Make the most of your vision care benefits

The State of New York provides vision care benefits to PEF-represented state employees.  The Vision Plan is administered and fully paid for by the state.  It offers quality eyewear services at little or no cost to eligible employees and their dependents who obtain covered services from a participating optometrist (Panel Provider).  For those who obtain services from a non-participating optometrist (Non-Panel Provider), reimbursement is available based on a fixed payment schedule.

Benefits are available to each enrollee and covered dependent once in any 24-month period, except for covered dependents under age 19 who are eligible once in any 12-month period.  Enrollees and covered dependents may also be eligible for annual vision services if it is medically necessary.  At least one year must have passed since the last service date, and the patient must have one of the following medical conditions:  diabetes, developing cataracts, keratoconus, taking a prescription drug that could cause vision changes, or any other medical condition that could reasonably be expected to result in a change in refractive status.

You can reduce your out-of-pocket costs by following the tips indicated below:   

•         Use a Panel Provider.  In addition to Empire and Davis Vision Centers, the panel includes optometrists in private or group practices as well.  For a list of Panel Providers, call Davis Vision at 1-800-999-5431 or use their website www.davisvision.com.  Panel providers provide an exam, Plan len ses and frames from a designated selection, at no cost.  You may purchase non-plan len ses and frames from Panel Providers, but you will be responsible for an additional charge.  The additional charges for popular non-plan lenses such as no-line bifocals, multifocal progressive, or plastic photosensitive lenses can add up quickly.  Be sure you know what your costs will be at the time you are ordering your eyewear.

•         You must use all components of your vision benefit (exam, corrective eyewear, and occupational eyewear) at the same time.  Partial use of the benefit is considered full use.  For example, if an enrollee obtains an exam from a Panel Provider, or submits a claim for an exam from a Non-Panel Provider, but does not obtain eyeglasses or contact len ses at the time of the exam, the Plan will not provide benefits for eyeglasses or contact len ses until his or her next eligibility date.  Therefore, be prepared to pick out your eyewear at the time of your exam.

•         Also, if your provider anticipates eyeglasses will be needed before your next eligibility date, you may wish to forego using the Plan benefits for just the exam.

•        An occupational vision benefit could be just what you're looking for if you need special corrective eyewear to do your job.  You must use a Panel Provider and you must receive the occupational vision care services at the same time as you receive your routine vision care services. These benefits, for the employee only, are available once in any 24-month period.

•       Consider using your benefit for eyeglasses rather than contact len ses.  W hen you use a Panel Provider, the plan offers standard, soft, daily-wear, disposable or planned replacement contact len ses with a $25 or $45 copayment (depending on the len ses prescribed).  If you are a new (to the provider or first time) wearer, you will receive either one pair of standard, soft, daily-wear len ses, or two boxes of disposable or planned replacement len ses (typically, a 3-6 month supply).  Existing disposable len s wearers will receive four boxes.  You will have to pay the full cost for additional len ses needed for the remainder of the benefit period.  In addition, you may be required to pay for another exam after one year in order to obtain a new prescription for your contact len ses.

•     If your spouse is also a state employee covered under the Vision Plan for the State of New York, each of you can be covered as both an enrollee and as a dependent.  In other words, you are eligible for benefits under both your plan and your spouse’s plan.  Covered dependents can also be enrolled as dependents of both parents.

•     Many of the HMOs provide benefits for routine vision exams and/or discounts on eyeglasses and contact len ses.  If you are an HMO member, and you or one of your covered dependents needs vision services before the Vision Plan will pay for them, check with your HMO.