F cus First. EyeCare. Agent Guide

Transcription

1 F cus First EyeCare Agent Guide

2 Table of Contents About the Affiliated Workers Association (AWA) About Focus First EyeCare Overview State Availability 3 4 AWA Health Care Discounts Focus First EyeCare Plan & Membership Rates Membership Plan and Rates Additional Features Limitations and Exclusions Frequently Asked Questions Forms

3 Welcome to AWA Membership to Affiliated Workers Association (AWA) has its advantages. You are now part of a non-profit organization comprised of small business owners, self-employed professionals and entrepreneurs from all across America. AWA is committed to providing education, resources and benefits to help our members save money, time and grow their business. As an AWA member, you receive valuable resources for information to help you navigate through the complexity of running a business. You also have access to industry-leading benefits to help you and your family stay healthy and reduce expenses in your daily life, like telemedicine, insurance and roadside assistance. Who We Serve Our membership is as diverse as our population, ranging from a shop owner in Texas to a freelance web designer in Pennsylvania. Membership is open to small business owners, independent contractors and entrepreneurs ages 18 and over, and can extend to the entire family. Our Approach One word that defines our commitment to our members: Empowerment. We work tirelessly to research resources and benefits that will help our members reduce overhead expenses and learn how to succeed in their business endeavors. We know our members work hard for their money, and we work hard for them. Seeking out the best benefit providers and assuring top-quality services is just part of the day-to-day business for the AWA. Our Partners The AWA is proud to be a strategic partner with a national advocacy group, Small Business Majority, to support our members in small business growth and provide information on issues that impact small businesses, including government, health care reform, clean energy, and other areas. 3

4 About Focus First EyeCare Experience You Can Trust Reliance Standard Life Insurance Company (Reliance Standard) was incorporated in 1907 as Central Life Insurance of Illinois. Reliance Standard is domiciled in Illinois, and maintains its administrative offices in Philadelphia, PA and Lincoln, NE. Reliance Standard is licensed in all states (except New York), the District of Columbia, Puerto Rico, the U.S. Virgin Islands and Guam. In business for over 100 years, Reliance Standard is a leading insurance carrier specializing in innovative and flexible benefits solutions. A Strong, Diversified Company As a premier insurance carrier, Reliance Standard consistently earns strong financial ratings: A.M. Best A+ (Superior), affirmed August 2013 Standard & Poor s A+ (Superior), affirmed July 2013 Reliance Standard is a member of the Tokio Marine Group. EyeMed Select Provider Network At EyeMed, they want to make sure that AWA members clearly see all the unforgettable moments that life has to offer. That s why they are committed to making it easy to visit one of the participating doctors in the network for an annual eye exam. Not only does EyeMed have a broad network of independent providers, they also offer five of the top six most admired national retail chains as in-network options including: LensCrafters, Sears Optical, Target Optical, JCPenney Optical and most Pearle Vision locations. With more than 63,000 independent and retail providers to choose from, including some that offer night and weekend hours, members can visit the provider that best suits their needs. 4

5 State Availability Focus First EyeCare is Available in 39 states and D.C. CA OR WA NV ID UT MT WY CO ND SD NE KS MN IA MO WI IL MI OH IN KY WV PA VA NY VT NJ DE MD ME NH MA RI CT AZ NM OK AR TN MS AL GA SC NC HI TX LA FL AK Available Not Available Focus First EyeCare is NOT Available in: AK, HI, ME, MT, NH, NY, OR, SD, UT, VT, WA. Coverage will not continue for active members who move to the following Carrier non-approved states: ME, MT, NH, NY, OR, SD, UT, VT, WA. 5

6 F cus First EyeCare AWA Health Care Discounts 6

7 Features: Prescription Discount ScriptSave Prescription Savings Card The ScriptSave Prescription Savings Card provides you access to discounted prescription drug prices. All household members can use the same card including pets, if the pet medication is a common drug that is also used by people. There are no limits on how many times members and their family can use the card. Save between 15% to 75%, with average savings of 44% (based on 2014 national program savings data) Accepted at over 62,000 participating pharmacies nationwide, including major chains and independent pharmacies An open formulary so nearly all medications qualify for discounts Discounts on brand and generic medication - no physician referrals needed Members will always receive the lowest price available on your prescription purchase Savings: FAMILIES WITH LIMITED OR NO PRESCRIPTION COVERAGE can reduce out of pocket costs INDIVIDUALS WITH PRESCRIPTION COVERAGE can reduce the cost of medications that are not covered SENIORS WITH MEDICARE PART D can save on prescriptions that are EXCLUDED from coverage Honored at Over 62,000 Participating Pharmacies, Including: Plus Thousands of Additional Chains and Independent Pharmacies Nationwide. DISCOUNT ONLY NOT INSURANCE. Discounts are available exclusively through participating pharmacies. The range of the discount will vary depending on the pharmacy or provider chosen and services rendered. The program does not make payments directly to the pharmacies or providers. Members are required to pay for all health care services. 7

8 39DollarGlasses.com AWA Discounts Members can save 70% or more when purchasing glasses online. 39DollarGlasses.com was developed by eye doctors to create an inexpensive method for people to acquire high-quality, complete prescription eyeglasses and sunglasses through its e-commerce website. Experience As one of the largest online optical sites, 39DollarGlasses.com is the most recognized and trusted name for prescription eyeglasses and sunglasses. Feedback from thousands of happy customers has earned 39DollarGlasses.com the prestigious 5-Star rating in Yahoo! Shopping and an A+ Rating with the Better Business Bureau as an accredited business since Eyeglasses Lenses 39DollarGlasses.com manufactures their eyewear solely in the United States using the same high-quality materials seen at more expensive establishments. They offer top brands, such as Varilux no-line bifocals and Transitions Lenses at a fraction of the typical retail cost. Polycarbonate lenses are the most impact-resistant and lightest material made for eyeglasses. All lenses come with a scratch-resistant coating (on both sides of the lenses) and a 100% UV coating at no extra charge. As a finishing touch, all lens edges are polished. Prescription Sunglasses Any of their stylish frames can be made into prescription sunglasses with the same discounts as regular eyewear. In fact, all of their frames can be purchased online as non-prescription or prescription sunglasses. Bifocal sunglasses are also available. Philanthropy Thousands of dollars worth of eyeglasses has been donated by 39DollarGlasses.com to a number of charities and organizations, including the Lions Club International organization, the New York City public schools and the Kress Vision Program, all in an effort to assist those in need. They are an American company that believes in giving back to the community. EyeBucks Rewards When members order from 39DollarGlasses.com, they are automatically enrolled in the EyeBucks Rewards program. 4% of their purchases will be deposited into their customer account for future purchases. Members simply go to My Account to see how much they have earned! 8

9 F cus First EyeCare Vision Plan & Membership Rates 9

10 About Focus First The importance of regular eye exams often is under-rated. Having annual eye exams should be as routine as having a dental checkup every six months. Regular eye exams are crucial to maintaining healthy vision and can often detect major medical problems in the early stages of development, such as diabetes, multiple sclerosis, hypertension, stroke, heart disease and high blood pressure. The Focus First EyeCare vision plan provides benefits for an eye exam and lenses once every 12 months, and frames once every 24 months. In addition, members receive benefits for contact lenses, as well as discounts on vision items not covered by the plan. Members receive higher benefits when they utilize one of the 65,000 network providers nationwide. Key Benefits: Annual Eye Exam covered in full Exam and Lenses every 12 months Frames every 24 months Single, Bifocal, Trifocal Lenses covered in full EyeMed s integrated provider network is included in the Focus First EyeCare plan. Members can choose from private practice optometrists, ophthalmologists, opticians and optical retailers and enjoy in-network savings. When visiting an EyeMed Select Network provider, members may choose from any frame available at the provider locations. Most independent providers and retail locations carry name-brand frames by Luxottica, the world s leading eyeglass frame manufacturer. Focus First EyeCare also offers savings on lens options such as ultraviolet coating, and up to 40% off the purchase of additional pairs of complete eyeglasses. Members also can enjoy cost reductions on laser vision correction surgery and conventional contact lenses through EyeMed. Out-of-network benefits are also available. If members choose an out-of-network eye care provider, benefits will be based on the out-of-network allowances. Any amounts exceeding the plan allowances are payable by the plan member. Healthy vision is one of the greatest gifts we have. Take care of yours with the Focus First EyeCare vision plan. 10

11 Vision Plan Focus First EyeCare Plan Plan Design Summary In Network 1 Out of Network Annual Eye Exam Deductible N/A N/A Frequency (based on date of service) Once every 12 months Once every 12 months Member Cost Covered in full Plan pays up to $30 Eyeglass Frames Deductible N/A N/A Frequency (based on date of service) Once every 24 months Once every 24 months Frames Plan pays up to $100 Plan pays up to $45 Eyeglass Lenses (Per Pair) Deductible Member cost $10 N/A Frequency (based on date of service) Once every 12 months Once every 12 months Single Vision Covered in full (after deductible) Plan pays up to $25 Bifocal Covered in full (after deductible) Plan pays up to $40 Trifocal Covered in full (after deductible) Plan pays up to $55 Lenticular 20% Discount N/A Lens Options 2 Standard Polycarbonate Member cost $40 N/A Scratch Resistant Coating Member cost $15 N/A Anti-Reflective Coating Member cost $45 N/A Ultraviolet Coating Member cost $15 N/A Tint (Solid & Gradient) Member cost $15 N/A Standard Progressive Member cost $65 N/A Premium Progressive Plan pays up to $120 N/A Contact Lenses Frequency (based on date of service) Once every 24 months Once every 24 months Elective Plan pays up to $115 Plan pays up to $92 Medically Necessary Covered in full Plan pays up to $200 Contact Lens Fit & Follow Up Exams 3 Frequency (based on date of service) Once every 12 months Once every 12 months Standard Allowance up to $40 N/A Premium 10% Discount N/A 1 EyeMed Select Network 2 Lens options available at an additional cost 3 The allowance of up to $40 for the fit and follow-up of contact lenses is included in the total maximum coverage for contacts of $115 per year. The total coverage the plan will pay for fit and follow-up combined with payment for contact lenses is $115. Standard Contact Lens Fitting - Spherical clear contact lenses in conventional wear and planned replacement (examples include but not limited to disposable, frequent replacement etc.) Premium Contact Lens Fitting - all lens designs, materials and specialty fittings other than Standard Contact Lenses (examples include toric, multifocal etc.) 11

12 Vision Plan & Membership Rates Additional TrueView Features (In Network) Lasik or PRK Average Discount of 15% off retail price or 5% off promotional price at US Laser Network participating providers Discounts 15% discount on the remaining balance in excess of the conventional contact lens allowance. 20% discount on the remaining balance in excess of the frame allowance. 20% discounts on items not covered by the plan at network providers, which may not be combined with any other discounts or promotional offers. These discounts do not apply to EyeMed Provider s professional services or contact lenses. Secondary Purchase Plan Members receive a 40% discount on a complete pair of glasses once the funded benefit has been exhausted. Members receive a 15% discount off the retail price on conventional contact lenses once the funded benefit has been exhausted. Discount applies to material only. Contact Lens Replacement by Mail Program After exhausting the contact lens benefit, replacement lenses may be obtained at significant discount online. Visit for details. Monthly Membership Rates* Member $21.00 Member + Spouse $33.00 Member + Child(ren) $34.00 Member + Family $43.00 *One time $15 enrollment fee applies. (This fee is waived when adding vision plan to an active AWA membership.) Rates include a $5 monthly administration fee. Social Security Number required for ALL insureds. Please capture SSN at time of enrollment to ensure member eligibility is processed correctly and benefits are assigned upon effective date. 12

13 Limitations and Exclusions Covered Eye Care Expenses will not include and no benefits will be payable for expenses incurred for: vision examinations more than the frequency as indicated in the certificate. lenses more than the frequency as indicated in the certificate. frames more than the frequency as indicated in the certificate. contact lenses more than once in any twelve month period. When chosen, contact lenses shall be in lieu of any other lens benefit during the twelve month period. When eyeglass lenses are chosen, expenses for contact lenses are not Covered Expenses during the twelve month period. contacts limited to the amount shown on the plan summary page unless they are medically necessary. Contact lenses are defined as medically necessary if the individual is diagnosed with one of the following conditions: keratoconus where the patient is not correctable to 20/30 in either or both eyes using standard spectacle lenses. high Ametropia exceeding -12 D or +9 D in spherical equivalent. anisometropia of 3 D or more. patients whose vision can be corrected two (2) lines of improvement on the visual acuity chart when compared to best corrected standard spectacle lenses. If the member is diagnosed with a medically necessary condition, the Provider will submit a request for pre-authorization to EyeMed. The Medical Director reviews all requests for medically necessary contact lenses. If approved, the member will be covered for medically necessary contact lenses up to the plan allowance. Such payment is limited to once in any twelve month period and is in lieu of lens benefits under this proposal. orthoptics or eye care training and any associated testing. plano non-prescription lenses and non-prescription sunglasses (except for 20% discount). two pairs of glasses in lieu of bifocals. (Does not apply to Secondary Discounts). lenses and frames which are lost or broken, except at the normal intervals when services are otherwise available. medical and/or surgical treatment of the eye, eyes, or supporting structures. services for which a claim is filed more than 1 year after completion of the service. for any procedure not listed on the Schedule of Eye Care Services. VISION INQUIRIES, BENEFITS AND CLAIMS EyeMed Vision Plan Customer Relations (800) Reliance Standard Vision: Group Claims P.O. Box Lincoln, NE

14 Online Membership Access Member Portal All memberships include exclusive access to our online Member Portal, a secure, convenient website that helps members to manage their membership. Visit: members.affiliatedworkersassociation.org Through quick and easy access, members can: Review their benefit information, association benefits and account information Search for an in-network provider Access benefit partner websites for valuable health care savings Download and print Member guide(s) and ID card(s) Update contact information Add a new form of payment Important Agent Note: Initial access to the Member Portal requires a valid member address. Be sure to capture at time of enrollment. 14

15 F cus First EyeCare Frequently Asked Questions 15

16 Frequently Asked Questions Q. Why is vision insurance important? Are eye exams really necessary? A. Yes! Getting an annual eye exam is not just about glasses. An eye exam can detect eye health problems like glaucoma or cataracts, but it can also help identify early signs of diseases that impact the whole body- high blood pressure, diabetes and high cholesterol just to name a few. Q. At what age should children first visit the eye doctor? A. The American Optometric Association recommends that children should have their first eye exam with an optometrist or ophthalmologist between six months of age and one year. The doctor will check for nearsightedness, farsightedness, astigmatism, amblyopia (or lazy eye ), proper eye movement and eye alignment, how the eye reacts to light and darkness, and other eye health problems. They also recommend that their next eye exam should take place sometime between the ages of 3 and 5, and then every year after that. During these exams, the doctor will conduct a comprehensive eye exam as well as vision screening tests. Q. Will members receive a separate Vision ID card? A. Yes, members will receive a packet from Reliance Standard containing their Vision ID card and certificate. Q. When can members begin using their Vision and other benefits? A. Members can begin using their benefits on their plan s effective date, subject to the terms and conditions of the plan. Q. Can members access their Focus First EyeCare plan membership information online? A. Yes, AWA membership includes access to our secure online Member Portal - members.affiliatedworkersassociation.org. On the website, members will find phone numbers, web links and information describing how to use the Focus First EyeCare plan included in their AWA membership. They will also be able to view, download and print their member materials, including a Membership Summary that contains information about their Focus First EyeCare plan, including deductible, coinsurance and plan maximums, as well as their AWA benefits. Q. Can members view their EyeMed benefits online? A. Yes, members can view their benefits and do a lot more on EyeMed s secure website. Members can also print an ID card, check the status of a claim, locate a provider and download an Explanation of Benefits. They can even do all of these things from their smartphone because the EyeMed member site is mobile-optimized. Q. How do members find a provider in the EyeMed Select Network? A. The EyeMed Select directory of more than 63,000 independent and retail providers can be accessed via the provider locator: or by calling EyeMed s Customer Care Center at (866) When members locate a provider through the EyeMed website, they can also schedule an appointment online. Q. Can members get the same quality of care at a retail provider as they can at an independent doctor? A. Absolutely. In fact, many of the optometrists who practice in retail settings share space with an optical store, but operate separately. All optometrists, regardless of the setting of their practice, must meet the same state licensing and credentialing requirements. In addition, due to the finite number of optometry schools in the United States, optometrists are trained consistently regardless of the practice model they eventually choose. Q. Does EyeMed offer any additional discounts? A. Yes, members receive 40% off additional eyewear purchases and 20% off non-prescription sunglasses and accessories at in-network providers. Q. Can members use their benefits to get laser vision correction? A. Yes, they just need to contact the US Laser Network online at or by phone at (877) to find a participating provider. Q. Can members use their benefits when they order contacts online? A. To get the most from their benefits, we suggest that members order contacts through one of EyeMed s in-network providers. Members may still be able to get an out-of-network reimbursement if they use a site like or order through an out-of-network provider. Q. Do members need to submit claims? A. When members visit one of EyeMed s in-network providers, the paperwork is all taken care of. If they see an out-of-network provider, they will need to pay at the time of service and complete a claim form to send to EyeMed for reimbursement. Q. Who can members call for help? A. Claims and Evidence of Insurability status inquiries can be answered 24/7 on the Reliance Standard website: or through their automated Customer Care system: (800) Customer Care Representatives are available weekdays from 8:00 am to 7:00 pm (Eastern Standard Time). 16

17 F cus First EyeCare Forms

18 Focus First EyeCare Enrollment Form * Fields are required. GROUP OR ASSOCIATION Affiliated Workers Association Requested Effective Date Are you an Entrepreneur, Self-Employed Professional or Independent Contractor? * Yes No Enrollee Name * Enrollee Address * City * State * Zip * Social Security Number * Daytime Phone Number * Date of Birth * Address * Gender: Male Female MEMBERSHIP LEVELS AWA Membership $15.00 Enrollment Fee / $5.00 Monthly Membership Dues Selection Focus First EyeCare Coverage Member Member + Spouse Member + Children Member + Family SPOUSE & DEPENDENT INFORMATION (Write spouse s name below if you are applying for Enrollee and Spouse or Enrollee and Family coverage; if no spouse or if spouse is not to be covered, put N/A or None in space below.) Spouse s Name Date of Birth * Social Security Number Gender (M/F) Dependent Name Date of Birth * Social Security Number Gender (M/F) Dependent Name Date of Birth * Social Security Number Gender (M/F) Beneficiary * (Please print full name) Relationship (The enrollee will be the beneficiary for his or her spouse and/or dependent children if dependent coverage is selected unless designated otherwise.) I hereby enroll as a member of the Affiliated Workers Association (the Association ). I appoint the Secretary of the Association in office at any particular time as my proxy to receive notice of and attend all meetings of the members and vote on my behalf and to otherwise act for me in the same manner and with the same effect as if I were personally present. This proxy shall be valid until revoked at any time prior to voting at any meeting by executing and delivering a written notice of revocation to the Secretary of the Association, by executing and delivering a subsequently dated proxy to the Secretary of the Association or by voting in person. By signing below, I and the individuals named herein are eligible for membership. I understand that the Insured Health benefits included with my membership are not major medical coverage and are not intended as a substitute for basic health insurance or major medical coverage. Membership will not begin until the effective date shown on the Member ID Card. I authorize the Affiliated Workers Association to collect any and all fees and dues for this membership. By signing below, I acknowledge that I have read, understand, and agree to the terms and conditions of membership as they have been presented to me. CREDIT CARD OR AUTOMATIC BANK DRAFT Credit Card Type Card Number Expiration Date Security Code Bank Name Routing Number Account Number Applicant Signature Date Agent Signature Agent Name (Print) Agent Number

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20 Focus First Agent Guide _