription eyewear, please check with your provider to make sure that this is permissible.
CEC members can utilize their vision benefit either in-network or out-of-network. Members who opt to see an out-of-network provider must pay the provider's full charges at the time of the visit, obtain a receipt, and file a claim with CEC within 180 days of the date of service. Co-pays for out-of-network visits are deducted from reimbursements. Reimbursement generally occurs within 60 days of submission. Note that out-of-network provider / practice locations must be able to fill an eyewear prescription even if non-prescription eyewear is purchased. The same out-of-network protocol applies to eyewear purchased online.
Coordination of Benefits
Coordination of benefits is not permitted, either with respect to other vision plans or with respect to vision benefits under health insurance plans.
CEC vision benefits are offered on a plan year basis. If an eye exam and / or contact lens exam is obtained, you will not be eligible for another exam until the next plan year. Similarly, if you utilize your full eyewear benefit provider, the eyewear benefit will not renew until the next plan year. If, however, you obtain only a portion of your eyewear benefit, you are permitted to utilize the remainder of the eyewear benefit during the same plan year. This protocol is valid for both CEC network providers and out-of-network providers.
Members are eligible to receive up to a 50% discount relative to national averages on LASIK from participating providers, including TLC Laser Eye Center. LASIK is not a covered benefit.