Vision Care – Flexible Plan Choices

Wellmark Blue Cross and Blue Shield is committed to total health for you and your employees. In addition to our comprehensive health insurance plans, we’re also your source for a variety of vision-plan options. With a number of flexible plan choices, you’re sure to find a vision benefit that makes the best sense for you, offers the best possible coverage for your employees, and adds another desirable component to your benefits package.

These vision plans are designed to reduce costs by delivering benefits and services through an organized network of providers. Participating providers include optometrists, opticians, and ophthalmologists.

• Option 1: Advantage Discount Plan
• Option 2: Select Exam Plus*
• Option 3: Select Advantage Plan (Fully Insured)*
• Option 4: Select Advantage Materials Only Plan

Option 1: Advantage Discount Plan

This is not an insurance-based program! It simply offers your employees substantial value on eyewear (hardware), with maximum convenience:

• For your employees, there are no claim forms, no reimbursement procedures, and no waiting periods.
• For you, it’s a simple offering. There are no participation levels to meet and no employer contribution requirements.

Members can receive up to 50 percent off of vision hardware with no restrictions on frames, lenses, color, size, or style. Eligible employees and family members may use the discount benefit as often as they like throughout the benefit period, without limitations on eyewear selection. To obtain benefits, members can simply visit one of the network locations in their area or find updated directories at www.avesis.com to locate a network retailer in their area.

Throughout the benefit period, all of your eligible full-time employees and their families members will be able to:

• Receive examinations that will be 20 percent less than the network provider’s documented usual and customary fee.
• Purchase “hardware” at discounted prices, including frames and lenses in any style they choose. (No restrictions and no limitations on quantities.)
• Access more than 10,000 vision network retailers.
• Enjoy a 30-day unconditional guarantee on their purchases.
• Obtain the lowest prices available on hardware.

The Advantage Discount Plan is available to small groups of 2-100 eligible employees and large groups of 101+ employees with no participation requirements.

Option 2: Select Exam Plus*

This option gives all the advantages of Option 1, plus:

• A covered-in-full vision exam after the applicable copayment.
• Complete access to in- or out-of-network providers with fixed benefit amounts.

If a patient has no specific vision complaint but wants a brief, routine check-up, the provider may perform a limited or intermediate exam.

The Select Exam Plus is available to small groups of 10 or more eligible employees and large groups of 101+ employees, with a minimum participation of 10 employees. Premium can be 100 percent employer paid, 100 percent employee paid or a combination of these funding options.

Option 3: Select Advantage Plan (Fully Insured)*

This is the most comprehensive plan. Select Advantage provides full coverage for an annual vision examination, standard lenses, and frames.

• An annual examination is covered in full after the applicable copayment.
• Standard single, bifocal, trifocal, and lenticolor lenses are covered in full after the applicable copayment.
• Frames and elective contact lenses are covered 100 percent within the plan allowance.
• Members can choose to receive a generous allowance towards the purchase of contacts instead of frames and lenses.
• Complete access to in- or out-of-network providers with fixed benefit amounts.

The Select Advantage Plan is available to all size groups. Participation requirements and premium contributions vary according to group size.

Option 4: Select Advantage Materials Only Plan

This plan benefits groups that already have an eye exam under their medical plan.

• Standard lenses and frames are covered in full after the applicable copayment.
• Standard single, bifocal, trifocal, and lenticolor lenses are covered in full after the applicable copayment.
• Frames and elective contact lenses are covered 100 percent within the plan allowance
• Members can choose to receive a generous allowance towards the purchase of contacts instead of frames and lenses.
• Complete access to in- or out-of-network providers with fixed benefit amounts.

The Select Advantage Materials Only Plan is available to all size groups. Participation requirements and premium contributions vary according to group size.

For more information on these vision plans, including rates, please contact your Wellmark representative or broker, or call 1-800-797-6282 ext. 11.

*Select Exam Plus and Select Advantage are designed to cover eye examinations, corrective eyewear, and visual needs. Should a member select options that are not covered under a plan, the member will pay a discounted fee to the participating provider.

^{Select Advantage is underwritten by Fidelity Security Life Insurance Company of Kansas City, MO and administered by Avesis Third Party Administrator, Inc. of Phoenix, AZ. Wellmark is a separate entity and is in no way legally affiliated with the companies that underwrite and administer this vision plan. Nothing contained in this outline shall be determined to constitute these corporations as partners nor be construed in any proceeding for any purpose whatsoever as to make either or both corporations liable for the debts or faults of the other.}

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