PEF REGION 5
|
|
|
Changing
from General
Questions Q:
On what date does EyeMed Vision Care replace A:
Q:
A:
The Department of Civil Service (DCS), the Governor’s Office of
Employee Relations (GOER) and the Division of the Budget (DOB) are responsible
for selecting EyeMed Vision Care to administer the NYS Vision Plan.
Q:
A: The state used a competitive bid process to select EyeMed Vision Care to administer the NYS Vision Plan. Staff from Civil Service, GOER, and DOB evaluated each bidder’s proposal and determined that the EyeMed Vision Care proposal provides the best value. Civil Service estimates that its contract with EyeMed will cost the state $6 million less than Davis Vision’s proposal over the five-year life of the contract. Q:
A: In late-December, EyeMed mailed the following to enrollees’ homes:
Service
Questions Q:
A:
You should call the Q:
A:
Representatives are available from Q:
A: Details about the plan can be found on the Civil Service website at www.cs.state.ny.us. There is also a link to the custom EyeMed website for the NYS Vision Plan which allows registered users to access benefit information, locate a provider, review benefits and eligibility status, access forms, download a benefit booklet, request replacement ID cards and more. Q:
I didn’t receive the information EyeMed mailed to enrollees’ homes.
A:
You can request identification cards by calling the Enrollment/Eligibility Questions Q:
On page two of the New York State Vision Plan
2007 book, it states that I must sign up for coverage.
If I was enrolled in the vision plan prior to the switch to EyeMed Vision
Care, do I have to re-enroll? A:
No, it’s not necessary to re-enroll if you were previously enrolled
in the vision plan through Davis Vision. Q:
A:
Initially, the member ID will be your social security number.
However, it will not appear on the ID cards and only the last 4 digits of
your social security number will be displayed on any EyeMed correspondence.
If you choose not to give your social security number to a provider or
the call center, you can identify yourself as an enrollee in the NYS Vision Plan
and provide your name, and date of birth as an alternative.
EyeMed will be replacing social security numbers with alternate
identifiers for all of their customers during the second half of 2007. At
that time, EyeMed will reissue ID cards with alternate identifiers to NYS Vision
Plan enrollees. Q:
How is eligibility verified at the time of service? A:
A network provider will verify your eligibility either on-line or by
calling EyeMed’s Q:
A:
You will need to complete the Student Verification Form found in your
benefit booklet, or on both the Civil Service and custom EyeMed websites, and
send it to EyeMed when your full-time student dependent child is eligible for
benefits. More details on the
process are included in the benefit booklet.
Benefit Questions Q:
A: No. You will continue to receive the same level of benefits. However, some changes will result. Most members will find they have a broader range of participating providers from which to choose. The EyeMed network provides access to both independent practitioners and optical retailers including LensCrafters, Target Optical, Sears Optical, JCPenney Optical and most Pearle Vision locations. In addition, the selection of plan-covered eyeglass frames will also differ from the current selection. (Additions to FAQs) Service Questions Q:
I didn’t receive the information EyeMed mailed to enrollees’ homes.
A:
You can request identification cards by calling the Network
Questions Q:
My vision care provider submitted an application to participate in the
EyeMed network. How long will it be
before EyeMed notifies him or her of their decision? A:
Providers wishing to participate in the EyeMed network must go
through a review and verification process called credentialing.
Credentialing is used to determine the current clinical competence of a
provider and whether the provider meets EyeMed’s
criteria for participation in the network.
This process typically takes 60-90 days from the date EyeMed receives the
provider’s application. Q:
How does the selection of frames differ? A: Plan-covered frames are not limited to the “Tower Collection” or certain colored tags. You may choose from any available frame with a retail allowance up to $100 at all network provider locations. If you choose a frame with a retail allowance greater than $100, you pay the balance over $100 less 20% at all network provider locations. In addition, the selection of frames will differ from one network provider location to another. EyeMed network providers carry different styles so if you are unhappy with the selection at LensCrafters, for example, you might find something you like at a Sears Optical. Given the differences in the selection of frames available, you may want to “shop around” to determine which network provider location has the frames you want before scheduling your exam. Since you must purchase your eyewear on the same day that you have your exam, you will not have time to comparison shop once you have had your exam. Q:
Do I still have to receive all parts of my vision care benefit on the
same day to receive benefits? A:
Yes, you must receive the exam and purchase your eyewear on the same
day in order to receive benefits. You
cannot “split” the benefit. Q:
Can I go to one provider for my exam and another provider for eyewear? A: You may choose to have your exam at one provider and receive your eyewear at another, but you must purchase your eyewear on the same day as your exam to receive benefits for both. Q:
On page eight of the New York State Vision
Plan 2007 book, it states that members must purchase eyewear on the same date as
the exam. Otherwise, the eyewear
benefit will not be available. My
eye exam is performed by an ophthalmologist, and benefits are provided under my
health care plan. In the past,
I’ve taken my prescription to a network vision care provider and the vision
plan has provided benefits for my eyewear.
A:
Yes, you will still receive benefits for your eyewear if your health
plan is providing benefits for your eye exam.
It is only when you are using the vision plan benefits for both your eye
exam and your eyewear that you must purchase your eyewear on the same date.
Q:
Do my benefits restart on A:
No, your benefits will not restart on Q:
Describe the procedures members must follow to access in-network
benefits. A:
To access benefits, you simply locate a network provider, call for an
appointment or walk-in to the many providers that accept walk-ins, and present
your member ID card at the time of service. Network providers will verify
your eligibility and submit your claim. Q:
Q:
Are members required to submit claim forms? A: You will only be required to submit a claim if you use a non-network provider. If you use a network provider, the provider will submit the claim for you. Benefit Questions (cont.) Q:
A:
Yes, EyeMed does offer a laser vision discount program.
To locate a laser provider and begin the process, enrollees should call
1-877-572-7822. Network Questions Q:
A:
The EyeMed network of participating providers is different from the Davis
Vision network. Therefore, your
current eye care provider may not participate in the EyeMed network.
The EyeMed network provides access to over 1,800 providers in Q:
How can I find out if my eye care provider is in the EyeMed network? A:
The EyeMed brochure/ID card mailing sent to you in late December
included a listing of the network providers nearest your home.
You may also call EyeMed’s Q:
Can I nominate a provider for inclusion in the EyeMed network? A:
Yes, a Provider Nomination form is available on
the custom EyeMed website for the NYS Vision Plan, which you can link to from
the Civil Service website www.cs.state.ny.us.
Your provider may also call an EyeMed Provider Relations representative
at 888-581-3648. This telephone
number is a dedicated line for providers use only. Q:
My vision care provider submitted an application to participate in the
EyeMed network. How long will it be
before EyeMed notifies him or her of their decision? A:
Providers wishing to participate in the EyeMed network must go
through a review and verification process called credentialing.
Credentialing is used to determine the current clinical competence of a
provider and whether the provider meets EyeMed’s
criteria for participation in the network.
This process typically takes 60-90 days from the date EyeMed receives the
provider’s application. Q:
Q:
How will the warranty offered by A:
|
Send mail to pefregion5@yahoo.com with
questions or comments about this web site.
|
