ENROLLMENT HEALTH AND WELLNESS 33 Vision To help keep your life in focus Feature Core Vision Option Voluntary Buy-up Vision Option Vision Providers* Benefits shown below assumes use of EyeMed providers Benefits shown below assumes use of EyeMed providers Eye Exam (every 12 months) $10 copay (copay waived at Plus Providers) $10 copay (copay waived at Plus Providers) Frames (every 24 months) $100 retail allowance* ($150 frame allowance at Plus Providers) $125 retail allowance* ($175 frame allowance at Plus Providers) Standard Lenses (every 12 months) • Single vision, bifocal, trifocal • Lenticular • Premium progressive (Tier 1-4) No copay No copay $85, $95, $110, $175 copay No copay No copay $85, $95, $110, $175 copay Lens Options • Tints • U/V treatment • Anti-reflective coating • Photochromatic • Scratch coating • Edge coating • Polycarbonate (adults) • Polycarbonate (children < 19) $15 copay $15 copay $45-$85 copay $75 copay $15 copay 20% off retail $40 copay No copay No copay No copay $0-$85 copay $75 copay $0 copay 20% off retail $40 copay No copay Contact Lenses** • Cosmetic or convenience • Medically necessary $105 allowance, 15% off balance Paid in full (in lieu of spectacle lenses, lens options and frame) $105 allowance, 15% off balance Paid in full (in lieu of spectacle lenses, lens options and frame) * Retail eyewear benefits will be converted to wholesale-equivalent prices at certain provider locations. Go to eyemed.com for details. ** Contact lens fitting fees – Standard – Up to $40, Premium – 10% off retail price. Contacts are in lieu of lenses only. You are entitled to a full pair of glasses frame & lenses OR contacts and frames. Using Vision Benefits Participating Vision Care Providers Visit the vision page at MyScrippsHealthPlan.com to find participating vision care providers. Obtaining services from a participating provider will maximize your benefits. All Other Vision Providers If covered services are received from a non-participating provider, you are responsible for paying the provider in full and submitting a claim to EyeMed within 12 months of the date of service. More information and an EyeMed claim form are available on MyScrippsHealthPlan.com. You do not need to be enrolled in a medical plan in order to select vision benefits. Your coverage category for vision may be different from the choice you made for medical. Choose an EyeMed network provider to pay less out-of-pocket for covered vision services. Quick Facts ELIGIBILITY/ENROLLMENT • F ull-time and part-time benefit-eligible employees are eligible the first of the month following 60 days of employment; must enroll within 60 days of hire • D epartment Directors and above, Fellows and Residents are eligible the first day of employment; must enroll within 31 days of hire OPTIONS • Scripps Vision Plan • Vision Buy-up Option COVERAGE TIERS • Employee only • Employee plus adult • Employee plus child(ren) • Employee plus adult & child(ren) OPEN ENROLLMENT/MID-YEAR CHANGES • Current employees can make changes during the Open Enrollment period or within 31 days of a Qualifying Life Event • Enroll or make changes online using the benefits web enrollment system RESOURCES • Member Services – 844-409-3401: eligibility, claims, and pre-authorization • MyScrippsHealthPlan.com: Summary Plan Document (SPD), provider network information • Scripps HR Service Center – 858-678-MyHR (6947): to report a Qualifying Life Event during the year, general questions You may choose to enroll in vision benefits through Scripps Vision Plan utilizing EyeMed. You may choose to enroll in the Scripps Vision Plan or the Vision Buy-up option. The Vision Buy-up option includes enhanced coverage as shown in the table below.
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