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:
   
   Superior Vision Claims Administration
   PO Box 967
   Rancho Cordova, CA  95741
   
3. You will be reimbursed according to the schedule of allowances for out-of-network services.

Discounts on additional purchases are available and vary by provider. Discounts are subject to change without notice. Discounts do not apply when prohibited by the manufacturer. Not all Superior Vision providers participate in the discount program.

SVP8-20 (Applies to covered pair of glasses.

Frames. 20% discount off of the difference between your chosen retail frame and the retail frame allowance.

Lens option & upgrade.  20% discount off retail rate. Some options on certain lenses are discounted to a specific amount; this list does NOT include high-end, name brand, or non-standard options. Fixed price standard options on standard lens types include Factory Scratch coat ($13), UV coat ($15), Anti-Reflective ($50), glass coloring ($35), and solid and gradient tints $25). On standard single vision lenses, fixed price standard options include High Index 1.6 ($55), Polycarbonate ($40),and Photochromic ($80).

Materials Discounts on Additional Purchases (off retail prices)
Prescription eyeglass lenses     30%
Eyeglass frames                         20%
Lens options & upgrades             20%
Contact lenses (hard or soft)     20%
Disposable contacts                 10%

Refractive Surgery Discounts
Superior Vision Services has a nationwide network of refractive surgeons. These providers offer Superior Vision Plan members a discounted rate off of the usual and customer prices for LASIK surgery. These discounts very between 10-20% depending on the provider, but are the best possible discounts available to Superior Vision. Check with your Superior Vision provider for details.

Contact Lenses, Elective/Cosmetic.  Elective/Cosmetic contact lenses refer to contact lenses members choose to wear instead of eyeglasses for reasons of comfort or appearance. Contact lenses covered by the Plan must contain a prescription for correcting a vision deficiency.

Contact Lenses, Medically Necessary.  Medically Necessary contact lenses are provided only under certain medical conditions. These medical conditions prevent the member from achieving a specified level of visual acuity (performance) through the wearing of conventional eyeglasses. These contact lenses must be specifically prescribed by the eye doctor to be used for the reason or reasons described below.

. Aphakia (after cataract surgery without implant lenses). A pair of prescription single vision or multifocal eyeglass lenses and an eyeframe can be provided along with contact lenses prescribed for this reason.

. Pseudophakia (after cataract surgery with implant lenses).  When visual acuity cannot be corrected to 20/70 in the better eye except through the use of contact lenses (must be 20/60 or better).

. Anisometropia of 4.0 diopters or more, provided visual acuity (performance) improves to 20/60 or better in the weak eye

. Keratoconus

Note: The narrowing of visual fields due to high minus or plus corrections is not considered a reason for medically necessary contact lenses. All requests for medically necessary contact lenses must be reviewed and approved by the Superior Vision Medical Advisory Board.

The Contact Lens Prescription. The contact lens prescription includes specifications of optical and physical characteristics (such as power, size, curvature, flexibility, gas permeability, etc.). The contact lens prescription is not a part of the covered comprehensive eye examination procedure.

The Contact Lens Benefit Allowance. The contact lens allowance can be used for costs involved in the fitting and/or the supply of contact lenses. The allowance is based on retail prices, and may include the Contact Lens Fitting exam cost if your company has not contracted to have it as a stand-alone benefit. It is at the discretion of the member as to which charges are applied to the plan allowance and which, if any, are paid for out-of-pocket.

Contact Lens Exam/Fitting Fee:  Most providers charge a fee for the fitting of contact lenses. This fee is separate from the fee for the comprehensive eye examination. The cost will vary depending on the provider's fee structure policies. The cost may also vary due to circumstances or complexities involving the physiological condition of the eyes and cornea, the lens prescription, and the type of lenses used.

1.   Professional Services and/or Materials in conjunction with:

1. compensated or special multi-focal lenses
2. plain (non-prescription) lenses
3. anti-reflective, scratch, UV400, or any coating or lamination applied to lenses.
4. subnormal vision aids
5. tints other than solid
6. orthoptics, vision training and developmental vision procedures
7. polycarbonate lenses

2.   Medical or surgical treatment of the eyes

3.   Any eye examination or any corrective eyewear required by an Employer as a condition of employment

4.   Any injury or illness when covered under Workers' Compensation or similar law

5.   Plain or prescription sunglasses, no-line bifocals, blended lenses or oversize lenses. Although no-line bifocals and blended lenses are not covered, an Insured may elect to apply the maximum allowance for standard lenses toward his or her cost of progressive lenses.

6.   Subnormal vision aids

7.   Services rendered or Materials purchased outside the U.S., unless:

1. the Member resides in the U.S.; and
2. the charges are incurred while on a business or pleasure trip

8.   Charges in excess of the Usual, Customary and Reasonable charge for the Professional Service or Materials

9.   Experimental or non-conventional treatment or device

10. Safety eyewear

11. Spectacle lens styles, materials, treatments of "add-ons" not shown in the Benefits Summary

12. Services or Materials rendered by a provider other than an Ophthalmologist, Optometrist or Optician acting within the scope of his or her license

13. Any additional service required outside basic vision analysis for contact lenses, except fitting fees.

14. Services rendered after the date an Insured ceases to be covered under this Certificate, except when vision Materials ordered before coverage ended are delivered and the services rendered to the Insured within 31 days from the date of such order.

15. Services rendered or Materials ordered before the date of coverage began under this Certificate

16. Regardless of Optical Necessity, benefits are not available more frequently than that which is specified in the Benefits Summary