|
This list of commonly asked questions and answers will help you better understand your benefits. Additional benefits information is in your enrollment
materials, and can be found in the "Benefit Coverage" section of the secure member portal. If you still have questions, you may contact our Customer Service
department at 800-507-3800.
Eyecare Providers
How to Use Your Benefits
Frame & Lens Benefits
Materials Discounts
How do I find a provider?
Finding a provider is easy – just go to our home page and click on Locate a Provider. The icon has a map of the US on it. You will also find Locate a Provider
in the navigation bar in the member portal, and you can always call our Customer Service department if you are having trouble finding a provider.
Return to Top
What is the difference between an in-network provider and out-of-network provider?
Your vision benefits are offered through a PPO (Preferred Provider Organization) plan. We have "in-network" providers (those for whom we have a PPO contract)
and "out-of-network" providers (no PPO contract). This means that you can obtain products or services through any provider you choose, though you'll generally
pay less with our in-network providers. When visiting an in-network provider, you are responsible for paying any applicable co-pay and for items that are not
covered, or that exceed your benefit limitations. When visiting out-of-network providers, you pay for all services in full, and then file a claim with Superior
Vision for reimbursement according to your out-of-network benefits schedule.
Return to Top
How do I know which services are offered by the in-network providers?
All in-network providers are listed in our directories with the specific services for which they have contracted. If you need assistance locating a provider,
visit our website or call Customer Service at 800-507-3800.
Return to Top
What if there are no in-network providers close to me?
There are two options for your convenience. One, select an out-of-network provider and use your out-of-network benefits. Two, nominate a provider in your area
to the Superior Vision Plan Provider network (see next question).
Return to Top
What if my present provider is not in the provider network?
A Provider Nomination Form can be found and submitted from the member portal on our website. In addition, you may make the request through our Customer
Service department at 800-507-3800, or you can fax this information to 916-852-2380. All nomination requests are handled by our Provider Relations department.
Return to Top
Do I need to give Superior Vision the name of the provider that I have selected to receive my vision care services?
No, you do not need to pre-select your provider or give Superior Vision the name of your provider prior to receiving services. You need only to select your
provider, make your appointment, and identify yourself to the provider as a Superior Vision Plan member.
Return to Top
Can I get my eye examination at one location and the materials at another?
Yes, you can. However, each provider will need to call Superior Vision Customer Service to verify your eligibility.
Return to Top
How do I know what my plan coverage and eligibility is?
Log in to the secure section of the member portal to view information about your benefits, including eligibility, verification of covered dependents,
plan frequency, co-pays, allowances, and information on your previous date of service.
Return to Top
How often can I use my insured plan benefits?
Your exam, lens, and frame benefits vary based on your plan type. Please contact your HR department or refer to your plan documents for more information.
Return to Top
Is there a co-pay that applies to my vision benefit?
If there is a co-pay that is applicable to your benefit plan, it will be noted in the Outline of Benefits schedule in your enrollment materials. All co-payments are paid directly to the in-network provider, or deducted from the out-of-network reimbursement.
Return to Top
Do I need to show my Superior Vision ID card to the in-network provider to receive services?
No, though the ID card includes helpful information and phone numbers for the provider to reference regarding your benefits or discount plan.
While you don’t need your card, it is important that you always identify yourself as a Superior Vision member.
Please remember: Your medical health plan and Superior Vision are separate companies; our eye care providers will not accept your medical health insurance
plan ID card in place of your Superior Vision ID card.
Return to Top
Do my covered dependents need to have separate ID cards?
No, dependents can use the member’s ID card to use vision benefits.
Return to Top
Do I need to obtain an authorization form or voucher prior to receiving services?
There are no vouchers, pre-authorization forms, or any type of notification needed prior to receiving services from an in-network provider.
For services from an out-of-network provider, see the instructions listed below for out-of-network procedures.
Return to Top
How do I get my benefit when seeking services from an out-of-network provider?
First verify that the provider you wish to see is not in our network. Then, call our Customer Service department to obtain an authorization number to see
that provider. Schedule your appointment, and pay the provider directly for the services rendered.
Return to Top
How do I get reimbursed when using an out-of-network provider?
Obtain a Member Claim form either from the member section of our website, or from a Customer Service Representative. Complete the claim form and attach a
copy of your receipt or itemized bill that explains what services were provided (keep the original for your records). Mail or fax these to Superior Vision’s
Customer Service (see Contact Us). You will be reimbursed the allowable amount as outlined in the out-of-network section of your Outline of Benefits.
Return to Top
How can I use my elective (cosmetic) contact lens allowance?
If available on your plan, you may choose to wear contact lenses in lieu of glasses as your vision correction. The specified allowance may be applied toward
the purchase of any type of elective contact lenses. Your benefit is greater when dispensed by an in-network provider.
Return to Top
What is a Contact Lens Fitting exam?
A Contact Lens Fitting (CLF) exam measures and examines your eyes for the purpose of evaluating and fitting them for contacts, and your provider charges a
separate fee for this service. In some Superior Vision plans, the CLF is an additional, stand-alone benefit – it is separate from your contact lens benefit.
CLF charges do not get deducted from your contact lens allowance.
In some plans, the CLF is not a covered benefit. In this case you will need to pay the provider for the CLF.
Return to Top
How does the retail frame allowance work?
You may select a frame up to your benefit’s specific retail price frame allowance (found on your card).
- If you have a co-pay for materials, you will pay that amount when you order your frames and/or lenses.
- If the retail price of the frame is greater than your frame allowance, you will pay the difference. Some providers may also give a discount on your
out-of-pocket cost for the frame. Refer to your specific Outline of Benefits for more information and details.
- If part of the frame allowance is unused, it may NOT be applied to lenses or other benefits
Return to Top
What kind of frame can I select for my insured benefit?
You can select any frame in the in-network provider's frame inventory up to the retail allowance shown in your Outline of Benefits schedule without incurring
any additional out-of-network pocket cost.
Return to Top
Does the benefit cover tinted eyeglass lenses?
The benefit covers the cost of the basic lenses which includes Rose Tint #1 and #2. For the darker sunglass tint colors, you will need to pay an additional
charge over the standard lens.
Return to Top
What are non-elective, "medically necessary" contact lenses?
Non-elective (medically necessary) contact lenses are prescribed by a doctor solely for purposes of correcting a specific medical condition, such as keratoconus
or other conditions that prevent your vision from being corrected to a specified level of visual acuity using conventional eyeglasses. Choosing contacts over
glasses for a standard prescription is considered elective/ cosmetic.
Return to Top
How are progressive lenses (no-line lenses) covered?
Lined bifocals and trifocals are standard lenses and covered in full. If you select no-line progressive lenses, you will pay the difference between the retail
price of the selected progressive lens and the retail price of the lined trifocal. The difference may also be subject to a discount.
Return to Top
What discount features are available?
Your specific discount features are listed in the Discount Features section of your enrollment brochure. Depending on your plan, you may be eligible for
discounts off the retail charges for a variety of lens upgrades and add-ons, overages on frame allowances, and/or additional frame and lens purchases.
Services must be obtained from a provider indicated in our provider directory as participating in a specific discount plan as there are some providers who do not.
Be sure to show your Superior Vision ID card to ensure you receive these discounts.
Return to Top
How often can I use my discounts?
There are no limits as to the number of times you can use the discounts during the contract period of your insured benefit. The discounts are limited to your
personal use and that of your covered family members.
Return to Top
Do I need to show my ID card to the provider to use the discounts?
Yes, to use the discounts you and your dependents must show your ID card to the in-network provider to verify your eligibility.
Return to Top
Are there any limitations on the frame selection when using the discounts?
Unless otherwise prohibited by the manufacturer, the frame discount may be applied as long as you seek services from a participating discount plan provider.
Return to Top
Can I utilize in-store specials, promotions, or coupons along with my Superior Vision plan benefit?
Your benefits provide discounted rates from in-network providers, and cannot be used in conjunction with coupons, promotions, sales, or other types of discounts.
An exception: if you use the services of an in-network provider but choose to take advantage of a sale, coupon, or other in-store special, the provider may require
that you pay in full and then submit your receipt to Superior Vision for reimbursement at the out-of-network rates. If you have questions about the use of discounts,
call Customer Service before you seek services as rules may vary from state to state and be subject to state laws.
Return to Top
Do any discounts apply to my covered eyeglass lenses and frame?
The Superior Vision Plan includes discounts on many of your out-of-pocket expenses associated with eyeglass lens add-ons, upgrades, or overages on your frame
allowance for your covered eyeglass lenses and frame. There are also discounts available on any additional purchases, and these discounts can be utilized as often
as you like as long as you seek services from a participating discount plan provider.
Return to Top
|