Frequently Asked Questions

Benefits Manager Frequently Asked Questions

Our desire is for each and every member to have a superior experience when interacting with us. In order for that to occur, it is important that employees are fully educated in how the plan their employer has selected works. Understanding their plan will help them in several ways:

  • In finding the appropriate provider for their specific personal needs;
  • In selecting the benefit options they would like to utilize;
  • In understanding the frequency of those benefit options;
  • In understanding the claims and reimbursement processes.

Eyecare Providers

How To Use Your Benefits

Frame and Lens Benefits

Material Discounts

Eyecare Providers

What should I tell an employee to do if there are no "in-network" providers close to his/her residence?

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 be added to the Superior Vision Provider Panel.

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If an employee's current doctor is not listed as a participating "in-network" provider in the provider listing, is there any way to request that the provider be added to the panel?

Yes, a Provider Nomination Form can be found on our website. In addition, the employee may email us or may make the request through our Customer Service Department at 800.507.3800. You can also fax this information to 916.852.2380. All nomination requests are handled by our Provider Relations Department.

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Are our employees have responsible for a co-pay at the provider's office when they utilize their 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. All co-payments are paid directly to the in-network provider, or deducted from the out-of-network reimbursement.

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Is it necessary for employees to give Superior Vision the name of the provider they have selected in advance in order to receive vision care services?

No, unlike some benefit plans, Superior Vision does not require members to pre-select a provider, or to give Superior Vision the name of the provider prior to receiving services. Employees need only select a provider, make an appointment, and identify themselves to the provider as Superior Vision Plan members.

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Are there any situations that would require an employee to pay anything directly to an "in-network" provider?

Members pay the provider directly for the following:

  • Any specified co-pay for the eye exam and any specified co-pay for the materials.
  • Any charges over and above the contact lens or frame allowance.
  • Any additional charges for products or services that are not fully covered under your plan. See the Limitations and Exclusions section in your welcome packet.
  • Any time the member takes advantage of an in-store sale or promotion.
  • See your Outline of Benefits for your benefit allowance amounts.

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Can our employees get their eye examinations at one location and go somewhere else for their frames or contacts?

Yes, however, each provider will need to contact Superior Vision Customer Service to verify eligibility.

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How To Use Your Benefits

What is the best way for my employees to know which services are offered by the different providers?

In the Superior Vision Provider Directory, codes for the covered services are printed beneath each provider's name and address. These abbreviated codes will tell you and your employees which services are provided at each location.

EX = Routine Eye Exam
GL = Eyeglasses
CL = Contact Lenses Exam Fit
DP = Discount Benefit Available
DP8-20 = SVP8-20 Discount Benefit Available
RF = Refractive/LASIK Surgery Discount Available
** = Services Not Available

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Does Superior Vision require that an employee obtain an authorization form or a voucher prior to being able to receive services at an "in-network" provider?

There are no vouchers or pre-authorization forms to obtain prior to receiving services from an "in-network" provider.

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What is the best way for an employee to utilize his vision benefit when using a provider who is not on the Superior Vision provider list?

  • First, call Superior Vision Customer Service at 800.507.3800 and get an authorization number/eligibility number.
  • Second, see your provider and pay for your examination and/or materials. You do not pay the non-network provider a co-pay.
  • Third, place in an envelope your original itemized billing or receipt, describing all of the services and materials that were provided to you, along with your name, address and the authorization/eligibility number you received from Customer Services and mail to:
    Superior Vision
    P.O. Box 967
    Rancho Cordova, CA 95741
    You will be reimbursed according to the schedule of allowances for out-of-network services, less any required co-pays.

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Are employees required to notify Superior Vision in advance that they want to use their vision benefits or can they just go directly to the provider?

When using an in-network provider, it is not necessary to notify Superior Vision prior to receiving services.

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Does an employee have to show their Superior Vision ID card to the provider when he/she goes in for the examination, or to get glasses or contacts?

The ID card assists provider in identifying Superior Vision members and the plans under which they are covered. It is recommended that employees show the ID card to the provider; however, they can receive services without the ID card. Employees should simply identify themselves as Superior Vision Plan members with proper personal identification, ID number, and employer's name.

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If one of my employees has a problem or needs assistance in resolving an issue with an "in-network" provider, who should he/she call?

The member should first try to resolve the issue directly with the provider. However, if assistance is needed, the employee should call our Customer Service Department for further information and assistance.

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If an employee would like to know exactly what is or is not covered by the vision plan, what is the best way to obtain that information?

Attendance at one of the open enrollment meetings is the best way to gain all the information and details regarding the use of your organization's vision plan. In addition, the benefits are outlined in the packet of information employees receive along with their ID card. The employee can also call our Customer Service Department or visit this website to obtain additional information.

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Do an employee's dependents need to have their own ID cards to receive benefits?

No, it is not necessary for dependents to have personal I.D cards in order to use the Superior Vision Plan benefits. Dependents may use the primary member's ID card.

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Frame and Lens Benefits

What does the term "covered in full" mean as it relates to our employee's prescription lens benefit?

The vision plan is designed to cover "basic" lenses and frames. A basic lens is considered an uncoated plastic or glass lens. Any upgrades or add-on's to the lens will be the member's responsibility unless specifically covered by their employer's plan. Examples of upgrades and add-on's include anti-reflective and scratch coatings. The member pays the extra charges directly to the provider. Items requiring additional charges are listed under the Limitations & Exclusions section of the Outline of Benefits schedule.

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How are progressive lenses covered under our vision plan?

Lined bifocals and trifocals are standard lenses and covered in full; progressive lenses are covered at the provider’s in-office retail price for a standard lined trifocal. The member pays the difference between their selected progressive lens and their provider’s retail price for a standard lined trifocal lens, less applicable discount if receiving the lenses from a provider who accepts our discounts. The member also pays the applicable co-pay for materials.
Please see your Outline of Benefits schedule for any possible variation for your company’s coverage of progressive lenses.

Some plans do include coverage of progressive power lenses. Please see your Outline of Benefits schedule.

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How do employees determine what kinds of frames they can select as part of their vision benefit?

Your employee can select any frame in the network provider's inventory up to the retail allowance shown in your Outline of Benefits schedule without incurring any additional out-of-pocket cost.

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If an employee selects a frame that is more expensive than the frame allowance that is included in their plan, what does he/she need to do?

The employee will pay the difference between your plan's in-network allowance and the regular retail price of the frame selected.

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Does the Superior Vision plan cover tinted eyeglass lenses for our employees?

The benefit covers the cost of the basic lenses which includes Rose Tint #1 and #2. For the darker sunglass tint colors, the member will need to pay an additional charge over the standard lenses.

Some plans do cover all tints. Please see your plan outline.

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Can employees who wear both contact lenses and glasses use their benefits for both of them within the same benefit period?

Under most plans, employees may use their benefits for one or the other, but not both during the same benefit period. However, some plans do cover both eyeglasses and contact lenses within the same benefit period. Please see your plan outline.

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Material Discounts

Can employees use the discount feature to purchase non-prescription sunglasses?

Yes, discounts are available for non-prescription sunglasses except when discounts are prohibited by the manufacturer.

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Can an employee apply "discount coupons" in addition to the discount they receive at a provider when they utilize the discount feature of the vision plan?

No, the discount feature cannot be used with any other discounts.

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