Vision insurance plans are underwritten by Aetna Life Insurance Company (Aetna). That really narrows down the three most important things for myself and my family, simply because we just, we didn't have that before on the plan that we had. To use your Aetna Vision membership, find an in-network eye doctor through the above provider locator and schedule an appointment. Tip: You can see any vision provider you want but staying in network will help you save. You may obtain care from any licensed eye care provider. You can see who you want to see, when and where you want to see them. The following extra discounts and savings are only available from network doctors. The LASIK discount is only available from U.S. Laser Network by calling 1-800-422-6600. Plus, you can choose frames from top eyewear brands such as Ray-Ban and Oakley. But dont take our word for it. CPT is a registered trademark of the American Medical Association. When you stay in-network, you save more money and get the full value of your vision benefits. MA-only plans can also include a host of benefits that are not part of standard VA coverage. Vision Benefits What's really great about Aetna's plans is that there's a plan for every type of need out there. Replacement of lost, stolen or broken prescription lenses or frames. 80% of charge less $120 allowance + $75 copay. The FEDVIP law does not provide a role for OPM to review disputed claims. Certain claims administration services are provided by First American Administrators, Inc. and certain network administration services are provided through EyeMed Vision Care, LLC. There are two exceptions: Generally, enrollments and enrollment changes made based on a QLE are effective on the first day of the pay period following the one in which BENEFEDS receives and confirms the enrollment or change. Annuitants automatically pay premiums through annuity deductions using post-tax dollars. EyeMed and Aetna are independent contractors and not agents of each other. If your provider is not currently participating in the provider network, you can nominate them to join. This is what youpay out-of-pocket for covered care: Aetna is responsible for the selection of in-network providers in your area. This is known as the Use-it-or-Lose-it rule. When you visit an Aetna Vision network doctor, your eye exam and prescription glasses or contacts are covered after any co-payments. NOTE: Contact Lenses, Choose eyeglasslenses or contact lenses every calendar year.You cannot use both benefits within the samecalendar year. dental and vision benefit programs to be made available to Federal employees, annuitants, and their eligible family members. The timeframe for requesting a QLE change is from 31 days before to 60 days after the event. Being part of the Aetna Vision Plan truly allows myself to plan around my busy schedule, around my busy family schedule. Postal employees, and TRICARE-eligible individuals when you: Under FEDVIP, there is no 31-day extension of coverage. Network applications (behavioral health, dental, facility, and pharmacy) Practice changes and provider termination. 2023 Aetna. You should confirm that both the doctor and the retail location are participating prior to seeking services. Choice, savings and convenience There's a lot to consider when choosing a vision insurance plan for you and your family, like how it fits your budget and your life. Vision Insurance Plans for Individuals & Families | Aetna You may also request or view the most current directory via our website at www.aetnafeds.com. No need to wonder about your eye care if you have a break abroad. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. *Position must be in a Federal agencythat provides dental and/or vision coverage with 50 percent or more employer-paid premium. Members should discuss any matters related to their coverage or condition with their treating provider. We're sorry but Vision Benefits Portal doesn't work properly without JavaScript enabled. Each lens is adjustable, with a -6 to +3 diopter range. 1-800-US-AETNA ( 1-800-872-3862) (TTY: 711) between 8:00 AM and 6:00 PM ET. If you do not want to change plans or options, your enrollment will continue automatically. FEHB Temporary Continuation of Coverage (TCC) enrollees, Anyone receiving an insurable interest annuity who is not also an eligible family member, There is no time limit for a change based on moving from a regional plans service area; and. The AMA is a third party beneficiary to this Agreement. The LASIK discount is only available from U.S. Laser Network by calling 1-800-422-6600. So when you buy Aetna Dental Direct, you can add Aetna VisionSM Preferred to your dental plan in most states. Contact us by phone. The maximum benefit payment for services received.Please refer to Section 4, Your Cost for Covered Services, for the maximum benefit payment for services received in limited access areas or out-of-networkand Section 6, International Services and Supplies, for services received outside the United States or Puerto Rico. Your child over age 22 (unless they are disabled and incapable of self-support). It is important to bring your FEDVIP and FEHB identification cards to every vision appointment because most FEHB plans offer some level of vision benefits separate from your FEDVIP coverage. With paperless EOBs, there's no need to shred any documents. Manage all your vision care needs on the go with the Aetna Vision Preferred app. PDF A Nationwide Vision Plan, available nationwide and overseas - BENEFEDS You are responsible for charges billed over the amounts shown. You'll have up to24 months of statements organized by month and year online. If you have an HCFSA or LEX HCFSA FSAFEDS account and you havent exhausted your funds by December 31st of the plan year, FSAFEDS can automatically carry over up to $610 of unspent funds into another health care or limited expense account for the subsequent year. Discounts may not be available in all states at all in-network providers. If the provider does not resolve the matter, call us at. OPM negotiates benefits and rates with each carrier annually. Children and dependent unmarried persons must be under age 21 if they are not a student, under age 23 if they are a full-time student, or incapable of self-support because of a mental or physical incapacity. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites. If you are enrolled in an FEHB plan, it is important to bring your FEHB identification card to every vision appointment because most FEHB plans offer some level of vision benefits, (includes applications of clear, soft, spherical, daily-wear contact lenses for single-vision prescriptions) - once every calendar year, (Includes the application of toric (astigmatism .62D or higher in the contact lens), multifocal/monovision, post-surgical and gas permeable lenses. Self Only: A Self Only enrollment covers only you as the enrolled employee or annuitant. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. Welcome to Aetna - Vision Benefits For non-participating health care professionals. Contact Us | Aetna Participating doctorsprovide a comprehensive exam that focuses on your eyes and overall wellness, including dilation as necessary. Charges made for the following are not covered. LensCrafters no longer meet the definition of an eligible employee, annuitant, or TRICARE-eligible individual; as a Retired Reservist you begin active duty; as sponsor or primary enrollee leaves active duty. In addition, some services are specifically limited or excluded. When you visit a network doctor, you do not complete any paperwork or claim forms. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. The following are also NOT available under FEDVIP plans: If you are planning to enroll in an FSAFEDS Health Care Flexible Spending Account (HCFSA) or Limited Expense Health Care Flexible Spending Account (LEX HCFSA), you should consider how coverage under a FEDVIP plan will affect your annual expenses, and thus the amount that you should allot to an FSAFEDS account. 2. Rick Tapnio: Some TRICARE beneficiaries may not be eligible to enroll in both. Employee's Address (include ZIP Code) Address is new 8. Not every vision care service or supply is covered by the plan, even if prescribed, recommended, or approved by your physician. Both the High and Standard vision options include out-of-network benefit coverage. To be eligible for carryover, you must be employed by an agency that participates in FSAFEDS and actively making allotments from your pay through December 31. If you require the services of a specialist and one is not available in your area, please contact us for assistance. This also includes stepchildrenand foster children who live with you in a regular parent-child relationship. New and revised codes are added to the CPBs as they are updated. Plan features and availability may vary by location and are subject to change. If you want to continue your current enrollment, do nothing. Under circumstances where a sponsor is not an enrollee, a TEI family member may accept responsibility to self-certify as an enrollee and enroll TEI family members, TRICARE-eligible individual (TEI) family member. When it comes to vision insurance, you know, do you wear glasses, do you wear contacts? A simple vision planthat makes taking care of your eyes easy. Your enrollment or your eligibility to enroll may continue after retirement. You do not need to be enrolled in FEDVIP for any length of time to continue enrollment into retirement. Your family members may also be able to continue enrollment after your death. Please see Section 1, Eligibility, for more information. Up to 40% off additional pairs of glasses. All those types of things are going to be important factors when you're looking at different options. PDF Aetna - Vision Benefits Claim Form & Instructions Aetna is responsible for the selection of in-network providers in your area. Get advice from registered dietitians with nutrition services. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). Save on popular products from health and fitness vendors, like blood pressure monitors, pedometers and activity trackers, devices for pain relief and many other products. CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. Note: You cannot enroll or change enrollment in a FEDVIP plan using the Health Benefits Election Form (SF 2809) or through an agency self-service system, such as Employee Express, PostalEase, EBIS, MyPay, or Employee Personal Page. So you have a lot to choose fromwithout ever paying full price. For more information on family member eligibilityvisitthe website atwww.opm.gov/healthcare-insurance/dental-vision/ or contact your employing agency or retirement system. If you are enrolled in Self Plus One, you and your designated family member are entitled to these benefits. What's your budget like? For language services, please call the number on your member ID card and request an operator. You cannot change plans, outside of open season, because of changes to the provider network. Certain claims administration services are provided by First American Administrators, Inc. and certain network administration services are provided through EyeMed Vision Care (EyeMed), LLC. For language services, please call the number on your member ID card and request an operator. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. This is the phone number for the Corporate Contact Center. Important things you should keep in mind about these benefits: Please remember that all benefits are subject to the definitions, limitations and exclusions in this brochure and are payable only when we determine they are necessary for the prevention, diagnosis, care or treatment of a covered condition and meet generally accepted protocols. Patient's Name 10. You can also select from several nationwide vision plans. Applicable FARS/DFARS apply. You will also receive 20% off any out-of- pocket costs over your frame allowance and a savings of 15% on any balance over your conventional contact allowance. This is the procedure used by the plan to pre-approve services and the amount that the plan will cover. Health Insurance Forms for Individuals & Families - Aetna During future annual Open Seasons, you may enroll in a plan, or change or cancel your dental and/or vision coverage. Depending on your plan, Aetna Vision Preferred vision insurance generally includes:*. Policy/Group Number 3. Any frame available at the provider location. We have increased the out-of-network frame allowance from $75 to $80. Employee's Aetna ID Number or SSN 4. *The amount shown is the negotiated discounted price you will pay the provider. There is no requirement to have coverage for5 years of service prior to retirement in orderto continue coverage into retirement, as there is with the FEHB Program. A co-payment is a fixed amount of money you pay to the provider when you receive services. Self Plus One: A Self Plus One enrollment covers you as the enrolled employee or annuitant plus one eligible family member whom you specify. Aetna Vision is a nationwide vision plan and therefore does not have network doctors overseas. Policy forms issued in Oklahoma include: GR-9N, GR-29N. You may enroll in a dental plan or a vision plan, or both. the sponsor or primary enrollee leaves active duty. Active Retired Date of Retirement 7. Youll get many features to keep your eyes healthy, a big choice in providers and preferred plan savings so youll never have to pay full price. Carefully consider the amount you will elect. Vision Benefits Vision insurance plans contain exclusions and limitations. Providers in the Aetna Vision network are contracted and credentialed through EyeMed Vision Care, LLC according to EyeMed's requirements. And just for being an Aetna member - you'll get discounts on gym memberships, acupuncture, chiropractic care, weight loss programs, books, dental products, travel, electronics, auto, dining and more. You can select from several nationwide, and in some areas, regional dental Preferred Provider Organization (PPO) or Health Maintenance Organization (HMO) plans, and high and standard coverage options. One eye exam per year with $0 co-pay. Vision Benefits This information is neither an offer of coverage nor medical advice. And we really look at the person in total as we're really trying to assess what's going on, not only with their eyes, but what relates from their body, into the eye. The following services and materials are not covered: Benefits may not be combined with any discount or promotional offering unless otherwise noted in an offer. An eligible family members coverage also ends upon the effective date of the cancellation. CVS and Aetna are part of the CVS Health family of companies. Find a network provider near you or check out your online provider options, Access your member ID card whenever you need it and more. Carefully review your explanation of benefits (EOBs) statements, which is available online at. Visit the international eye care provider of your choice. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. You can download a claim form by going to www.aetnafeds.com, resources, claim forms and select Vision Claim form (for FEDVIP Aetna Vision Preferred Plan) and mail to the address on the form or go green and get paid faster by submitted electronically by accessing the online form. Without the cost savings from the Aetna Preferred Vision Plan, I would have paid hundreds more for these frames. 4. If you use in-network providers to obtain covered care, benefits are paid at the in-network level. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. There is no obligation to enroll. Some plans include comprehensive services such as fillings and extractions. The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT), copyright 2015 by the American Medical Association (AMA). The information you will be accessing is provided by another organization or vendor. Because these providers are out of our network, we will reimburse you up to the maximum reimbursement amount allowed by the plan. Use your benefit and start saving Find a provider Choose from thousands of retail and independent providers, and even schedule your next eye exam online. On December 23, 2004, President George W. Bush signed the Federal Employee Dental and Vision Benefits EnhancementAct of 2004 (Public Law 108-496). Federal Employees Dental and Vision Insurance Program brochure an employee returning to service following a break in service of at least 31 days. 1. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Employees automatically pay premiums through payroll deductions using pre-tax dollars. However, those sites may provide a link to BENEFEDS. Aetna is responsible for the selection of in-network providers in your area. Ask us in writing to reconsider our initial decision. TEI family members include a sponsors spouse, unremarried widow, unremarried widower, unmarried child, and certain unmarried persons placed in a sponsors legal custody by a court. Find a provider . Rates are shown at the end of this brochure. Rick Tapnio: The out-of-network benefit structure is listed under the Summary of Benefits section. Contact lenses are medically necessary if youre diagnosed with one of these conditions (ask your eye doctor for more info): * Please refer to Section 4, Your Cost for Covered Services, for the nationwide reimbursement schedule and Section 6, International Services and Supplies, for the international reimbursement schedule. It takes approximately 10 minutes to complete. Select a language. Your medical information remains secure online. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Choice, convenience, and savings with Aetna VisionSM Preferred. Find a provider . Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Exclusions That Apply to Vision Care Insurance Coverage TRICARE enrollees automatically pay premiums through payroll deduction or automatic bank withdrawal (ABW) using post-tax dollars. Go to the American Medical Association Web site. Policy/Group Number 3. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. You cannot request a new enrollment based on a QLE before the QLE occurs, except for enrollment because of a loss of dental or vision insurance. Treating providers are solely responsible for medical advice and treatment of members.
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