Be sure to review Section 1, Eligibility, of this brochure, prior to submitting your enrollment or obtaining benefits. If the provider does not resolve the matter, call us at. You can find specific benefit information in the Evidence of Coverage. (available for select locations) Find a provider Learn more: Convenience & choice Self Plus One: A Self Plus One enrollment covers you as the enrolled employee or annuitant plus one eligible family member whom you specify. In response to the legislation, OPM established the Federal Employees Dental and Vision Insurance Program (FEDVIP). Under any workers compensation law or any other law of like purpose. The following extra discounts and savings are only available from network doctors. You are responsible for charges billed over the amounts shown. It is your responsibility to ensure that the provider chosen is an active participant in the program at the time you receive services. If you are enrolled in Self Plus One, you and your designated family member are entitled to these benefits. There are two ways for you to save at thousands of locations through Hearing Care Solutions or Amplifon Hearing Health Care. You may look up information on our plan or ask a question at. 1. A compensationer is someone receiving monthly compensation from the Department of Labors Office of Workers Compensation Programs (OWCP) due to an on-the-job injury/illness who is determined by the Secretary of Labor to be unable to return to duty. You are eligible to enroll in FEDVIP or continue FEDVIP enrollment into compensation status. Premium deductions will start with the first full pay period beginning on/after January 1, 2023. The Aetna Vision Preferred plan offers both in- and out-of-network coverage. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. Plan features and availability may vary by location and are subject to change. It is only a partial, general description of plan or program benefits and does not constitute a contract. Discounts may not be available in all states at all in-network providers. Participating doctorsprovide a comprehensive exam that focuses on your eyes and overall wellness, including dilation as necessary. and needs. You may also request or view the most current directory via our website at www.aetnafeds.com. Vision wellness . This search will use the five-tier subtype. Simply add vision to your dental plan to get plenty of convenient eye care choices. In addition to the annual Open Season, there are certain events that allow you to make specific types of enrollment changes throughout the year. When you visit an Aetna Vision network doctor, your eye exam and prescription glasses or contacts are covered after any co-payments. If you decide not to see an Aetna Vision doctor, you are required to pay the provider in full at the time of your appointment and submit a claim for reimbursement up to the amount allowed by the plan. Pearle Vision This is what youpay out-of-pocket for covered care: Aetna is responsible for the selection of in-network providers in your area. On December 23, 2004, President George W. Bush signed the Federal Employee Dental and Vision Benefits EnhancementAct of 2004 (Public Law 108-496). Certain claims administration services are provided by First American Administrators, Inc. and certain network administration services are provided through EyeMed Vision Care (EyeMed), LLC. Provider participation may change without notice. This decision is not subject to judicial review. If your provider is not currently participating in the provider network, you can nominate them to join. If you live in an area with limited access to a network provider and you receive covered services from an out-of-network provider, we will pay the same benefit level as if you utilized the services of an in-network provider. Plan features and availability may vary by service area. We negotiate rates with vision care providers and other health care providers to help save you money. **The amount shown is the negotiated discounted price you will pay the provider. To use your Aetna Vision membership, find an in-network eye doctor through the above provider locator and schedule an appointment. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Any charges in excess of the benefit, dollar, or supply limits stated in this brochure; Any exams given during your stay in a hospital or other facility for medical care; Eye surgery for the correction of vision, including radial keratotomy, LASIK and similar procedures; Special vision procedures, such as orthoptics, vision therapy or vision training; Vision services or supplies which do not meet professionally accepted standards; Duplicate or spare eyeglasses or lenses or frames for them; Special supplies such as nonprescription sunglasses and subnormal vision aids; Any vision service, treatment or materials not specifically listed as a covered service; Services and materials that are experimental or investigational; Services and materials which are rendered prior to your effective date; Services and materials incurred after the termination date of your coverage unless otherwise indicated; Services and materials not meeting accepted standards of optometric practice; Services and materials resulting from your failure to comply with professionally prescribed treatment; Any charges for failure to keep a scheduled appointment; Any services that are strictly cosmetic in nature including, but not limited to, charges for personalization or characterization of prosthetic appliances; Services or materials provided as a result of intentionally self-inflicted injury or illness; Services or materials provided as a result of injuries suffered while committing or attempting to commit a felony, engaging in an illegal occupation, or participating in a riot, rebellion or insurrection; Charges for copies of your records, charts, or any costs associated with forwarding/mailing copies of your records or charts; State or territorial taxes on vision services performed; Medical treatment of eye disease or injury; Special lens designs or coatings other than those described in this brochure; Two pairs of eyeglasses in lieu of bifocals; Services not performed by licensed personnel; Professional services you receive from immediate relatives or household members, such as a spouse, parent, child, brother or sister, by blood, marriage or adoption. Or, members can save $800 and get a free LASIK exam at featured LasikPlus Vision Centers for a limited time. Special supplies such as nonprescription sunglasses and subnormal vision aids. You may enroll in a dental plan or a vision plan, or both. We have increased the in-network contact lens allowance from $150 to $170. What's really great about Aetna's plans is that there's a plan for every type of need out there. CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. To help us direct your question or comment to the correct area, please select a category below. This Aetna Vision Plan and all other FEDVIP plans are not a part of the Federal Employees Health Benefits (FEHB) Program. Each main plan type has more than one subtype. This information is neither an offer of coverage nor medical advice. Employee's Daytime Telephone Number ( ) 9. The address for our administrative office is: Aetna VisionFederal Plans PO Box 550 Blue Bell, PA 19422-05501-855-347-6899www.aetnafeds.com. Do you want to continue? Eye examination - covered in full (once every calendar year). While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Please enter your member ID and date of birth to get started. We have increased the in-network frame allowance from $150 to $160. Since Clinical Policy Bulletins (CPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. Any amount over $150 plan allowance after a 15% discount, Frame - Once every calendar year. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. Links to various non-Aetna sites are provided for your convenience only. a previously ineligible employee who transferred to a covered position; a survivor annuitant if not already covered under FEDVIP; or. You cannot use both benefits within the same calendar year. Unlisted, unspecified and nonspecific codes should be avoided. Provider networks may be more extensive in some areas than others. Exclusions That Apply to Vision Care Insurance Coverage You can also select from several nationwide vision plans. Discounts may not be available in all states at all in-network providers. Those who were previously eligible for the TRDP are now eligible to enroll in FEDVIP. Hearing aids and exams - Save on hearing exams, a large choice of leading brand hearing aids, batteries and free routine follow-up services. Discounts not applicable to certain brand name Vision Materials for which the manufacturer imposes a no-discount practice. We have increased the out-of-network contact lens allowance from $120 to $136. Are you just going for your annual exam? Employee's Aetna ID Number or SSN 4. Contact lenses are medically necessary if youre diagnosed with one of these conditions (ask your eye doctor for more info): * Please refer to Section 4, Your Cost for Covered Services, for the nationwide reimbursement schedule and Section 6, International Services and Supplies, for the international reimbursement schedule. Plans that offer benefits through a network cover preventive care such as oral exams, cleanings and X-rays.*. Policy/Group Number 3. Former spouses of employees or annuitants. It is your responsibility to be informed about your benefits. Find the forms and documents you need Medical, dental & vision claim forms Pharmacy mail-order & claims This Agreement will terminate upon notice if you violate its terms. Federal Employees Dental and Vision Insurance Program. If you do not intend to leave our site, close this message. Vision insurance plans contain exclusions and limitations. Call us 1-855-347-6899, if you are having problems locating a provider in your area. If the member indicates that benefits should be paid directly to the physician or . No need to wonder about your eye care if you have a break abroad. Plus, with Aetna VisionSM Preferred Network providers across the nation, you have access to thousands of convenient options that fit your lifestyle. Fraud or intentional misrepresentation of material fact is prohibited under the plan. Save on teeth whitening, electronic toothbrushes, replacement brush heads and various oral health care kits. You may enroll within 60 days after you become eligible as: Your enrollment will be effective the first day of the pay period following the one in which BENEFEDS receives and confirms your enrollment. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. The Aetna Vision Preferred network is specific to routine vision care and is different from the network for the Aetna medical plan. Its free and doesnt count toward your benefit allowance. Vision insurance never looked so good. The network offers over 600 locations including preferred featured providers like LasikPlus, TLC Laser Eye Centers and The LASIK Vision Institute. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. But dont take our word for it. You get lots of cost-friendly features to keep your mouth healthy. Use your benefit and start saving Find a provider Choose from thousands of retail and independent providers, and even schedule your next eye exam online. Follow this disputed claims process if you disagree with our decision on your claim or request for services. When you arrive at your appointment, you will answer their check-in questions, pay any co-pay due and the doctor will finish the rest of your membership claim. See www.fsafeds.com or call 1-877-FSAFEDS (372-3337) or TTY: 1-866-353-8058. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. Treating providers are solely responsible for medical advice and treatment of members. Please enable it to continue. The timeframe for requesting a QLE change is from 31 days before to 60 days after the event. Pursuant to Section 1557, Aetna does not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, age, disability, or sex. Contact us 1-855-347-6899 for the names of participating providers or to request a provider directory. Please keep a copy of the information and mail the originals to: Out-of-network claims must be submitted to Aetna Vision within 15 months of the date of service for reimbursement. By clicking on I Accept, I acknowledge and accept that: The Applied Behavior Analysis (ABA) Medical Necessity Guidehelps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. You may use your benefits as soon asyour enrollmentis confirmed. Contact us online. This brochure describes the benefits of Aetna Vision under Aetna Life Insurance Companys contract OPM02-FEDVIP-02AP-02 with OPM, as authorized by the FEDVIP law. When it comes to vision insurance, you know, do you wear glasses, do you wear contacts? This includes legally adopted children and recognized natural children who meet certain dependency requirements. Conventional contact lenses NOTE: Contact Lenses,Choose eyeglass lenses or contact lenses every calendar year. Tinting of eyeglass lenses. The FEDVIP law does not provide a role for OPM to review disputed claims. That I love about the Aetna Preferred Vision Plan is choice, savings, and convenience. That means once you have enrolled in either a dental or a visionplan, you cannot change or cancel that particular enrollment until the next Open Season, unless you experience a QLE that allows such a change or cancellation. The member's benefit plan determines coverage. Your reenrollment must be for at least the minimum of $100. CPT is a registered trademark of the American Medical Association. Any frame available at the provider location. This year,Open Season runs from November 14, 2022through midnight EST December 12, 2022. There may be an error. retired on an immediate annuity under the Civil Service Retirement System (CSRS), the Federal Employees Retirement System (FERS), or another retirement system for employees of the Federal Government; retired for disability under CSRS, FERS, or another retirement system for employees of the Federal Government. Aetnawill submit your expenses for reimbursement for you. If you or one of your family members is enrolled in or covered by one FEDVIP plan, that person cannot be enrolled in or covered as a family member by another FEDVIP plan offering the same type of coverage; i.e., you (or covered family members) cannot be covered by two FEDVIP dental plans or two FEDVIP vision plans. Employee's Address (include ZIP Code) Address is new 8. YourFEDVIP enrollment will continue into retirement, if you retire on an immediate annuity or for disability under CSRS, FERS or another retirement system for employees of the Government, regardless of the length of time you had FEDVIP coverage as an employee. Employee's Name 5. The provider directory is on our website www.aetnafeds.com. Locate a provider 2. The LASIK discount is only available from U.S. Laser Network by calling 1-800-422-6600. You are responsible for any difference between the amount billed and our payment. Contact us 1-855-347-6899 for the names of participating. FEDVIP rules and FEHB rules for family member eligibility are NOT the same. This information helps us provide information tailored to your Medicare eligibility, which is based on age. From your local eye care provider to national and regional retailers, youve got choices to fit your busy lifestyle. For your convenience, we recommend that you add your Member Services number to your phone contacts. Box 8504, Mason, OH 45040-7111. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. When scheduling an appointment, you should identify yourself as a member of the FEDVIP Aetna Vision Preferred plan. So, we designed Aetna Vision Preferred to give you maximum choice, savings and convenience. For other language services: . Lenses: covered in full (once every calendar year), Standard Plastic single vision, lined bifocal, lined trifocal, andlenticular lenses. The following are also NOT available under FEDVIP plans: If you are planning to enroll in an FSAFEDS Health Care Flexible Spending Account (HCFSA) or Limited Expense Health Care Flexible Spending Account (LEX HCFSA), you should consider how coverage under a FEDVIP plan will affect your annual expenses, and thus the amount that you should allot to an FSAFEDS account. And with over 120,000 dental providers in our Dental PPO network,* youll never have trouble finding care. See plan documents for a complete description of benefits, exclusions and limitations of coverage. With Aetna Vision Preferred, you get coverage that takes you further. Ask us in writing to reconsider our initial decision. If you are a Federal or U.S. Note: We do not coordinate benefits with non-FEHB health plans. So when you buy Aetna Dental Direct, you can add Aetna VisionSM Preferred to your dental plan in most states. Find a provider . Please visit the Aetna Vision website (once enrolled) to search for an in-network provider in your area. dental and vision benefit programs to be made available to Federal employees, annuitants, and their eligible family members. Get advice from registered dietitians with nutrition services. For more information on family member eligibilityvisitthe website atwww.opm.gov/healthcare-insurance/dental-vision/ or contact your employing agency or retirement system. Understanding vision benefits can be confusing. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Members will receive a discount of 15% off retail or 5% off promotional prices at providers in the US Laser network. One of the things that people most often ask is, you know, which plan is going to be the best for me, and there's no real easy answer to that question. Find a provider ; Select a . Depending on your plan, Aetna Vision Preferred vision insurance generally includes:*. For a health care or limited expense account, each participant must contribute a minimum of $100 to a maximum of $3,050. Policy/Group Number 3. You can print a temporary ID card online or call customer serviceat 1-855-347-6899 to verify your eligibility in the plan. You get coverage for eye exams,glasses,contact lenses. Avoid using providers who say that an item or service is not usually covered, but they know how to bill us to get it paid. Any charges in excess of the benefit, dollar, or supply limits stated in this Booklet-Certificate. If you are enrolled in this plan, you are entitled to the benefits described in this brochure. Children include legally adopted children, stepchildren, and pre-adoptive children. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Enrollment in the FEHB Program or a Health Insurance Marketplace (Exchange) plan is not required. The provider is then responsible for verifying eligibility by contacting Aetna Vision Preferred either by telephone or via the web. FEHB Temporary Continuation of Coverage (TCC) enrollees, Anyone receiving an insurable interest annuity who is not also an eligible family member, There is no time limit for a change based on moving from a regional plans service area; and. To find forms customized for your benefits, log in to your member account. Visit www.aetnavision.com for details. That really narrows down the three most important things for myself and my family, simply because we just, we didn't have that before on the plan that we had. I would absolutely recommend the Aetna Preferred Vision Plan to a friend or family, simply because it was the best choice for myself and my family. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Carefully review your explanation of benefits (EOBs) statements, which is available online at. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. You cannot use both benefits within the same calendar year. Contact us by phone. The following persons are not eligible to enroll in FEDVIP, regardless of FEHB eligibility or receipt of an annuity or portion of an annuity: You must use BENEFEDS to enroll or change enrollment in a FEDVIP plan. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Choice, savings and convenience There's a lot to consider when choosing a vision insurance plan for you and your family, like how it fits your budget and your life. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Links to various non-Aetna sites are provided for your convenience only. To see a list of providers who do honor discounts, go to www.aetnavision.com, select Find a Provider, and if you see "May not accept all additional plan discounts" you should contact the provider to confirm. Your FEDVIP coverage will end if you retire on a Minimum Retirement Age (MRA) + 10 retirement and postpone receipt of your annuity. Children and dependent unmarried persons must be under age 21 if they are not a student, under age 23 if they are a full-time student, or incapable of self-support because of a mental or physical incapacity. The following services and materials are not covered: Benefits may not be combined with any discount or promotional offering unless otherwise noted in an offer. Covered services or payment for covered services to which enrollees and covered family members are entitled to the extent provided by this brochure. Let only the appropriate providers review your clinical record or recommend services. Coverage is effective January 1, 2023. Employee's Name 5. It is important to bring your FEDVIP and FEHB identification cards to every vision appointment because most FEHB plans offer some level of vision benefits separate from your FEDVIP coverage. If we ask your provider, we will send you a copy of our request. 2023 Aetna. You may obtain an out-of-network claim form for reimbursement by visiting our website, www.aetnafeds.com or calling our customer service at 1-855-347-6899. Contact us 1-855-347-6899 for the names of participating providers or to request a provider directory. Postal Service employee or annuitant and you are receiving an annuity, you may enroll or continue the existing enrollment. Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). With respect to TRICARE-eligible individuals, family members include your spouse, unremarried widow, unremarried widower, unmarried child, and certain unmarried persons placed in your legal custody by a court. The law directed the Office of Personnel Management (OPM) to establish supplementaldental and vision benefit programs to be made available to Federal employees, annuitants, and their eligible family members.In response to the legislation, OPM established the Federal Employees Dental and Vision Insurance Program (FEDVIP).OPM has contracted with dental and vision insurers to offer an array of choices to Federal employees and annuitants. Postal Service employee, you are eligible to enroll in FEDVIP, if you are eligible for the Federal Employees Health Benefits (FEHB) Program or the Health Insurance Marketplace (Exchange) and your position is not excluded by law or regulation.
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