Routine Vision Coverage
Coverage under the above plan 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.
Fundus photography is not covered and coordination of benefits is not permitted, either with respect to other vision plans or with respect to vision benefits under health insurance plans.
Contact Lens Fitting
The Community Eye Care vision benefit includes coverage for all three types of contact lens examinations --- new fittings, re-fits, and evaluations. Each of these is described below:
A new contact lens fitting is a type of exam that's performed in a member who has never before worn contact lenses. Its purpose is to determine the ideal contact lens type, size and curvature.
A re-fit is performed in either of two situations:
- an individual who previously wore contact lenses is resuming contact lens wear after a lengthy hiatus; and
- an individual who already wears contact lenses is either switching to a different type of lens (e.g. gas-permeable lenses, toric lenses, bi-focal lenses) or is in need of a change in lens diameter or base curve.
A contact lens evaluation refers to an annual evaluation that's performed in an existing contact lens wearer for the purpose of renewing their prescription or adjusting the strength of their prescription. The member is not new to contact lenses, nor are they changing to a different type of lens, a different lens diameter, or a different base curve.
Maximum coverage for contact lens fittings is $100, and maximum coverage for contact lens evaluations is $80.
You can access your 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 Community Eye Care within 180 days of the date of service. Reimbursement generally occurs within 60 days of submission.
If you obtain your eye exam from an out-of-network doctor, you will not be eligible for another exam until the next plan year. Similarly, if you obtain your full eyewear benefit from an out-of-network provider, the eyewear benefit will not renew until the next plan year. Note, however, that if you obtain only a portion of your eyewear benefit from an out-of-network provider, you are permitted to utilize the remainder of the eyewear benefit during the same plan year.
CEC will not reimburse out-of-network claims for purchases made at any of the following locations: Macy’s, Nordstrom, Belk, Dillards, Oakley, Oakley Vault, Kate Spade, Kate Spade Outlet, Coach, Coach Outlet, Designer Frames Outlet, Ray-Ban, Sunglass Hut, Solstice Sunglasses, Dick’s Sporting Goods, Bass Pro Shops, REI, Golf Galaxy, Golfsmith, Play It Again Sports, Sports Authority, Omega Sports, Academy Sports, Gander Outdoors, Visit Sun & Ski, Cabela’s, Amazon, Etsy, Ebay, The General Store, Lululemon Athletica. Note that this is a partial list and other location restrictions may apply.
Non-Prescription Eyewear Policy
Most providers in the Community Eye Care 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 the provider to make sure that this is permissible.
Community Eye Care (CEC) understands that vision plan members may encounter sales promotions (such as “two-for-one sales”) or steep discounts offered by some of our optical providers. As is true of most vision plans, your CEC vision plan is not intended for use in conjunction with these types of offers. In general, providers will allow only one of the following:
- The CEC vision benefit, or
- The sales promotion (the sale price or discount)
Members who select the sales promotion are not eligible for reimbursement for that purchase.
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.
Members receive up to a 50% discount relative to national averages on LASIK from participating providers. LASIK is not an insured benefit.
Overview of Plan Design
The vision plans offered by Community Eye Care are notable for their simplicity and ease of administration. The typical benefit consists of:
- One routine eye examination annually
- An annual allowance for eyewear (glasses and/or contact lenses)
- A contact lens fitting or evaluation annually
The eyewear allowance acts like a credit. So long as the member selects eyewear having a retail price that’s less than or equal to the allowance, the member incurs no out-of-pocket expense (except for any applicable co-pay). If the member exceeds their allowance, they are eligible for discounts on the balance. Note that there are no limitations on the choice of eyewear, i.e., the member does not have to select frames and lenses from a limited selection of “plan eyewear.”
Should a CEC member leave employment, the member is given the option of continuing their vision benefit at the same rate for as long as they wish. CEC handles all administration.
The voluntary vision plans administered by Community Eye Care are employee-paid, with fees handled through payroll deduction. Many clients opt to place the CEC vision benefit under their Section 125 Plan so that employees can enjoy a pre-tax advantage. Self-funded options are also available.
Note that CEC has no minimum level of participation within each employer group.
Regular eye examinations and accurate eyewear prescriptions benefit health in a variety of ways. The clarity of sight afforded by proper glasses or contact lenses reduces eyestrain, blurred vision, computer-related fatigue and headaches. As a result, efficiency and job productivity are enhanced.
Many eye diseases can be detected before symptoms occur by performing a detailed examination of the eye. These include glaucoma, macular degeneration, and diabetic retinopathy. The early detection of these conditions allows treatment to be instituted at a stage of disease when vision can still be preserved.
Nearly all systemic diseases have ocular manifestations. An examination of the eye may disclose evidence of high blood pressure, diabetes, heart disease, blood disorders, multiple sclerosis, autoimmune diseases, systemic infections, metabolic abnormalities, or cancer. For patients with known systemic disease, such as diabetes, regular monitoring of the eye is critical to detecting the appearance of treatable ocular complications. In patients who are presumed to be healthy, an eye examination may provide the first clue to the presence of an underlying disorder.