Common Member Questions

Here you'll find the answers to some common questions about your vision plan. Select a category below to view questions about specific topics or watch our video tutorial to get more personalized help.

 View Your Vision Benefit  |   The EyeMed Provider Network

Using Your Vision Benefit

Q. How do I use my benefit?

A. Using your vision benefit at a network provider is easy, read below or watch this video.

  1. Locate a provider that services your plan by using our Enhanced Provider Search.
  2. Call the eyewear provider to confirm he or she accepts your plan.
  3. Schedule an appointment.
  4. Show your EyeMed Member ID card at the time of service. Don't have your ID card? No worries! You don't need one to receive services. Simply show your driver's license or pull up your digital card on the EyeMed Members App.

The provider's staff will do the rest! You pay for any copays indicated, as well as any applicable amounts over the allowances. Your provider will supply you with these amounts.

Q. How do I submit a claim?

A. When you visit one of our in-network providers we take care of all of the paperwork - there is nothing you need to do on your part! However,if you see an out-of-network provider AND you have out-of-network benefits as part of your plan, you?ll need to pay at the time of service and submit a claim form online for reimbursement. You will need to upload an itemized paid receipt with your name included.

Q. How can I check on the status of a claim?

A. If you used your benefits at an in-network provider, you do not need to check the status of a claim, as we will work with the provider directly. If you filed an out-of-network claim, please contact our Customer Care Center at the number listed on your Member ID card to inquire about the status of a claim.  Have your Member ID available for faster service.

Q. As a subscriber, why do I not see benefits or claims information for my dependent?

A. Due to privacy guidelines, we only show family members who are under the age of 18 under the subscriber?s account. Anyone 18 or older will need to register for his or her own account. For more information watch this video.

Q. Can I apply Flexible Spending Account (FSA) funds to out-of-pocket costs after my vision benefit is applied?

A. Yes. You can use your FSA to pay for a variety of health-related out-of pocket expenses, including those associated with ancillary benefits like this plan. Money from your FSA can be applied toward the eye exam copay, out-of-pocket costs for prescription glasses or contact lenses (including upgrades) and supplies such as contact lens solution. Employees can even use FSA funds for LASIK surgery.

Q. I'm interested in receiving my benefit communications electronically. How do I modify my paperless options?

A. If you have paperless options available, you can manage them within the Manage Profile page. The link is accessible throughout the site in the upper right corner of the page. From there, you can select to receive paperless Explanation of Benefits on this site (as Adobe Acrobat PDF files) and to be notified via email. You can also opt to receive other benefit-related communications from us via email. (Note that we will never sell your email address to a third party.)

Q. I currently have paperless options enabled; however, I would like to start receiving my Explanation of Benefits documents via U.S. mail. How do I modify my paperless options?

A. You can manage your paperless options within the Manage Profile page. The link is accessible throughout the site in the upper right corner of the page. From there, you can deselect the option to receive paperless Explanation of Benefits on this site (as Adobe Acrobat PDF files). You will then begin receiving these documents via U.S mail.

You can separately opt to receive other benefit-related communications from us via email, or you can also deselect this option within the Manage Profile page. (Note that we will never sell your email address to a third party.)

Q. Where can I find a list of tiers for progressive lenses and anti-reflective coatings?

A. You can download a pdf copy of our tier classifications here

Q. How can I find out what my appeal rights are?

A. It?s easy. View your appeal rights by state listed below.

State of California

Your request for a review of an adverse benefit determination must be submitted within 180 days of the date of your Explanation of Payment.

A copy of the specific rule, guideline, or protocol relied upon in the adverse benefit determination will be provided free of charge upon request by you or your authorized representative. You may also review the documents relevant to your claim.

You may seek review by the California Department of Insurance of a claim that an insurer has contested or denied by contacting the California Department of Insurance Consumer Communications Bureau, 300 South Spring Street, South Tower, Los Angeles, CA 90013, or call the Consumer Hotline at 800.927.HELP (4357), 213.897.8921 for out-of-state callers, TDD at 800.482.4TDD (4833) or online at www.insurance.ca.gov.

You have a right to enter into the dispute resolution process described in Section 10123.13 of Article 1. General Provisions ? California Insurance Code.

You may have other alternative dispute resolution options, such as mediation. One way to find out what may be available is to contact your local U.S. Department of Labor office and the California Department of Insurance.

State of Delaware

You have the right to seek review of our decision regarding the amount of your reimbursement. The Delaware Insurance Department provides claim arbitration services which are in addition to, but do not replace, any other legal or equitable right you may have to review of this decision or any right of review based on your contract with us. You can contact the Delaware Insurance Department for information about arbitration by calling the Arbitration Secretary at 302-674-7322 or by sending an email to: DOIarbitration@state.de.us. All requests for arbitration must be filed within 60 days from the date you receive this notice; otherwise, this decision will be final.

State of Illinois

If you are not satisfied with a coverage decision, you are entitled to a review (appeal) of the benefit determination.  To obtain a review, you or your authorized representative should submit your request in writing to:

Member Appeals Coordinator
EyeMed Vision Care
4000 Luxottica Place
Mason, OH  45040

Your request for a review of an adverse benefit determination must be submitted within 180 days of the date of your Explanation of Payment.

A copy of the specific rule, guideline, or protocol relied upon in the adverse benefit determination will be provided free of charge upon request by you or your authorized representative.  You may also review the documents relevant to your claim.

Notice of Availability:  Part 919 of the Rules of the Illinois Department of Insurance requires that our company advise you that, if you wish to take this matter up with the Illinois Department of Insurance, it maintains a Consumer Division in Chicago at 122 S. Michigan Ave., 19th Floor, Chicago, Illinois 60603 (312-814-2420) and in Springfield at 320 West Washington Street, Springfield, Illinois 62767 (217-782-4515) or contact the Illinois Department of Insurance at http://insurance.illinois.gov/.

You may have other alternative dispute resolution options, such as mediation.  One way to find out what may be available is to contact your local U.S. Department of Labor office and the Illinois Department of Insurance.

The EyeMed Provider Network

Q. How do I find a provider who accepts my EyeMed plan?

A. EyeMed makes it easy to find an eye doctor and schedule an exam online. Visit our enhanced provider search to choose from more than 95,000 in-network providers*. You can even filter your search by your frame preferences, provider hours and much more.  Watch this video for more information.

*On the access network

Q. Can I use my benefits online?

A. Absolutely! You can utilize your in-network EyeMed benefits online by visiting  www.contactsdirect.com , www.lenscrafterscontacts.com or Target Optical to purchase contact lenses online.  To purchases glasses online visit www.glasses.com or Target Optical.

Q. I can't find a provider near my home or office, who can I see?

A. You can visit an out-of-network provider and access your in-network level of benefits when you cannot schedule an appointment within two-weeks because there is no in-network provider available without excessive travel or delay. You must submit a claim form into EyeMed for reimbursement. Complete the OON claim form, which includes additional information and requirements.

Q. What does excessive travel or delay mean?

A. It means that you were unable to: (i) schedule a visit within two-weeks, (ii) locate a participating provider within a 10-mile radius in an urban-suburban area, or (iii) locate a participating provider within a 20-mile radius in a rural area.

It does not mean that you may obtain the in-network level of benefits because you choose to use an out-of-network provider due to (i) your preference or (ii) when your personal schedule does not permit you to schedule an appointment with a provider who has available appointments within the two-week period.

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