Professional Provider Services a. Except as limited, the following are covered:
Professional Provider Services. Standards of care for eye examinations are entirely consistent with those established by State Departments of Health and include preventive eye care with glaucoma testing, refractive care and the prescribing of eyeglasses. Each patient receives a comprehensive eye examination with a preferred optometrist or ophthalmologist which includes the following components: Case History – chief complaint, eye and vision history, medical history Entrance distance acuities External ocular evaluation including slit lamp examination Internal ocular examination inclusive of dilated fundus evaluation Tonometry Distance refraction – objective and subjective Binocular coordination and ocular motility evaluation Evaluation of pupillary function Biomicroscopy Gross visual fields Assessment and plan Patient education Form completion – school, motor vehicle, etc. All of these components are fully within the education, training and scope of licensure for both optometrists and ophthalmologists. VISION PLAN HIGHLIGHTS – Effective July 1, 2011 Feature Participating Provider Non-participating Provider Annual Deductible None None Eye Exam (Once every 12 months) You pay the network provider a $25 copay No claim filing is required. You pay the expense in full and file a claim with EyeMed. The Plan reimburses you up to $42. Lenses* (Once every 12 months)* Standard Progressive Lens Premium Progressive Lens You pay the network provider $0 co-pay for just lenses. $65 co-pay 20% off retail price, then apply a $55 allowance, and you pay the remaining amount. You pay the expense in full and file a claim with EyeMed. The Plan reimburses you after copay as follows: Single vision – up to $40 Bifocal – up to $60 Trifocal – up to $80 Lenticular – up to $125 Plan reimburses up to $60 Plan reimburses up to $60 Frames* (Once every 12 months)* $0 copay, $115 allowance, then 20% off balance over $115, and you pay the remaining amount. Reimbursement up to $45. You pay the expense in full and file a claim with EyeMed. Contact Lenses (Once every 12 months – allowances cover material only)* Conventional: Disposable: Medically Necessary: $0 Co-pay, $105 allowance, then 15% off balance over $105 and you pay the remaining amount $0 Co-pay, $105 allowance $0 Co-pay, plan pays in full You pay the expense in full and file a claim with EyeMed. The plan reimburses you up to $105 after co-pay The plan reimburses you up to $105 after co-pay The plan reimburses you up to $210 Laser Vision Correction Discounts availabl...
Professional Provider Services. Standards of care for eye examinations are entirely consistent with those established by State Departments of Health and include preventive eye care with glaucoma testing, refractive care and the prescribing of eyeglasses. Each patient receives a comprehensive eye examination with a preferred optometrist or ophthalmologist which includes the following components: • Case History – chief complaint, eye and vision history, medical history • Entrance distance acuities • External ocular evaluation including slit lamp examination • Internal ocular examination inclusive of dilated fundus evaluation • Tonometry • Distance refraction – objective and subjective • Binocular coordination and ocular motility evaluation • Evaluation of pupillary function • Biomicroscopy • Gross visual fields • Assessment and plan • Patient education • Form completion – school, motor vehicle, etc. All of these components are fully within the education, training and scope of licensure for both optometrists and ophthalmologists. Attachment A Verizon California Inc. Verizon Florida Inc. Verizon North Inc. Verizon Northwest Inc. Verizon South Inc. Verizon West Coast Inc. Attachment B STATE ZONE LIST OF EXCHANGES California High Desert Adelanto, Apple Valley, Barstow, Big Bear City, Big Bear City, Big Bear Lake, Boron, California City, Desert Knolls, El Mirage, Fort Xxxxx, Hesperia, Lenwood, Lucerne Valley, Nebo, Xxxxxxxx Springs, North Edwards, Phelan, Running Springs, South Barstow, Summit Valley, Victorville, Wrightwood, Yermo Florida Area 1 – Coastal Bayou, Clearwater, Countryside, Dunedin, Feather Sound, Gandy, Hudson, Indian Rocks, Largo, Lealman, Moon Lake, New Port Xxxxxx, North Gulf Beach, Pasadena, Pinellas, Safety Harbor, St. Xxxxxx, St. Petersburg Main, Seven Springs, Skyway, South Gulf Beach, Tarpon Springs Florida Area 2 – Tampa Alafia, Bayshore, Beach Park, Brandon, Carrollwood, Hyde Park, Keystone, Land O Lakes, Lutz, Oldsmar, Ruskin, Seminole, Sulpher Springs, Sweetwater, Tampa Main, Temple Terrace, Thonotosassa, University, Wallcraft, Xxxxxx Chapel, Westside, Wimauma, Ybor Florida Area 3 – Southern Xxxx Xxxxx, Bradenton, Englewood, Long Boat Key, Myakka City, North Port, Northside, Osprey, Palma Sola, Palmetto, Parrish, Sarasota Main, St. Armands, Siesta Key, Southside, Springs, Venice Florida Area 4 – Eastern Alturas, Auburndale, Babson Park, Bartow, Bradley, Cypress Gardens, Dundee, Frostproof, Xxxxxx City, Xxxxxx City North, Highlands, Indian Lake, Xxxx Xxxxxx, Lake Wales...
