HD InSight Vision Benefit Plan HDIS0917. Agent Guide

Transcription

1 HD InSight Vision Benefit Plan HDIS0917 Agent Guide

2 Table of Contents About Health Depot Association Value-Added Benefits 39DollarGlasses.com HealthFitLabs Retail Benefits Vision Insurance Benefits About the Carrier Eligibility / State Availability Vision Benefits Vision Network Healthy Vision Tips Limitations & Exclusions Frequently Asked Questions Membership Rates

3 About Health Depot Association 2 At Health Depot, we are committed to providing premier customer service and maintaining relationships of trust with all of the people we serve including our members, carriers and business partners. We provide access to affordable health and consumer benefits to the people who need these products most entrepreneurs, self-employed professionals and contractors. We are also dedicated to empowering our members with valuable resources, information and support to guide them in making their personal and professional lives easier and more fulfilling. Health Depot offers only the most valuable solutions from trusted names in the consumer products and benefits industry. We work closely with our business partners and vendors to ensure that these products meet our extremely high quality standards. Vision & Values Create a community of people who collectively help one another socially by interacting and exchanging ideas with one another, financially by leveraging the power of the group to acquire benefits and services, and physically by providing support, information and benefits related to individual health. Well-being, Diversity, Discovery, Caring, & Integrity We believe in making our members more comfortable, healthy, and happy. We recognize that every member is different; each one shaped by unique life experiences with different needs for well-being. We promote education and learning new ideas for our members. We understand, empathize with, are compassionate toward, and meet the needs and requests of our members. We do what is right, are accountable for, and take pride in our actions in everything we do for our members.

4 Health Depot Association Benefits

5 39DollarGlasses.com 4 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. 39DollarGlasses.com 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 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. Lenses 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. 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!

6 HealthFitLabs & Retail Benefits 5 HealthFitLabs is an online merchant that sells only the highest-quality natural vitamins, nutritional supplements, and bath and personal care products. Visit to browse several different product search options including categories such as Healthy Lifestyle, Vitamins & Minerals, Bath & Personal Care, and Healthy Pets. Members can also search by health condition. For instance, they have supplements for Eye Health Support, as well as others like Blood Sugar Support, Mood Support and more. Or shop by brand name; there are 1,900 products available on their website. Most vitamins are available to ship within 24 hours. Members save an additional 20% off already reduced prices on their first order at checkout. HealthFitLabs & Retail Benefits HealthFitLabs is dedicated to helping members meet their health goals at the best possible prices. Retail Benefits is an online shopping site with a wide array of offerings. Members can earn up to 40% cash back at more than 5,000 leading merchants. Save even more with coupons that can be used instantly at your favorite stores. As an association member, you and your family receive special pricing for stores, many with items that can prove beneficial to vision. The Shopping Assistant Toolbar, which can be downloaded to any computer, allows you to search for a product or merchant right from your browser without having to visit the Retail Benefits site first. You can search for products and compare prices and earnings between stores from the comfort of your home! Ways Retail Benefit Can Help Members Improve Their Eye Health: Receive up to 4.2% cashback at Office Depot for screen filters to help reduce eyestrain while using the computer Get up to 7.0% cashback for 39dollarglasses.com Enjoy cashback and discounts on contacts from BestContacts.com and ACLens Review a variety of sunglasses discounts available from brands like Ray-Ban and Sunglass Hut Find discounts for Vitamin A, an essential supplement for eye health, from stores like Puritan s Pride and GNC Health Depot Association members will be amazed at how quickly their earnings add up! Once you have registered, you can invite friends and family to create their own accounts and take advantage of this great benefit.

7 Vision Plan Benefits

8 About the Carrier 7 Gerber Products the baby food people established Gerber Life Insurance Company as a separate subsidiary in The two companies share a common goal: to help parents raise happy, healthy children. For Gerber Life, this means providing quality life insurance especially for young families on limited budgets and people at every stage of life. About the Carrier Today Gerber Life insures over 2 million people throughout the United States and Canada. The Company s underwriting principles, persistent cost controls, and careful monitoring of policy reserves for future benefit payments combine to build stability that can be counted on now and for the years to come. Gerber Life Insurance Company has achieved A rating (Excellent) from A.M. Best. Since 1976, MESVision has provided outstanding vision care services to large and small employer groups through well-known insurance companies, health plans, preferred provider organizations and self-funded (administrative services only) plans. A third party administrator focused on efficiently and effectively administering vision benefit programs, MESVision performs claims administration, eligibility verification, billing and collections, as well as customer service regarding all member and provider inquiries. MESVision is a Preferred Provider Organization committed to developing and maintaining a strong vision provider network. With one of the largest and most comprehensive networks nationwide, members have their choice of a substantial panel of Ophthalmologists (MDs), Optometrists (ODs) or Opticians located throughout the United States, including some of the most popular retail optical chain locations. Participating providers are required to meet stringent quality of care and credentialing standards. Members utilize participating providers 98% of the time, due to the quality of vision care services.

9 Membership Eligibility Requirements 8 Membership Eligibility Requirements Reside in an available state Adults age eighteen (18) or above Dependent children covered to age 26 Common Law Spouses and Domestic Partners are accepted Membership Eligibility Requirements 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 N/A in AK, HI, NY, WA.

10 Vision Benefits HD InSight Vision Benefits Annual Eye Exam Vision Service Participating Provider Benefit Amount Covered by the Plan Non-Participating Provider Benefit Amount Reimbursed by the Plan 1 Frequency (based on date of service) Once every 12 months Once every 12 months Deductible $10 $10 Member Benefit Covered in Full $40 Eye Glass Frames ² Frequency (based on date of service) Once every 24 months Once every 24 months Frames Up to $100 Retail $40 Deductible $25 $25 Eye Glass Standard Lenses (up to 61mm) 9 Vision Benefits Frequency (based on date of service) Once every 24 months 3 Once every 24 months 3 Single Vision Covered in Full $30 Bifocal Covered in Full $50 Trifocal Covered in Full $65 Lenticular Covered in Full $125 Lens Options Polycarbonate Lenses 4 Up to $85 $55 Progressive Lenses Up to $89.50 $65 Contact Lenses 5 Frequency (based on date of service) Once every 24 months Once every 24 months Elective Up to $100 Retail $100 Non-Elective Covered in Full with Authorization $250 1 Less any applicable copay. 2 Retail frame benefits will be converted to wholesale or warehouse equivalent prices at category 5 or 6 provider locations, (please refer to the Plan s website at The wholesale or warehouse equivalent may be approximately 30% less than the retail frame allowance; please confirm this benefit before ordering your eyewear months with one or more of the following prescription changes: A change of 0.50 diopter or more in one eye, or total in both eyes. A shift in the axis of the cylinder of 15 degrees, or less than 15 degrees on a graduated scale as the cylinder power increases over 0.75 diopter. The graduated scale is based on the shift in the axis multiplied by the cylinder power resulting in a factor of 8 or more. Table available to provider on request. 4 For Dependent Children through age This benefit is in addition to the comprehensive vision examination, but in lieu of lenses and frame. If contact lenses are for cosmetic or convenience purposes, the Policy will pay up to the above stated amount toward the contact lens evaluation, fitting costs and materials. Any balance is your responsibility. If contact lenses are medically necessary, they are a fully covered benefit. Approval from MESVision is required. Please refer to your Policy if you require additional information.

11 Vision Benefits Additional Features (in Network) Discounts A 20% discount is available for cosmetic extras, such as tints, coatings and other add-on charges to standard lenses, after Covered Services are rendered. The discount may be applied to charges for the frame or contact lenses (except disposable or replacement contact lenses) over the stated allowances. The 20% discount also applies to additional pairs of glasses and/or pairs of standard contact lenses. 10 Vision Benefits To determine whether a provider offers the 20% discount, an insured individual can review their Participating Provider Directory, call MESVision at (800) or visit Contact Lens Replacement by Mail Program MESVision plan members can now order contact lenses online through our website. Ordering contacts is easy. You can use your benefit at checkout, no claim form required and any order over $50 ships free. Please visit to learn more. LASIK Procedures Discounts are available through LasikPlus and Qualsight Lasik for conventional and custom LASIK procedures. Please visit and qualsight.com/-mesvision to learn more. Helpful Hints for Eye Health Add foods Foods that are rich in vitamin C, vitamin E, zinc, lutein, zeaxanthin, beta-carotene and omega-3 fatty acids to promote good eye health. Berries, spinach, carrots, sweet potatoes, salmon, trout, eggs and almonds can all help your overall eye health. Wear protective eyewear Safety glasses for sports and sunglasses to protect from the sun s ultraviolet rays can all be fashionable and beneficial to your vision. Give your eyes a rest Use the rule: Every 20 minutes look away from the screen to about 20 feet in front of you for 20 seconds to help reduce eyestrain.

12 Vision Network MESVision Provides Real Choice MESVision has been providing Real Choice in exceptional vision care services to thousands of companies and millions of vision plan participants since Vision Network Using an In-Network doctor maximizes your benefits Access Members now have access to one of the largest vision provider networks available in the United States with thousands of locations nationwide. You have thousands of Choices! Shop and Compare MESVision providers can Choose eyewear from ALL brands and ALL materials available. They are not restricted to certain brands and optical laboratories as with other vision plan companies. The Choice is yours to shop and compare to receive the most value for your benefit dollar. Flexibility Members can Choose to utilize one provider for your examination and eyewear materials or you can Choose to receive your examination from one provider and your materials from another provider. The Choice is yours! MESVision Network The MESVision Network includes Real Choices in network vision care providers: Independent Ophthalmologists (MD) Independent Optometrists (OD) Independent Opticians (OPT) Optical Retail Chain Locations including LensCrafters Walmart Target Pearle Vision EyeMasters EyeGlass World Costco Sam s Club Sears Optical Texas State Optical VisionWorks And More... Members can receive care from any licensed Ophthalmologist, Optician, or Optometrist, but their benefits differ and their out-of-pocket costs will be higher with a non-network doctor. And In-Network doctors also file claims for members, saving them time and the hassle of paperwork. For more information on your HD Insight Vision plan or to search for an MESVision provider, visit or call (800)

13 Healthy Vision Tips Regular Eye Exams - Why Should You Get Your Eyes Examined? An eye exam is one of the best ways to protect your vision because it can detect eye problems at their earliest stage when they re most treatable. Regular eye exams give your eye doctor a chance to help you correct or adapt to vision changes. Even if you think your eyes are healthy, you still need an eye exam from time to time. Here are some guidelines to follow for eye health: Children 5 Years and Younger Screening for eye disease should be conducted at: Newborn to 3 months 6 months to 1 year 3 years 5 years Some factors may put your child at increased risk for eye disease. If any of these factors apply to your child, check with your eye doctor to see how often you should have a medical eye exam: Developmental Delay Premature birth Personal or family history of eye disease Previous serious eye injury Use of certain medications (check with you eye doctor) Some diseases that affect the whole body (such as diabetes or HIV infection) 12 Healthy Vision Tips School Age Children and Adolescents Have your child s vision checked before he or she enters first grade. If your child has no symptoms of vision problems and doesn t have a family history of vision problems, have your child s vision rechecked every two years. Talk to your child s eye doctor about what checkup schedule is best for your child. Adults If you don t wear glasses or contacts, have no symptoms of eye trouble, don t have a family history of eye disease and you don t have a chronic disease, such as diabetes, that puts you at risk of eye disease, have an eye exam at the following intervals: Ages 20 to 29: one examination Ages 30 to 39: two examinations Ages 40 to 65: examination every two to four years Ages 65 and over: examination every one to two years If you do wear glasses or contacts, you ll need to have your eyes checked yearly. And if you notice any problems with your vision, schedule an appointment with your eye doctor as soon as possible. Blurred vision, for example, may suggest you need a prescription change. A sudden increase in the number of floaters (dark circles darting through your vision) could suggest visionthreatening changes to your retina. Sources: American Academy of Ophthalmology (AAO) The Mayo Clinic

14 Limitations & Exclusions 13 Limitations & Exclusions LIMITATIONS Covered Services paid up to the Schedule of Benefits: We may limit benefits, as shown in the Schedule of Benefits, for: 1. Contact lenses, except as specifically provided; 2. Contact lens fitting, except as specifically provided; 3. Eyewear when there is no prescription change, except when benefits are otherwise available; 4. Non-standard lenses or lens options including, but not limited to polycarbonate, progressive, photochromic, polarized, highindex, occupational, beveled, faceted, coated (i.e., anti-reflective, scratch, mirrored and UV), oversized exceeding the allowance for covered lenses or such custom lens options; 5. Tints, other than pink or rose #1 or #2, except as specifically provided; 6. New patient intermediate (follow-up) examinations: You should see the same doctor for both the comprehensive and intermediate (follow-up) examinations in order to receive the maximum benefit and to optimize continuity of care. When You elect to have a comprehensive examination and You are eligible for an intermediate examination or select a different provider to perform the intermediate (follow-up) examination, You will be responsible for the difference between the intermediate (followup) examination allowance and the comprehensive examination allowance; and 7. Non-prescription (plano) eyewear. EXCLUSIONS Non-Covered Services : We will not pay benefits for: 1. Any eye examination required by an employer as a condition of employment; 2. Care or treatment of a condition for which You are entitled to or eligible for benefits under any Workers Compensation Act or similar law. 3. Replacement contact lens insurance offered by providers, care kits or frame cases; 4. Covered services which began prior to the insured s effective date, or after the benefit has terminated; 5. Covered Services for which You are not legally obligated to pay; 6. Covered Services required by any government agency or program, (federal, state or subdivision thereof); 7. Covered Services performed by a close relative or by an individual who ordinarily resides in the insured s home; 8. Orthoptics, vision training or subnormal vision aids; 9. Services that are Experimental or Investigational in nature; 10. Any services provided in connection with war or any act of war, whether declared or undeclared, or condition contracted or accident occurring while on full-time active duty in the armed forces of any country or combination of countries. 11. Procedures that are not included in the Schedule of Benefits. 12. Any charge for services that the appropriate regulatory board determines were provided as a result of a referral prohibited by State Law. 13. Medical or surgical treatment of the eyes. 14. Any Covered Services provided by another vision policy; and 15. Replacement of lenses or frames which are lost, stolen or broken, except when benefits are otherwise available. Limitations & Exclusions HD InSight MESVision Plan Medical Eye Services (MESVision) P.O. Box Santa Ana, CA Locate participating providers at or call (800)

15 Frequently Asked Questions

16 Frequently Asked Questions 15 Frequently Asked Questions Why is vision insurance important? Are eye exams really necessary? 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. At what age should children first visit the eye doctor? 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. When can members begin using their Vision and other benefits? Members can begin using their benefits on their plan s effective date, subject to the terms and conditions of the plan. Can members access their HD InSight plan membership information online? Yes, membership includes access to our secure online Member Portal - members.healthdepotassociation.com. Once logged in, members can view, download and print their member materials, including ID card, benefits guide and certificate, as well as access phone numbers, web links and information regarding their HD InSight plan membership. What is the vision network and how do members find participating providers? Members can select a participating vision care provider at or by calling MESVision s Customer Care Center at (800) When you make an appointment with the participating provider of your choice, inform them that you are a MESVision member and they will call to verfiy your eligible plan benefits. Can members get the same quality of care at a retail provider as they can at an independent doctor? 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. Can members use their benefits to get laser vision correction? Yes, discounts are available for conventional and custom LASIK procedures through our partners, LasikPlus and Qualsight Lasik. Visit their websites for more information (see page 10). Can members use their benefits when they order contacts online? Yes, the contact lens benefit will apply to the purchase of contacts at their provider s office or online at com/optics. Ordering contacts online is easy. Members can use their benefit at checkout, with no claim form required and any order over $50 ships free. Do members need to submit claims? When members visit one of MESVision s in-network providers, the paperwork is all taken care of. If they see an outof-network provider, they will need to pay at the time of service and complete a claim form to send to MESVision for reimbursement. Who can members call for help? Please contact Health Depot s Customer Service at (855) and one of our friendly representatives will be glad to help you! Frequently Asked Questions

17 Membership Rates

18 Monthly Membership Rates 17 HD InSight Monthly Membership Rates Member $15 Member + Spouse $27 Member + Child(ren) $25 Monthly Membership Rates Member + Family $35 One-time $25 enrollment fee applies. Fee is waived when Vision is added to an active Health Depot membership. N/A in AK, HI, NY, WA.

19 The Health Depot Association healthdepotassociation.com (855) V090617