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Virginia Private CollegesBenefits Consortium, Inc.
UniView Vision Virginia Private Colleges Benefits ConsortiumJanuary 1, 2020Welcome to your UniView Vision plan!You have many choices when it comes to using your benefits. As a UniView Vision plan member, you have access to one of the nation’slargest vision networks. You may choose from many private practice doctors, local optical stores, and national retail stores includingLensCrafters , Target Optical , Sears Optical , JCPenney Optical and most Pearle Vision locations. You may also use your innetwork benefits to order eyewear online at Glasses.com and ContactsDirect.com. To locate a participating network eye care doctor orlocation, log in at unicare.com, or from the home page, select Find a Doctor. You may also call member services for assistance at1-888-884-8428.Out-of-Network – If you choose to, you may instead receive covered benefits outside of the UniView Vision network. Just pay in full atthe time of service, obtain an itemized receipt, and file a claim for reimbursement up to your maximum out-of-network allowance.YOUR UNIVIEW VISION PLAN BENEFITSIN-NETWORKOUT-OF-NETWORKFREQUENCY 15 copayUp to 50 allowanceOnce everycalendar year 130 allowance, then 20%off any remaining balanceUp to 100 allowanceOnce everytwo calendar years 15 copay 15 copay 15 copayUp to 50 allowanceUp to 80 allowanceUp to 110 allowanceOnce everycalendar yearRoutine Eye ExamA comprehensive eye examinationEyeglass FramesOne pair of eyeglass framesEyeglass LensesOne pair of standard plastic prescription lenses: Single vision lenses Bifocal lenses Trifocal lensesEyeglass Lens EnhancementsWhen obtaining covered eyewear from a UniView Vision provider, you may choose to add any of the following lens enhancements at no extra cost. Lenses (for a child under age 19)Standard polycarbonate (for a child under age 19)Factory scratch coating 0 copay 0 copay 0 copayNo allowancewhen obtainedout-of-networkSame as coveredeyeglass lensesContact Lenses (in addition to eyeglass lenses)Contact lens allowance will only be applied toward the first purchase of contacts made during a benefit period. Any unused amount remaining cannotbe used for subsequent purchases in the same benefit period, nor can any unused amount be carried over to the following benefit period. Elective conventional (non-disposable)OR Elective disposableOR Non-elective (medically necessary) 130 allowance, then 15%off any remaining balanceUp to 130 allowance 130 allowance(no additional discount)Up to 130 allowanceCovered in fullUp to 210 allowanceOnce everycalendar yearContact lens fit and follow-upA contact lens fitting and up to two follow-up visits are available to you once a comprehensive eye exam has been completed. Standard contact lens fitting1 0 35 allowance Premium contact lens fitting210% off retail price,then apply 55 allowance 35 allowance1 Standard2 PremiumOnce everycalendar yearfitting includes spherical clear lenses for conventional wear and planned replacement. Examples include but are not limited to disposable and frequent replacement.fitting includes all lens designs, materials and specialty fittings other than standard contact lenses. Examples include but are not limited to toric and multifocal.This is a primary vision care benefit intended to cover only routine eye examinations and corrective eyewear. UniView Vision is for routine eye care only. If you need medicaltreatment for your eyes, visit a participating eye care doctor from your medical network. Benefits are payable only for expenses incurred while the group and insured person’scoverage is in force. This information is intended to be a brief outline of coverage. All terms and conditions of coverage, including benefits and exclusions, are contained in themember’s policy, which shall control in the event of a conflict with this overview. This benefit overview is only one piece of your entire enrollment package.
EXCLUSIONS & LIMITATIONS (not a comprehensive list – please refer to the member Certificate of Coverage for a complete list)Combined Offers. Not to be combined with any offer, coupon, or in-storeLost or Broken Lenses or Frames. Any lost or broken lenses or framesadvertisement.are not eligible for replacement unless the insured person has reached hisExcess Amounts. Amounts in excess of covered vision expense.or her normal service interval as indicated in the plan design.Non-Prescription Lenses. Any non-prescription lenses, eyeglasses orSunglasses. Plano sunglasses and accompanying frames.contacts. Plano lenses or lenses that have no refractive power.Safety Glasses. Safety glasses and accompanying frames.Not Specifically Listed. Services not specifically listed in this plan asOrthoptics. Orthoptics or vision training and any associated supplementalcovered services.testing.OPTIONAL SAVINGS AVAILABLE FROM UNIVIEW VISION IN-NETWORK PROVIDERS ONLYRetinal Imaging - at member’s option can be performed at time of eye examEyeglass lens upgradesWhen obtaining eyewear from a UniView Visionprovider, you may choose to upgrade your neweyeglass lenses at a discounted cost. Eyeglass lenscopayment applies. Additional Pairs of EyeglassesAnytime from any UniView Vision network provider. Eyewear Accessories Conventional Contact Lenses In-network Member Cost(after any applicable copay)Not more than 39lenses (Adults)Standard Polycarbonate (Adults)Tint (Solid and Gradient)UV CoatingProgressive Lenses1 Standard Premium Tier 1 Premium Tier 2 Premium Tier 3Anti-Reflective Coating2 Standard Premium Tier 1 Premium Tier 2Other Add-ons 75 40 15 15 45 57 6820% off retail priceComplete PairEyeglass materials purchased separately40% off retail price20% off retail priceItems such as non-prescription sunglasses,lens cleaning supplies, contact lenssolutions, eyeglass cases, etc.20% off retail priceDiscount applies to materials only15% off retail price 65 85 95 1101 Please ask your provider for his/her recommendation as well as the available progressive brands by tier.2 Please ask your provider for his/her recommendation as well as the available coating brands by tier.Discounts are subject to change without notice. Discounts are not ‘covered benefits’ under your vision plan and will not be listed in your certificate of coverage. Discounts willbe offered from in-network providers except where state law prevents discounting of products and services that are not covered benefits under the plan. Discounts on frameswill not apply if the manufacturer has imposed a no discount policy on sales at retail and independent provider locations. Some of our in-network providers include:ADDITIONAL SAVINGS AVAILABLE THROUGH UNICARE’S SPECIAL OFFERS PROGRAM *Savings on items like additional eyewear after your benefits have been used, non-prescription sunglasses, hearing aids and even LASIK laser visioncorrection surgery are available through a variety of vendors. Just log in at unicare.com, select discounts, then Vision, Hearing & Dental.* Discounts cannot be used in conjunction with your covered benefits.OUT-OF-NETWORKIf you choose to receive covered services or purchase covered eyewear from an out-of-network provider, network discounts will not apply and you will beresponsible for payment of services and/or eyewear materials at the time of service. Please complete an out-of-network claim form and submit it along withyour itemized receipt to the fax number, email address, or mailing address below. To download a claim form, log in at unicare.com, or from the home pagemenu under Customer Support select Download Forms, scroll down under the heading for Claims and select Vision Claim Form. You may instead callmember services at 1-888-884-8428 to request a claim form.To Fax: 866-293-7373To Email: [email protected] Mail: UniView VisionAttn: Out-of-Network ClaimsP.O. Box 8504Mason, OH 45070-7111Transitions and the swirl are registered trademarks of Transitions Optical, Inc.For self- funded plans, claims are administered by UniCare Life & Health Insurance Company. Insurance coverage is provided by UniCare Life & Health Insurance Company.UniView Vision VA FS 2017
UniView VisionSMAnswers to SomeFrequently Asked QuestionsLog in atunicare.com to:Find an eye care providerPrint a list of eye careproviders in your areaView your benefitinformationSee when you’re eligiblefor more benefitsView claim statusWhat is covered in a comprehensive eye exam?Some of the tests and procedures performed in a comprehensive eye exam include: Case historyEvaluation of visual system’s status (including dilation)Refractive statusBinocular functionAssessment, diagnosis and treatment planAre contact lens fitting fees included in the vision exam?Professional contact lens fitting fees are not considered a part of routine eye care andare not included in the vision exam. Plan coverage and discounts vary so membersshould refer to their specific plan design for details. Members can view their specificvision coverage by signing into the secure member portal and selecting View Vision,Vision Benefit Details and then My Benefits.What is the difference between standard and premium contact lens fit andfollow-up?Your eye doctor will determine what type of contact lens is best for you. In general, contact lens evaluation fees are based on thetype of contact lens the doctor prescribes.Standard contact lenses are considered to be single vision, clear, soft, and for daily wear. If you are prescribed standardcontact lenses, your eye doctor will perform a standard fitting with follow up evaluation.If the contact lens your eye doctor prescribes for you does not fall into the category of a standard contact lens, it isconsidered to be a premium contact lens. Premium contact lenses are basically more complex types of lenses andinclude but are not limited to toric (to correct astigmatism), multifocal/monovision (bifocal), post-surgical (forexample, following cataract surgery), gas permeable (hard), and those used for extended/overnight wear. If you areprescribed premium contact lenses, your eye doctor will perform a premium fitting with follow up evaluation.When would an eye care provider charge for contact lens fit and follow-up?You will likely pay for a contact lens fitting and follow-up evaluation if any of the following apply:If you are going to be wearing contact lenses for the first timeIf you are renewing your contact lens prescriptionIf you have a change in your contact lens prescriptionIf you are going to change to a different type or brand of contact lensesIf you are a contact lens wearer and are seeing a new eye doctor for the first timeWhat is the difference between elective and non-elective contact lenses?Doctors prescribe Elective contact lenses when there is no natural condition that prevents good vision with glasses. Typically, inthis case, patients have a choice of wearing glasses or contacts, and contacts are considered cosmetic because they are mainlyused for cosmetic purposes.Doctors prescribe Non-elective contact lenses for purposes of correcting a specific natural condition that prevents satisfactoryvision with eyeglasses. They are considered non-elective because they allow the wearer to see better with contacts than withglasses.
UniView VisionSMWhat is the difference between conventional and disposable contacts?Conventional contact lenses are worn for one day during waking hours (daily wear) and then removed, cleaned, storedovernight, and reused the next day. In some cases, specially approved lenses can be worn to sleep but must be removedaccording to the doctor’s instructions.Disposable contact lenses are made for either daily (one time) use or longer term (extended wear). If the patient wears oneday lenses, they can be thrown away, rather than having to clean, store and then reuse the same lenses. They are then replacedwith fresh new lenses.Are disposable contact lenses covered?Disposable or daily wear contact lenses are covered under plans that include benefits for eyewear materials.Can I purchase contact lenses and glasses?Members who choose a supply of contact lenses elect to receive contact lenses instead ofeyeglass frames and spectacle lenses. However, members can save 15%- 40% off retail onadditional purchases of eyewear through UniView Vision providers.Does UniView Vision cover non-prescription items likesunglasses?Remember UniView Visionparticipatingproviders offermoney savingdiscounts!CUSTOMERSERVICEPhone:(888) 884-8428Hours:Monday – Saturday7:30 a.m. to11:00 p.m. ESTSunday 11:00 a.m. to8:00 p.m. ESTAvailable every dayexcept Easter,Thanksgiving andChristmasNon-prescription items are not covered benefits under our vision plans, however our AdditionalSavings Program lets members access substantial savings (15%-40%) on additional pairs ofeyewear purchases, most non-prescription sunglasses, lens treatments, specialized lenses andeyewear accessories through UniView Vision network providers.Does UniView Vision cover Lasik surgery?Lasik surgery is not a covered benefit, however discount offers on Lasik surgery areavailable from participating providers through UniCare’s SpecialOffers program. Otherdiscounts on a variety of products and services are also available through SpecialOffers,including savings from 1-800 Contacts and Glasses.com.Do I have to use UniView Vision providers?By utilizing the national UniView Vision network, your benefits will stretch further because ofnegotiated fees with more than 33,000 doctors and over 26,000 provider locations. In-networkproviders extend discounts on many non-covered items. If for any reason you still prefer to go toan out-of-network provider, you can use your out-of-network benefits to get reimbursed up to themaximum out-of-network benefit covered by your plan.Will I need to file a claim?If you use a UniView Vision network provider, you do not need to file a claim. The provider will filethe claim on your behalf. If you use an out-of-network provider, you will need to pay the providerat the time of service, obtain an itemized receipt for your expenses, and then submit a claim toUniView Vision for reimbursement of eligible services and/or materials. To obtain a UniView Visionout-of-network claim form, visit our webiste or contact customer service.Have other questions?Give us a call! We’re here to help 7 days a week.Discounts referenced are not covered benefits under the plan and are subject to change without notice. Laws in some states may prohibit network providers from discountingproducts and services that are not covered benefits under the plan.A Coverage is provided by one of the following companies: UniCare Life & Health Insurance Company, UniCare Health Insurance Company of the Midwest (IN & IL only), orUniCare Health Insurance Company of Texas (TX only). Registered mark of UniCare Inc.12/14
Unicare Sample ID CardsThis is your UniView Vision identification card provided by UniCare Life & HealthInsurance Company. Present it to the vision provider when you or your eligibledependents receive service or supplies. See your certificate(s) of coverage orbooklet(s) for a description of the benefits, terms,conditions, limitations andexclusions of coverage. When submitting inquiries always include your membernumber from the face of this card.POSSESSION OR USE OF THIS CARD DOES NOT GUARANTEE PAYMENT.In the event of a potentially life threatening condition, call 911UniView VisionSubmit Claims to:Group: GROUP NAMEMember NameMember ID Number: XXXxXXXXXGroup Number: xxxxxxxxxxPlan(s): UniView VisionVision Customer Service: 1-888-884-8428UniView Vision PlanP.O. Box 8504Mason, OH 45040-7111Vision Providers: To confirm plan participation and member eligibility please contactEyeMed at www.eyemedvisioncare.com or 800-521-3605Underwritten by UniCare Life & Health Insurance Company. Unicare is a registered trademark of Wellpoint, Inc.01/11/17This is your UniView Vision identification card provided by UniCare Life & HealthInsurance Company. Present it to the vision provider when you or your eligibledependents receive service or supplies. See your certificate(s) of coverage orbooklet(s) for a description of the benefits, terms,conditions, limitations andexclusions of coverage. When submitting inquiries always include your membernumber from the face of this card.POSSESSION OR USE OF THIS CARD DOES NOT GUARANTEE PAYMENT.In the event of a potentially life threatening condition, call 911UniView VisionGroup: GROUP NAMEMember 2 NameMember ID Number: XXXxXXXXXGroup Number: xxxxxxxxxxPlan(s): UniView VisionVision Customer Service: 1-888-884-8428Submit Claims to:UniView Vision PlanP.O. Box 8504Mason, OH 45040-7111Vision Providers: To confirm plan participation and member eligibility please contactEyeMed at www.eyemedvisioncare.com or 800-521-3605Underwritten by UniCare Life & Health Insurance Company. Unicare is a registered trademark of Wellpoint, Inc.01/11/17
UniCare Member Online ServicesHOW TO REGISTER FOR ACCESSRegistration is a few quick steps where a User Name and Password are created allowing secureaccess to your benefit information.ATTENTION! If you have both a UniCare UniView Vision Plan AND an Anthem Medical Plan witha Blue View VisionSM exam benefit, you will only need to register once on the Anthem.comwebsite. Your Anthem Medical Plan with a Blue View Vision exam benefit will be yourdefault coverage, this plan will show at login.To View your UniCare Vision Plan, click on the blue "View Other Coverage", located onthe right side of the screen. Click on the vision plan and you will be redirected to Unicare.comwebsite to view this coverage.Once you open the UniCare plan, to get back to the medical plan, click on the green"View Other Coverage", located on the right side of the screen and choose the medical coverage.In this example, we’ll show you how to register through the unicare.com website.To begin, just visit unicare.com and click Register Now.Continued on other side
Simply follow the4 steps1First you will enter your UniCare identification number which is located on your member ID card.2Next you will create a user name and password.3You can then enter your preferences.4And finally, you will confirm registration.Once you have registered, simply go the Member Log In area on the Unicare.com homepage, enter your user name and password, and click Log In.UniCare Life & Health Insurance Company.
UniView Vision Provider Locator GuideFinding a UniView Vision network provider is easy.TO BEGINVisitunicare.comchooseFind a Doctorand click Go.STEP 1Select ProviderType VisionSelect the Stateyou wish tosearch inSelect NetworkType UniViewVisionThen Click Next.
STEP 2Enter a locationfor the provider.Indicate how farfrom the locationyou’re willing totravel.When doneclick ViewResultsRESULTSA list of providerswill be displayed.Note: You can download and /orprint your results.Coverage is provided by one of the following companies: UniCare Life & Health Insurance Company, UniCare Health Insurance Company of the Midwest (IN & IL only),UniCare Health Plans of the Midwest, Inc. (HMO in IN & IL only).
For selfunded plans, claims are administered by UniCare Life & Health Insurance Company.- f Insurance coverage is provided by UniCare Life & Health Insurance Company. UniView Vision VA FS 2017 EXCLUSIONS & LIMITATIONS (not a comprehensive list – please refer t
