Vision Benefits Enrollment Information

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Vision Benefits Enrollment Information
®
SM
Vision Benefits
Enrollment
Infor ma tion
Select Plus 100 Plan
&
Select Plus 150 Plan
St. Petersburg College
®
SM
Who is Advantica?
At Advantica EyeCare our eyes are on your future and helping you maintain good vision health. We provide comprehensive eye care plans
for employer groups and managed care companies of all sizes. Our national network includes more than 10,000 vision care provider
locations offering benefits and services to over two million Advantica members across the country.
Advantica’s Vision is Focused on Our Clients
At Advantica EyeCare we do one thing, and we do it well. We provide vision care.
This vision-only focus has helped us achieve high marks with our clients, consistenty
ranking above 95% on member satisfaction and above 98% on several benchmarks
in audit reviews by major health plans.
95% in Member Satisfaction
98% in audit reviews by Major Health Plans
As your vision care partner, we are able to carefully balance the need for greater
benefits and better service while remaining sensitive to your specific cost
considerations. As a result, Advantica EyeCare has become one of the largest
regional vision benefits companies in the U.S. with more than two million satisfied
customers and growing.
In addition to providing superior consumer-driven vision plans, Advantica also
provides 24/7 access to eligibility status via our website and our toll-free number. In
fact, we promise 100% satisfaction in everything we do.
The Need for Vision Care is Plain to See.
Diabetic retinopathy is
the most common
diabetic eye disease
and leading cause of
blindness in American
adults. It is caused by
changes in the blood
vessels of the retina.
Diabetic Retinopathy
Normal Vision
- More than one million Americans, age 40 and over, are blind
from eye disease.
- Approximately 50,000 people will lose their sight this year due
to eye related dieases.
- 50% of eye related diseases can be prevented with annual eye
exams.
Glaucoma
Glaucoma leads to
blindness by
damaging the optic
nerve. Elevated
pressure in the eye is
a risk factor, but even
people with normal
pressure can lose
vision to glaucoma.
- Routine eye exams detect cataracts, glaucoma, macular
degeneration and retinal detachment.
- Serious health problems such as diabetes, hypertension and
other health conditions may be detected in an eye exam.
- Of the 75 million people who work on computers each day,
70% of them have some type of eye or vision related problem.
www.ad v anticae y ecare.com
S a v i n g S ig h t.
National Network of Independent & Retail Providers.
Advantica EyeCare’s national network is comprised of both independent and national retail optical
locations. Please visit our website at www.advanticaeyecare.com to view our entire network, or contact our
Service Center at (866) 425-2323.
When scheduling an appointment, please be sure to inform the provider that you are an Advantica member.
(866) 425-2323
®
SM
Select Plus 100 Plan
COVERAGE
IN-NETWORK
BENEFITS
OUT-OF-NETWORK
REIMBURSEMENT*
BENEFIT
FREQUENCY
Comprehensive Eye Examination
$10 copay
Reimbursed up to $40
(less applicable copay)
Once every 12 months
Reimbursed
(less applicable copay):
- Single up to $20
- Bifocal up to $40
- Trifocal up to $60
- Lenticular up to $100
Once every 12 months
$15 copay includes:
- Single
- Bifocal
- Trifocal
- Lenticular
Eyeglass Lenses (standard plastic)
Additional $50 copay
Standard Progressive
Lenses.
Select
Discount
Plan
The Select Discount Plan is in
addition to your plan benefits at
no additional cost. This plan can
be used for upgrades and
additional eyewear. This plan can
be utilized at any of participating
provider locations.
Eyeglass Lenses (standard plastic)
Single $35
Bifocal $55
Trifocal $85
Lenticular U&C less 10%
Standard Progressive
Multifocal $155
Additional $60 copay
Photochromic Lenses.
Eyeglass Frames
$15 copay
(no copay if included with
Eyeglass Lenses); paid in
full on Special Frame Selection;
outside of the Selection, $100
allowance (less applicable
copay) toward any prescription
eyeglass purchase.
Reimbursed up to $40
(no copay if included with
eyeglass lenses).
Once every 24 months
Contact Lenses (in lieu of Eyeglasses)**
Conventional / Disposable
$100 allowance
(less applicable copay)
Reimbursed up to $60
(less applicable copay)
Once every 12 months
Eyeglass Lens Upgrades
Ultra Violet Coating $12
Scratch Coating $12
Anti-Reflective Coating $36
Polycarbonate $30
Polarized-Single Vision $36
Polarized-Bifocal $54
All Other and Sunwear
Accessories retail less 10%
Eyeglass Frames
Retail less 15%
Additional Contact Lenses through
For Eyes Direct
Retail less 10% to 20%
Contact Lenses (in lieu of Eyeglasses)**
Medically necessary***
$250 allowance
(less applicable copay)
No reimbursement available.
Once every 12 months
Contact Lens Fitting Fee
$30 allowance
No reimbursement available.
Once every 12 months
Laser Vision Correction (LASIK)
15% discount off retail
No reimbursement available.
* Submit Member Out-Of-Network Reimbursement Form and copy of paid receipt to Advantica EyeCare.
** This benefit is paid only once during the Group’s Benefit Period and must be fully utilized at the time of purchase.
*** Limited to Aphakia, Keratoconus or Severe Anisometropia and requires pre-authorization by Advantica EyeCare.
Plan is qualified under IRS Section 125.
Insurance coverage provided by National Guardian Life Insurance Company. National Guardian Life Insurance Company is not affiliated with the Guardian Life Insurance Company of America
a/k/a The Guardian or Guardian Life. (Policy Form Series NVIGRP 5/07 and/or NVIGRP2002)
This is an in-network benefit only, and may not
be combined with any other discounts or
promotional offers.
Receiving your vision benefit
is as easy as visiting your
Advantica EyeCare provider.
To locate Network Providers,
visit
our
website
at
www.advanticaeyecare.com
or call toll free, (866)
425-2323, and speak with an
Advantica EyeCare Customer
Service Representative.
www.ad v anticae y ecare.com
S a v i n g S ig h t.
Select Plus 100 Savings Illustration
SUBSCRIBER
SUBSCRIBER +
SPOUSE
SUBSCRIBER +
FAMILY1
Monthly premium
5.48
10.97
21.65
Annual premium
65.76
131.64
259.80
13.15
26.33
51.96
Adjusted annual premium3
52.61
105.31
207.84
Copayments ($10 exam / $15 materials)
25.00
50.00
100.00
TOTAL ANNUAL PREMIUM / EYECARE EXPENSES
77.61
155.31
307.84
Eye examination
85.00
170.00
340.00
Single vision lenses
70.00
140.00
280.00
Eyeglass frames
120.00
240.00
480.00
AVERAGE ANNUAL EYECARE EXPENSES
275.00
550.00
1,100.00
$197.39
71.78%
$394.69
71.76%
$792.16
72.01%
Estimated pre-tax savings (20%)
2
VISION BENEFITS WITHOUT AN ADVANTICA VISION PLAN4
ADVANTICA MEMBER SAVINGS
PERCENTAGE SAVINGS
1
Employee and family coverage based on four (4) members
2
Contingent upon tax bracket
3
Annual premium minus estimated pre-tax savings
4
Estimated retail values
(866) 425-2323
®
SM
Select Plus 150 Plan
COVERAGE
IN-NETWORK
BENEFITS
OUT-OF-NETWORK
REIMBURSEMENT*
BENEFIT
FREQUENCY
Comprehensive Eye Examination
$10 copay
Reimbursed up to $40
(less applicable copay)
Once every 12 months
Reimbursed
(less applicable copay):
- Single up to $20
- Bifocal up to $40
- Trifocal up to $60
- Lenticular up to $100
Once every 12 months
$15 copay includes:
- Single
- Bifocal
- Trifocal
- Lenticular
Eyeglass Lenses (standard plastic)
Additional $50 copay
Standard Progressive
Lenses.
Additional $60 copay
Photochromic Lenses.
Eyeglass Frames
$15 copay
(no copay if included with
Eyeglass Lenses); paid in
full on Special Frame Selection;
outside of the Selection, $150
allowance (less applicable
copay) toward any prescription
eyeglass purchase.
Reimbursed up to $60
(no copay if included with
eyeglass lenses).
Once every 12 months
Contact Lenses (in lieu of Eyeglasses)**
Conventional / Disposable
$150 allowance
(less applicable copay)
Reimbursed up to $80
(less applicable copay)
Once every 12 months
Contact Lenses (in lieu of Eyeglasses)**
Medically necessary***
$250 allowance
(less applicable copay)
No reimbursement available.
Once every 12 months
Contact Lens Fitting Fee
$40 allowance
No reimbursement available.
Once every 12 months
Laser Vision Correction (LASIK)
15% discount off retail
No reimbursement available.
* Submit Member Out-Of-Network Reimbursement Form and copy of paid receipt to Advantica EyeCare.
** This benefit is paid only once during the Group’s Benefit Period and must be fully utilized at the time of purchase.
*** Limited to Aphakia, Keratoconus or Severe Anisometropia and requires pre-authorization by Advantica EyeCare.
Plan is qualified under IRS Section 125.
Insurance coverage provided by National Guardian Life Insurance Company. National Guardian Life Insurance Company is not affiliated with the Guardian Life Insurance Company of America
a/k/a The Guardian or Guardian Life. (Policy Form Series NVIGRP 5/07 and/or NVIGRP2002)
Select
Discount
Plan
The Select Discount Plan is in
addition to your plan benefits at
no additional cost. This plan can
be used for upgrades and
additional eyewear. This plan can
be utilized at any of participating
provider locations.
Eyeglass Lenses (standard plastic)
Single $35
Bifocal $55
Trifocal $85
Lenticular U&C less 10%
Standard Progressive
Multifocal $155
Eyeglass Lens Upgrades
Ultra Violet Coating $12
Scratch Coating $12
Anti-Reflective Coating $36
Polycarbonate $30
Polarized-Single Vision $36
Polarized-Bifocal $54
All Other and Sunwear
Accessories retail less 10%
Eyeglass Frames
Retail less 15%
Additional Contact Lenses through
For Eyes Direct
Retail less 10% to 20%
This is an in-network benefit only, and may not
be combined with any other discounts or
promotional offers.
Receiving your vision benefit
is as easy as visiting your
Advantica EyeCare provider.
To locate Network Providers,
visit
our
website
at
www.advanticaeyecare.com
or call toll free, (866)
425-2323, and speak with an
Advantica EyeCare Customer
Service Representative.
www.ad v anticae y ecare.com
S a v i n g S ig h t.
Select Plus 150 Savings Illustration
SUBSCRIBER
SUBSCRIBER +
SPOUSE
SUBSCRIBER +
FAMILY1
Monthly premium
7.42
14.84
28.12
Annual premium
89.04
178.08
337.44
17.81
35.62
67.49
Adjusted annual premium3
71.23
142.46
269.95
Copayments ($10 exam / $15 materials)
25.00
50.00
100.00
TOTAL ANNUAL PREMIUM / EYECARE EXPENSES
96.23
192.46
369.95
Eye examination
85.00
170.00
340.00
Single vision lenses
70.00
140.00
280.00
Eyeglass frames
120.00
240.00
480.00
AVERAGE ANNUAL EYECARE EXPENSES
275.00
550.00
1,100.00
$178.77
65.01%
$357.54
65.01%
$730.05
66.37%
Estimated pre-tax savings (20%)
2
VISION BENEFITS WITHOUT AN ADVANTICA VISION PLAN4
ADVANTICA MEMBER SAVINGS
PERCENTAGE SAVINGS
1
Employee and family coverage based on four (4) members
2
Contingent upon tax bracket
3
Annual premium minus estimated pre-tax savings
4
Estimated retail values
(866) 425-2323
Additional Benefits.
Give them the ‘Doctor’s Choice’ for healthy sight.
Photochromic lenses, like Transitions, are clear indoors and darken
outdoors in proportion to the intensity of UV rays.
LASIK benefits through Advantica EyeCare.
LASIK is the most the popular elective surgery in the U.S. Through the
partnership of Advantica EyeCare and TLCVision, leaders in their
industries, life-changing LASIK procedures are available at an
affordable cost.
The best photochromic technologies offer:
- Optimal darkness for every outdoor light condition.
- Enhanced contrast to optimize vision.
- Protection from glare (bright light) to reduce eyestrain and fatigue.
- UV blockage to help prevent age-related eye disease.
- Availability in impact-resistant lens material.
- Availability with anti-reflective coatings.
The TLCVision Advantage Program
Because every eye is different, we offer different LASIK procedures.
These include Conventional LASIK, Custom LASIK and Bladeless
LASIK. With a doctor’s advice, members can select the procedure that
offers the best possible outcome based upon their vision prescription,
healing profile and expectations.
0% Financing Available.
- Availability in progressive lens design.
Advantica covers photochromic lenses with a copay.
For more information on LASIK benefits, call
TLCVision at (877) 874-3937 or www.tlcvision.com.
Not an insurance product.
Mail order contact lenses from For Eyes Direct
Advantica EyeCare plans include contact lenses through For Eyes. For
Eyes Optical Company has been selling contact lenses for over 20
years. Now their everyday low prices and expert service are available to
members of Advantica EyeCare who prefer to shop from home.
Members may call, fax or email a current prescription to For Eyes for a
price quote.
Telephone: (800) 393-1393 / Fax: (800) 247-9048
www.foreyes.com / [email protected]
Advantica EyeCare members receive a 20% discount on all daily wear,
extended wear, toric and specialty contact lenses. There is a 10%
discount on all disposable brand contact lenses.
Hours of Operation (EST):
Monday-Friday 9:00am-9:00pm / Saturday 9:00am-6:00pm
Not an insurance product.
3290 Pine Orchard Lane, Suite D
Ellicott City, MD 21042
®
SM
Toll Free: (866) 425-2323
Telephone: (410) 410-4414
Facsimile: (410) 418-9508