Superior Vision Plan
Effective
April 1, 2008, the
University of Arkansas
has a new vision plan carrier, Superior Vision.
The Superior Vision plan replaces the current plan offered through Spectera.
Open Enrollment for the new Superior
Vision Plan will be through March 20, 2008.
Informational materials were mailed to all employees via campus mail.
In addition,
Superior
will mail information to employees home addresses.
See the Superior vision Summary of Benefits, available from this page, for additional coverage information. Also available from this page you will find the Superior enrollment application.
How do I enroll in the
Superior
Vision Plan?
If you
are currently in the Spectera plan, you don’t have to do anything.
Your current coverage will be transferred to the new Superior
Vision plan. Your Spectera coverage
will end March 31, 2008, and your Superior Vision coverage will begin April 1, 2008.
If you
want to sign up for vision for the first time or add or delete dependents to your
existing vision plan, you will need to fill out an enrollment form and return it
to Human Resources no later than Thursday, March 20, 2008.
Forms are available from this website or from Human Resources,
222 ADMN.
If you
miss the March 20, 2008, deadline, you may enroll at the end of the year when another
open enrollment will be held for coverage to start January 1, 2009.
However, annual open enrollment for Vision Insurance is not guaranteed
in the future. New employees will
be given 31 days from their benefits eligible appointment dates to enroll in Vision
Insurance, just like health and dental coverage.
Remember, Vision Insurance requires a calendar year participation. Once you’re enrolled, you will not be able
to cancel coverage or delete eligible dependents until the end of the calendar year.
Who are the
Superior
Vision Providers?
Superior
has an excellent provider list for you
to choose from. Retail providers include
Wal-Mart Vision Centers
, JC Penny Optical, Sears Optical, and LensCrafters.
Superior
also has an excellent list of private practice providers for you to select from. You can access a Superior Vision provider
directory from
Superior
’s website at
www.SuperiorVision.com
and from Human Resources (222 ADMN).
What are the rates & coverage for
Superior
Vision?
|
Monthly Premiums
|
12-Month
|
9-Month
(April & May)*
|
9-Month eff 9/1/2008**
|
|
Individual Coverage
|
$5.66
|
$14.15
|
$7.55
|
|
Employee/Spouse
|
$11.22
|
$28.05
|
14.96
|
|
Employee/Child(ren)
|
$10.98
|
$27.45
|
$14.64
|
|
Employee/Spouse/Child(ren)
|
$16.70
|
$41.75
|
$22.27
|
|
*
9-Month employees enrolling in vision coverage for the first time will pay this
premium April & May so that sufficient premiums are deducted to pre-pay for
June, July, & August 2008. Beginning
September 2008 the “9-Month eff 9/1/2008” premiums will be deducted.
**
9-Month employees who are existing participants who do not add or delete dependents
during this Open Enrollment period will pay the “9-Month eff
9/1/2008” premiums.
|
|
Co-payments:* $10.00 Exam
$20.00 Materials
$25.00 Contact Lens Fitting Exam Fee
*In-network co-payments
are paid directly to the provider.
Out-of-Network co-payments will be deducted from the out-of-network reimbursement.
Materials co-payment applies to lenses
and/or frames, not contact lenses.
|
Plan Services Frequency
Comprehensive Exam Once per calendar year
Lenses
Once per calendar year
Frames
Once every other calendar yr
Contact Lenses
Once per calendar year
|
|
Benefits
|
In-Network
|
Out-of-Network
|
|
Comprehensive Exam
Ophthalmologist (MD)
Optometrist (OD)
Standard Lenses (Per
Pair):
Single Vision
Bifocal
Trifocal
Lenticutlar
Contact Lenses (Per
Pair):*
Medically Necessary
Elective **
Standard Contact Lens Fitting Exam Fee ***
Specialty Contact Lens Fitting Exam Fee***
Frames – Standard***
|
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Up to $120.00
Covered in Full
Up to $50.00
Up to $125.00
|
Up to $42.00
Up to $36.00
Up to $28.00
Up to $42.00
Up to 56.00
Up to $78.00
Up to $210.00
Up to $100.00
Not Covered
Not Covered
Up to $70.00
|
|
*
Contact lenses are in lieu of eyeglass lenses and frames benefit.
**
The insured is responsible for paying any charges in excess
of this allowance.
***
Standard contact lens fitting fee applies to an existing contact lens user who
wears disposable, daily wear, or extended wear lenses only.
The specialty contact lens fitting fee applies to new contact lens wearers
and/or a member who wears toric, gas permeable, or multifocal lenses.
For the specialty fit, the member is responsible for any charges over $50.
|
|
|
|
|
|
|
|
How Do I Use the Plan?
Procedure
when using a Superior Vision Plan in-network provider:
1. Identify yourself to the in-network provider
as a member of the Superior Vision Plan. You can use your I.D. card for this purpose
or simply give the provider your name, employer name, and your unique identification
number. The provider will call the Superior Vision Customer Service Department to
verify your eligibility and obtain an authorization number. The I.D. card provided
to you can be used for all covered family members.
2. After eligibility is established and an authorization
number is received by the provider, services will be rendered. There is nothing
else that you need to do except pay the provider directly for any appropriate co-payments
or charges above the covered benefits. The in-network provider handles all claims
and paperwork.
Procedure
when using an out-of-network provider:
1. To receive services from an out-of-network
provider, it is important that you first call the Superior Vision Customer Service
Department at 1-800-507-3800 to receive your own authorization number. By doing
so, you may be assured of your eligibility and reimbursement for money spent.
2. After receiving services and paying in-full
for the examination and/or materials (you do not pay a co-payment to the out-of-network
provider), submit your original itemized billing or receipt received from the provider,
along with your authorization number, to the Superior Vision Claims Administration
office.
3. You will be reimbursed according to the
schedule of allowances for out-of-network services.
How Do I Contact
Superior
Vision?
Superior
Vision Customer Service:
800-507-3800
TDD (Hearing
impaired):
916-852-2382
Superior
Vision Customer Service/Claims Administration:
PO Box 967
Rancho Cordova
CA 95741