Vision Programs Overview

Easy-to-Use Benefits

In-network Utilization
The member selects an in-network provider and identifies themself at the time of service. The member can use the personalized I.D. card that is provided by Superior Vision or can simply give the provider his or her name, employer name and social security number.

The provider will then call Superior Vision Customer Services for verification of eligibility, receive an authorization number, and provide services. The provider handles all claims for in-network services.

Non-network Utilization
When using non-network services it is recommended that the member first call Superior Vision Customer Services to verify their eligibility and receive an authorization number. After receiving services, the member pays the provider for services received and obtains an  itemized invoice or receipt and submits it to SVS Customer Services for reimbursement in accordance with the non-network schedule of reimbursements, less any applicable co-pay amounts.

Contact Lens Benefits

Contact Lenses, Elective/Cosmetic
Elective/Cosmetic contact lenses refer to contact lenses members choose to wear instead of eyeglasses for reasons of comfort or appearance. Contact lenses covered by the Plan must contain a prescription for correcting a vision deficiency.

Contact Lenses, Medically Necessary
Medically Necessary contact lenses are provided only under certain medical conditions. These medical conditions prevent the member from achieving a specified level of visual acuity (performance) through the wearing of conventional eyeglasses. These contact lenses must be specifically prescribed by the eye doctor to be used for the reason or reasons described below. Reimbursement by Superior Vision for these lenses will be considered as payment-in-full when utilizing an in-network provider.

• Aphakia
  A pair of prescription single vision or multifocal eyeglass lenses and an eyeframe can be provided along with contact lenses prescribed for this reason.
• Psuedo-aphakia (after cataract surgery with implant lenses)
• When visual acuity cannot be corrected to 20/70 in the better eye except through the use of contact lenses (must be 20/60 or better).
• Anisometropia of 4.0 diopters or more, provided visual acuity (performance) improves to 20/60 or better in the weak eye
• Keratoconus
  
  Note: The narrowing of visual fields due to high minus or plus corrections is not considered a reason for medically necessary contact lenses. All requests for medically necessary contact lenses must be reviewed and approved by the Superior Vision Services Medical Advisory Board.

The Contact Lens Prescription
The contact lens prescription includes specifications of optical and physical characteristics (such as power, size, curvature, flexibility, gas permeability, etc.). The contact lens prescription is not a part of the covered comprehensive eye examination procedure.

The Contact Lens Exam/Fitting Fee
Most providers charge a fee for the fitting of contact lenses. This fee, which may also be referred to as the contact lens exam, is separate from the fee for the comprehensive eye examination. The cost will vary depending on the provider's fee structure policies. The cost may also vary due to circumstances or complexities involving the physiological condition of the eyes and cornea, the lens prescription, and the type of lenses used.

The Contact Lens Benefit Allowance
The contact lens allowance can be used for costs involved in the fitting and/or the supply of contact lenses. This includes the fitting fee (sometimes referred to as the contact lens exam-unless it is a stand alone benefit) and the materials (lenses). It is at the discretion of the member as to which charges are applied to the plan allowance and which, if any, are paid for out-of-pocket.

The Superior Vision Services Provider Network

An unrivaled network in every state
The Superior Vision provider network, the largest, most diverse nationwide, has hundreds of applications in the process of contracting and credentialing at all times. It is through our three "O" network (ophthalmologists, optometrists and optical companies) that we provide broad geographic coverage throughout every state in the U.S.

Members Have Freedom of Choice
A well-rounded provider network is important because it provides the member with a wide variety of choices from which to select their vision provider. The table below shows the provider types that make up our network and their percentage of the total.

Through the Superior Vision Plan provider network, which fairly represents all of the three O's (ophthalmologists, optometrists, opticians and optical chains), our members can closely pattern the source of their vision care to their daily work schedules and their shopping and healthcare system preferences.

The Provider Nomination System
Superior Vision Services provides employees with the opportunity to nominate their provider should their provider not appear in our directory. This assures the client, and the prospective client, that those providers who are currently serving their employees will have the opportunity to join the provider network. In areas where the network is not yet adequate, Provider Services Reps will contact providers to encourage their participation, and where feasible, will hold orientation meetings to assist in building the network.

Although Superior Vision manages the largest network of ophthalmologists in the nation and the largest network of optical chain locations, we do not promote, nor protect, one provider type over another. Our goal is to meet the provider access demands of our membership through a well balanced and diverse provider network.

Discounts are available for additional pairs of eyewear and contact lenses