IF: If yourcovered dependent childhas coverage through a non-FEHB plan and Aetna Vision coverage under FEDVIP.THEN: The parent's plan whose birthday occurs first in the calendar year (1. If you use in-network providers to obtain covered care, benefits are paid at the in-network level. Federal retirees (who retired on an immediate annuity), and survivors (of those who retired on an immediate annuity or died in service) receiving an annuity. This also includes those receiving compensation from the Department of Labors Office of Workers Compensation Programs, who are called compensationers. Annuitants are sometimes called retirees. Some plans include comprehensive services such as fillings and extractions. What kind of extra features are you looking for in your plan? Contact Us - Health Care Providers | Aetna We will base our decision on the information we already have. What's really great about Aetna's plans is that there's a plan for every type of need out there. Self Plus One: A Self Plus One enrollment covers you as the enrolled employee or annuitant plus one eligible family member whom you specify. You may obtain care from any licensed eye care provider. Members will receive a discount of 15% off retail or 5% off promotional pricesat providers in the US Laser network. Medicare Hearing Aids, Dental Coverage, & Eyewear | Aetna Medicare Its free and doesnt count toward your benefit allowance. Members will receive a discount of 15% off retail or 5% off promotional prices at providers in the US Laser network. Select a language. While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. Network applications (behavioral health, dental, facility, and pharmacy) Practice changes and provider termination. Eye examination - covered in full (once every calendar year). During future annual Open Seasons, you may enroll in a plan, or change or cancel your dental and/or vision coverage. Once you enroll, well also send you details on how to get special coupons and discounts on your member website. PDF GC-10 - Vision Benefits - Claim Instructions To see a list of providers who do honor discounts, go to www.aetnavision.com, select Find a Provider, and if you see "May not accept all additional plan discounts" you should contact the provider to confirm. If you have questions about which forms are meant for your use, call the toll-free number on the back of your member ID card. Aetna Vision: 5 Tips for Getting the Most from Your Benefits Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. The following persons are not eligible to enroll in FEDVIP, regardless of FEHB eligibility or receipt of an annuity or portion of an annuity: You must use BENEFEDS to enroll or change enrollment in a FEDVIP plan. This section describes expenses that are not covered or subject to special limitations. If you do not have access to a computer, call 1-877-888-FEDS (1-877-888-3337), TTY number 1-877-889-5680 to enroll or change your enrollment. Find the forms and documents you need Medical, dental & vision claim forms Pharmacy mail-order & claims If you do not want to change plans or options, your enrollment will continue automatically. 1. One eye exam per year with $0 co-pay. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Find a provider . Rick Tapnio: (Page numbers solely appear in the printed brochure), Opportunities to Enroll or Change Enrollment, FSAFEDS/High Deductible Health Plans and FEDVIP, Identification Cards/Enrollment Confirmation. You, your employees and agents are authorized to use CPT only as contained in Aetna Clinical Policy Bulletins (CPBs) solely for your own personal use in directly participating in healthcare programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. Vision Benefits Employee's Aetna ID Number or SSN 4. This includes legally adopted children and recognized natural children who meet certain dependency requirements. An eligible family members coverage also ends upon the effective date of the cancellation. Minimum savings of 20% on all non-covered lens options. Welcome to Aetna - Vision Benefits You may obtain an out-of-network claim form for reimbursement by visiting our website, www.aetnafeds.com or calling our customer service at 1-855-347-6899. Be sure to review Section 1, Eligibility, of this brochure, prior to submitting your enrollment or obtaining benefits. 2023 Aetna. In case of a conflict between your plan documents and this information, the plan documents will govern. We make using vision benefits as easy as 1-2-3! You must: a) Write to us within 15 months from the date of our decision; and, b) Send your request to us at:Aetna Vision, Attention: Appeal Resolution Team, PO Box 14463, Lexington, KY 40512; and. These featured providers offer specials throughout the year including free consultations and extra discounts on LASIK. 2023 Aetna. 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. Except with respect to TRICARE-eligible individuals,family members include your spouse and unmarried dependent children under age 22. You must also actively reenroll in a health care or limited expense account during the NEXT Open Season to be carryover eligible. Aetna is responsible for the selection of in-network providers in your area. A co-payment is a fixed amount of money you pay to the provider when you receive services. Rick Tapnio: Youve got a great way to take care of your eyes and your smile when you add vision coverage to your Aetna Dental Direct plan. Contact us 1-855-347-6899 for the names of participating providers or to request a provider directory. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Plan Allowance: The maximum benefit payment for services provided in areas not meeting the access standards are shown in the chart below. If you are an eligible employee, annuitant, or TRICARE-eligible individual, you may enroll in a dental and/or vision plan during the November 14, 2022,through midnight EST December 12, 2022, Open Season. You may also request or view the most current directory via our *Based on Aetna provider data, September 2019. Get Forms for your Medicare Plan | Aetna Medicare Contact us 1-855-347-6899 for the names of participating providers or to request a provider directory. You cannot use both benefits within the same calendar year. The FEDVIP law does not provide a role for OPM to review disputed claims. Rates are shown at the end of this brochure. 1. Pearle Vision Exclusions That Apply to Vision Care Insurance Coverage When you visit an Aetna Vision network doctor, your eye exam and prescription glasses or contacts are covered after any co-payments. To help us direct your question or comment to the correct area, please select a category below. You can print a temporary ID card online or call customer serviceat 1-855-347-6899 to verify your eligibility in the plan. Your cancellation is effective at the end of the day before the date OPM sets as the Open Season effective date. Providers in the Aetna Vision network are contracted and credentialed through EyeMed Vision Care, LLC according to EyeMed's requirements. When you visit a provider who participates with both, your FEHB plan and your FEDVIP plan, the FEHB plan will pay benefits first. Self and Family: A Self and Family enrollment covers you as the enrolled employee or annuitant and all of your eligible family members. You may use your benefits as soon asyour enrollmentis confirmed. Manage all your vision care needs on the go with the Aetna Vision Preferred app. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. *Position must be in a Federal agencythat provides dental and/or vision coverage with 50 percent or more employer-paid premium. Note: We do not coordinate benefits with non-FEHB health plans. Theres a lot to consider when choosing a vision insurance plan for you and your family, like how it fits your budget and your life. However, those sites may provide a link to BENEFEDS. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. Statistics show that close to four times as many people receive a comprehensive eye exam annually as compared to a physical. Visit www.aetnavision.com for details. Continued participation of any specific provider cannot be guaranteed. Locate a provider Schedule an appointment Use your benefit and start saving FIND A PROVIDER > Convenience & Choice You can select from a diverse network of national, regional and independent private practice locations. Schedule an appointment 3. If you choose to visit a non-participating provider, you will be reimbursed according to the following fee schedule allowances shown in the chart below. The LASIK discount is only available from U.S. Laser Network by calling 1-800-422-6600. We are responsible for facilitating the process with the primary FEHB payor. This is your first level appeal. If the member indicates that benefits should be paid directly to the physician or . This Agreement will terminate upon notice if you violate its terms. - once every calendar year, You will receive a 15% discount off the cost over $170 for convention, High Ametropia exceeding 10D or +10D in meridian powers, Keratoconus when vision is not correctable to 20/30 in either or both eyes using standard spectacle lenses, Vision improvement other than Keratoconus when vision can be corrected two lines of improvement on the visual acuity chart when compared to the best corrected standard spectacle lenses. Vision wellness . The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. Services/Material: ExamStandard Option We Pay: Up to $40High Option We Pay: Up to $40, Services/Material: Single Vision LensesStandard Option We Pay: Up to $40High Option We Pay: Up to $40, Services/Material: Bifocal LensesStandard Option We Pay: Up to $60High Option We Pay: Up to $60, Services/Material: Trifocal LensesStandard Option We Pay: Up to $80High Option We Pay: Up to $80, Services/Material: Lenticular LensesStandard Option We Pay: Up to $80High Option We Pay: Up to $80, Services/Material: Contact LensesStandard Option We Pay: Up to $120High Option We Pay: Up to $136, Services/Material: Medically Necessary Contact LensesStandard Option We Pay: Up to $210High Option We Pay: Up to $210, Services/Material: FramesStandard Option We Pay: Up to $80High Option We Pay: Up to $150. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. Unlisted, unspecified and nonspecific codes should be avoided. 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. If the dispute is not resolved through the reconsideration process, and the reason for the denial was based on medical necessity or for experimental or investigational reasons, you have the right to file a second level appeal. CPT is a registered trademark of the American Medical Association. Former spouses of employees or annuitants. To obtain services, visit any international eye care provider and you will be reimbursed out-of-network schedule: We have several convenient ways to submit a claim for reimbursement. Special supplies such as nonprescription sunglasses and subnormal vision aids. If you live in an area with limited access to a network provider and you receive covered services from an out-of-network provider, we will pay the same benefit level as if you utilized the services of an in-network provider. Aetna complies with all applicable Federal civil rights laws, to include both Title VII of the Civil Rights Act of 1964 and Section 1557 of the Affordable Care Act. Discounts may not be available in all states at all in-network providers. If you want to continue your current enrollment, do nothing. From your local eye care provider to national and regional retailers, youve got choices to fit your busy lifestyle. (available for select locations) Find a provider Learn more: Convenience & choice Please see Section 3, How You Obtain Care, for more information. 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. Aetna is responsible for the selection of in-network providers in your area. Are you just going for your annual exam?
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