Marlin ISD Eye Care Highlight Sheet – Policy # 30035

Vision Plan Highlights Effective Date: 1/1/2012 - 1/1/2015

VSP Choice Network Out of Network

Deductibles $10 Exam $10 Exam

$25 Eye Glass Lenses or Frames* $25 Eye Glass Lenses or Frames*

Annual Eye Exam Covered in full Up to $45

Lenses (per pair) Single Vision Covered in full Up to $30

Bifocal Covered in full Up to $50

Trifocal Covered in full Up to $65

Lenticular Covered in full Up to $100

Progressive Up to the bifocal allowance Up to $50

Contacts

Fit & Follow Up Exams 15% discount

Applied to contact lens allowance

Applied to contact lens allowance

See Additional Focus Features.

Elective Up to $130 Up to $105

Medically Necessary Covered in full Up to $210

Frames $130 Up to $70

Frequencies (months)

Exam/Lens/Frame 12/12/24 12/12/24

Based on date of service Based on date of service

*Deductible applies to a complete pair of glasses or to frames, whichever is selected.

Lens Options (member cost)*

VSP Choice Network Out of Network

Progressive Lenses $55-$175 No benefit

Std. Polycarbonate Covered in full for dependent children

$33 adults

No benefit

Solid Plastic Dye $15

(except Pink I & II)

No benefit

Plastic Gradient Dye $17 No benefit

Photochromatic Lenses (Glass & Plastic)

$31 No benefit

Scratch Resistant Coating $17-$33 No benefit

Anti-Reflective Coating $43-$85 No benefit

Ultraviolet Coating $16 No benefit

Lasik or PRK Average discount of 15% off retail.

See Additional Focus Features.

No benefit

*Lens Option member costs vary by prescription and option chosen.

Monthly Rates

Employee Only (EE) $ 7.60

EE + 1 Dependent $13.60

EE + 2 or more Dependents

PLAN # VIS305

$18.36

Marlin ISD Eye Care Highlight Sheet – Policy # 30035

Additional Focus® Choice Network Features

Contact Lenses Elective Cost of the fitting and evaluation is deducted from the allowance and any amount left is deducted

from the material allowance. Allowance can be applied to disposables, but the dollar amount must

be used all at once (provider will order 3 or 6 month supply). Applies when contacts chosen in lieu

of glasses.

Current soft contact lens wearers may be eligible for a special program that includes an initial

contact lens evaluation and initial supply of lenses. Contact VSP or your VSP provider for

additional details.

Additional Glasses 20% discount off the retail price on additional pairs of prescription glasses (complete pair).

Frame Discount VSP offers a 20% discount off the remaining balance in excess of the frame allowance.

Laser VisionCare VSP offers an average discount of 15% on LASIK and PRK. The maximum out-of-pocket per eye

for members is $1,800 for LASIK and $2,300 for custom LASIK using Wavefront technology, and

$1,500 for PRK. In order to receive the benefit, a VSP provider must coordinate the procedure.

Low Vision With prior authorization, 75% of approved amount (up to $1,000 is covered every two years).

Rx Savings

Our valued plan members and their covered dependents (even their pets) can save on prescription medications through any Walmart or Sam's Club

pharmacy across the nation. This Rx discount is offered at no additional cost, and it is not insurance.

To receive the Walmart Rx discount, Ameritas plan members just need to show their original Ameritas ID card. The identifier is the Ameritas logo.

It's that easy. Or members can visit us at ameritasgroup.com and sign into (or create) a secure member account where they can print off an online-

only Rx discount savings ID card.

Eye Care Plan Member Service

Focus eye care from Ameritas Group features the money-saving eye care network of VSP. Customer service is available to plan members through

VSP's well-trained and helpful service representatives. Call or go online to locate the nearest VSP network provider, view plan benefit information

and more.

VSP Call Center: 1-800-877-7195

� Service representative hours: 5 a.m. to 7 p.m. PST Monday through Friday, 6 a.m. to 2:30 p.m. PST Saturday

� Interactive Voice Response available 24/7

Locate a VSP provider at: ameritasgroup.com/member

View plan benefit information at: vsp.com

This document is a highlight of plan benefits provided by Ameritas Life Insurance Corp. as selected by your employer. It is not a certificate of insurance and does

not include exclusions and limitations. For exclusions and limitations, or a complete list of covered procedures, contact your benefits administrator.

 

VSP Provider List for Employees of Marlin ISD

All VSP doctors: accept new patients  

provide a WellVision ExamSM  

offer plenty of eyewear choices   

Salganik Vision Group  2201 W Loop 340, Suite 100 Waco, TX 76712 (254) 420‐3937  Blake R Christensen OD 512 S. Hewitt Dr. Hewitt, TX 76643 (254) 666‐2292  The Optical Dispensary 3713 Franklin Avenue Waco, TX 76710 (254) 752‐1081  John M Maloney OD 1119 S. 31st St. Temple, TX 76504 (254) 773‐3248  

Stacie Layne Virden OD 1000 W. Hwy. 6, Ste. 210 Waco, TX 76712 (254) 776‐8119  Eye Fashion Optical 4949 Franklin Ave. Waco, TX 76710 (254) 776‐2282  Crystal Clear Eyecare Center 190 N. New Rd. Waco, TX 76710 (254) 399‐9979  Lone Star Family Vision 533 N. Valley Mills Dr. Waco, TX 76710 (254) 776‐3937  

Spencer V Moore OD 1215A Lake Air Dr. Waco, TX 76710 (254) 752‐0471  Belton Eye Care Center 2609 N. Main St. Belton, TX 76513 (254) 939‐5261  Chris R Rand 801 McClintic Dr. Groesbeck, TX 76642 (254) 729‐4323  Mexia Vision Services 501 E. Milam Mexia, TX 76667 (254) 562‐3883  

 

About Our Doctors 

 The best doctors provide the best care. We choose our doctors carefully based on their professional licensing, work history, education, malpractice history, professional liability and ethics.   Our optometrists are Therapeutic Pharmaceutical Agent (TPA) certified and our ophthalmologists are American Board of Ophthalmology (ABO) certified.   Our credentialing process complies with the National Committee for Quality Assurance (NCQA) standards. This guarantees you'll get quality care when seeing a VSP doctor.  

 

VSP Proprietary & Confidential 2

88% of VSP preferred providers offer early morning, evening, or weekend hours.

More Provider ChoicesWhile nearly 95% of our members choose a VSP preferred provider, we understand choice is important. That’s why we offer a variety of options to ensure satisfaction.

VSP Preferred Providers We know members want one-stop-shopping, a large eyewear selection, andmaximumcost-savings.That’swhyallVSPpreferredprovidersofferthorougheyeexamsandawidevarietyofqualityeyewear.Andmemberspaylessout-of-pocketthankstoexclusivediscounts.VSPpreferredproviders are located in retail, neighborhood, medical, and professional settingsformaximumconvenience.

Retail Chain Affiliate ProvidersEffective January 1, 2012, our retail chain affiliate providers, which include Costco® Optical and Eye Care Centers of AmericaTM (ECCA), give your employees added convenience and additional retail choices. Costco Optical has 400 locations across the country, while ECCA manages nearly 400 optical stores in 37 states and DC, including well-known storessuchasEyeMasters,Visionworks,Dr.Bizer’sVisionWorld,EyeDRx,and Hour Eyes, to name a few. Your employees enjoy a covered-in-full benefitexperiencewithequivalentframebenefitatanyoftheseretailchain locations.

Other ProvidersYour employees always have the freedom to choose any other provider.

• Ourplanincludesagenerousreimbursementscheduleforservices obtained from other providers, including national or local chains.

• AllotherproviderscancontactVSPdirectlytocheckeligibilityand submit claims on your employees’ behalf.

• VSPhasanationalarrangementwithWalmartthatmakesitsimple for your employees to use their VSP benefits at Walmart and Sam’s Club locations.