Vision Care for Self-Managed Plans
- 100% coverage for annual eye exam (Category 1 & 2, Category 3 may be subject to balance billing)
- Up to $150 in hardware annually
- Not subject to deductible
- Available only with these medical plans: Activate, Innova & Engage
Vision Care Plans I, II, III
(Idaho only)
Vision Care plans I, II and III are available to groups
with 15 or more enrolled employees. Benefits will be
provided at 100% of the allowable charge for participating
and nonparticipating physicians and/or optometrists.
Enrolled employees and eligible dependents will receive
benefits for a routine eye refraction once every calendar
year as outlined below:
Frames, Lenses & Contacts
In addition to a routine eye refraction, enrolled
employees and eligible dependents will receive benefits
for the cost of frames, lenses, or contacts. Benefits
for frames, lenses, or contacts shall be provided each
calendar year according to the schedule of the vision
plan selected.
| |
Plan
I |
Plan
II |
Plan III |
| Frames |
up to $20.00 |
up to $25.00 |
up to $30.00 |
| Lenses
(each) |
Plan
I |
Plan
II |
Plan
III |
|
Single Vision |
up to $12.00 |
up to $15.00 |
up to $18.00 |
|
Bi-Focal |
up to $21.00 |
up to $26.00 |
up to $30.00 |
|
Tri-Focal |
up to $27.00 |
up to $33.00 |
up to $40.00 |
| Lenticular |
up to $52.00 |
up to $64.00 |
up to $68.00 |
| Contact (pair) |
up to $65.00 |
up to $80.00 |
up to $95.00 |
| Monthly
Rates
Effective July 1, 2007 - June 30, 2008 |
|
Groups of 2-50 Enrolled Employees* |
| Plan |
Enrolled
Employee |
Enrolled
Employee & Family |
| Vision Care I |
$7.00 |
$14.00 |
| Vision Care II |
$12.00 |
$20.00 |
| Vision Care III |
$14.00 |
$23.00 |
*Please contact a Regence BlueShield of Idaho sale representative for rates on groups of 51-99 enrolled employees.
Vision Care Plan IV
(Idaho only)
Plan IV is available to groups of 2-14 enrolled employees.
Benefits will be provided at 100% of the allowable charge
for participating and nonparticipating physicians and/or
optometrists. Enrolled employees and eligible dependents
will receive benefits for a routine eye refraction once
every calendar year as outlined below:
Frames, Lenses & Contacts
In addition to a routine eye refraction, enrolled
employees and eligible dependents will receive benefits
for the cost of frames, lenses, or contacts. Benefits
for frames, lenses, or contacts shall be provided each
calendar year according to the schedule of the vision
plan selected.
| Frames |
up to $25.00 |
| Lenses (each) |
|
Single Vision |
up to $15.00 |
| Bi-Focal |
up to $26.00 |
| Tri-Focal |
up to $33.00 |
| Lenticular |
up to $64.00 |
| Contact
(pair) |
up to $80.00 |
Vision
Care IV Monthly Rates
Effective July 1, 2007 - June 30, 2008 |
| Employee |
$12.00 |
| Enrolled Employee & Family |
$29.00 |
Vision Care Plan 9
(Washington only)
Exams
A routine eye refraction is an examination of the eyes
for determination of refractive errors of the eye and
correction by glasses or contact lenses. Insureds will
receive benefits for a routine eye refraction once every
calendar year as outlined below:
- Benefits will be provided at 100% of the allowable
charge for participating and nonparticipating physicians
and/or optometrists.
Frames, Lenses & Contacts
In addition to the services for a routine eye refraction,
insureds will receive benefits for frames and lenses.
Benefits for frames and lenses shall be provided each
calendar year according to the following schedule:
| Frames |
up to $25.00 |
| Lenses (each) |
|
Single Vision |
up to $15.00 |
| Bi-Focal |
up to $26.00 |
| Tri-Focal
or Progressive |
up to $33.00 |
| Lenticular |
up to $64.00 |
| Contact
(pair) |
up to $160.00 |
Vision
Care 9 Monthly Rates |
| Enrolled Employee |
$13.00 |
| Enrolled Employee & Family |
$22.00 |
|
