Routine Vision Coverage
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. Additionally, fundus photography is not covered under your CEC plan.
Contact Lens Fitting
The CEC vision benefit includes coverage for all three types of contact lens examinations --- new fittings, re-fits and evaluations. Maximum coverage for contact lens fittings is $100, and maximum coverage for contact lens evaluations is $80. Any amount that exceeds the maximum coverage is not covered.
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. Note that not all plans include overage discounts in the benefit.
As is true of most vision plans, providers will only allow members to use either their vision benefit allowance or an optical discount/promotion. Members who select the sales promotion (such as “two-for-one sales”) or a steep discount are not eligible for reimbursement from CEC for that purchase. Therefore, members cannot buy their eyewear at the sales promotion and submit an out-of-network claim for reimbursement for that purchase. The member will still be able to use their CEC benefit at a later date either through the same provider or through a different provider.
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. 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.
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.
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.