WWW.DISSERTATION.XLIBX.INFO
FREE ELECTRONIC LIBRARY - Dissertations, online materials
 
<< HOME
CONTACTS



Pages:   || 2 | 3 |

«Program Summary Important This Program Summary applies to all employees, effective January 1, 2015. For more information on other benefit programs ...»

-- [ Page 1 ] --

Vision Care Program (VCP)

All Employees

Effective: January 1, 2016

Program Summary

Important

This Program Summary applies to all employees, effective January 1, 2015. For more

information on other benefit programs under the Sandia Health Benefits Plan for

Employees, see the Sandia Health Benefits Plan for Employees Summary Plan

Description.

The Vision Care Program is maintained at the discretion of Sandia and is not intended to

create a contract of employment and does not change the at will employment relationship between you and Sandia. The Sandia Board of Directors (or designated representative) reserves the right to amend (in writing) any or all provisions of the Vision Care Program, and to terminate (in writing) the Vision Care Program at any time without prior notice, subject to applicable collective bargaining agreements.

The Vision Care Program’s terms cannot be modified by written or oral statements to you from human resources representatives or HBE or other Sandia personnel.

Sandia National Laboratories is a multi-program laboratory managed and operated by Sandia Corporation, a wholly owned subsidiary of Lockheed Martin Corporation, for the U.S. Department of Energy’s Nat ional Nuclear Security Administration under contract DE-AC04-94AL85000. SAND Number: 2016-1543O This page intentionally left blank.

Contents Section 1. Introduction

Section 2. Summary of Changes

Section 3. Accessing Care

Network and Non-Network Options

In-Network Option

Network Providers

Out-of-Network Option

Non-Network (non-participating) Providers

Section 4. Benefits and Limitations

Types of Expenses and VCP Benefit

The Enhanced Plan, For Represented and Non-Represented Employees

Examples of Covered Expenses for the Enhanced Plan

When Expenses Are Incurred

Section 5. What’s Not Covered - Exclusions

What the Vision Care Program Does Not Cover

Section 6. Coordination of Benefits

Section 7. How to File a Claim

Filing an Initial Claim

In-Network Claim Processing

Out-of-Network Claim Processing

Benefit Payments

Network (Participating) Provider Benefits

Non-Network (non-participating) Provider

Right to Recover Excess Payments

Section 8. How to File an Appeal

Davis Vision Appeals Procedure

Section 9. Vision Care Program Administrative Services

Davis Vision

Member Services

Member ID Card

Davis Vision Website

Section 10. Definitions

Appendix A. Davis Vision – Vision Care Program Benefit Description

Vision Care Program (VCP) Program Summary Section 1. Introduction This is a summary of highlights of the Vision Care Program, a component of the Sandia Health Benefits Plan for Employees (ERISA Plan 540). This Program Summary is part of the Sandia Health Benefits Plan for Employees Summary Plan Description. It contains important information about your Sandia health benefits.

Certain capitalized words in this Program Summary have special meaning. These words have been defined in Section 10: Definitions.

When the words “we”, “us”, and “our” appear in this document, we are referring to Sandia.

When the words “you” and “your” are used throughout this document, we are referring to people who are Covered Members as defined in Section 10: Definitions.

Many sections of this Program Summary are related to other sections of the Program Summary and to information contained in the Sandia Health Benefits Plan for Employees Summary Plan Description. You will not have all of the information you need by reading just one section or just one booklet. For example, you will need to refer to the Sandia Health Benefits Plan for Employees Summary Plan Description for information about eligibility, enrollment, disenrollment, premiums, termination, coordination of benefits, subrogation and reimbursement rights, when coverage ends, continuation of coverage provisions, and your rights under the Employee Retirement Income Security Act of 1974 (ERISA).

To receive a paper copy of this Program Summary, other Program Summaries, and/or the Sandia Health Benefits Plan for Employees Summary Plan Description, please contact Sandia HBE Customer Service at 1-505-844-HBES (4237) or email hbesupport@mailps.custhelp.com. These documents are also available electronically at https://hbeupdate.custhelp.com/app/answers/detail/a_id/3585.

Since these documents will continue to be updated, we recommend that you check back on a regular basis for the most recent version.

–  –  –

Network and Non-Network Options The in-network option provides you access to a national network of physicians, retailers, and materials contracted with Davis Vision to provide their services at negotiated fees. For the most updated in-network provider listing in your area, contact Davis Vision at 888-575-0191 or access the website at www.davisvision.com; click “Member” and type “3255” in the Client Code box.

The advantages of using the in-network option include:

• Copays for examinations and prescription Lenses

• Allowance for Frames and Contact Lenses

• Access to discounted materials and fees





• No claims to file The non-network option offers a lower level of benefit but enables you to get services from any licensed provider. No referrals are required. You receive a flat reimbursement up to a specified dollar amount for examinations, Frames, prescription Lenses, and Contact Lenses. You are responsible for all charges above this flat reimbursement.

In-Network OptionNetwork Providers

• Call a Network Provider of your choice and schedule an appointment.

• Identify yourself as a Davis Vision participant and Sandia National Laboratories member or dependent.

• Provide the office with your Davis Vision issued ID number or social security number and the name and date of birth of any covered dependent needing services.

The provider's office will verify your eligibility for services. The claim will be processed electronically (no claim form filing is required for in-network services or material purchases).

For more information call Davis Vision member services at 888-575-0191; visit Davis Vision's website at www.davisvision.com. Note: New members – when visiting the web prior to enrollment, enter web Control Code 3255.

Vision Care Program (VCP) Program Summary Out-of-Network Option Non-Network (non-participating) Providers

• Contact any licensed provider of your choice and schedule an appointment.

• Obtain a claim form from the Davis Vision website www.davisvision.com (Member login/Forms).

• Take the claim form with you to the appointment and have the provider complete it.

In lieu of having the provider complete the form, you can attach an original itemized copy of the billing received from the Non-Network Provider and send it with the claim form to Davis Vision.

• You will be responsible for full payment at the time expenses are incurred.

• Submit the claim form to Davis Vision within one year of the date of service to obtain reimbursement based on the out-of-network Program design.

Vision Care Program (VCP) Program Summary Section 4. Benefits and Limitations The VCP provides benefits for you on a scheduled basis, with reimbursement available every 12 months for Comprehensive Vision Examination benefits and Lens benefits, and once every 24 months for Frame benefits. Benefits reset on the first day of the month when the individual is eligible to use the benefits again. Please refer to Examples of Covered Expenses for the Enhanced Plan for more information.

Benefits vary depending on your choice of a Network (participating) Provider or Non-Network (non-participating) Provider as described in this section.

Types of Expenses and VCP Benefit The Enhanced Plan, For Represented and Non-Represented Employees Network (Participating) Providers

As specified under the VCP, your cost or copayments for specific expenses are as follows:

–  –  –

Additional Davis Vision In-Network Benefits Offered

Additional discounts include:

• Davis Vision Frame Collection

• Breakage Warranty

• Discounted Fixed Fee Materials/Services

• Discounted Laser Vision Correction Services

• Contact Lens Replacement Program

• Member discount benefit for additional purchases Non-Network (Nonparticipating) Providers As specified under the VCP, Davis Vision pays a fixed amount for specific vision care expenses.

The type of expenses and the maximum fixed amounts are shown on the following pages:

–  –  –

Comprehensive Vision Examination. Contact Lens examinations may require additional fees.

These fees are separate from the Comprehensive Vision Examination and vary from provider to Every 12 months with provider. The Contact Lens exam/fitting fees may benefits resetting on the Reimbursed up to $30 be included in the Contact Lens allowance. first day of the month Note: Vision examination is not a covered benefit for Kaiser members. The VCP will not reimburse any portion of the applicable Kaiser copayment.

–  –  –

Examples of Covered Expenses for the Enhanced Plan Example 1 A Covered Participant had a Comprehensive Vision Examination on February 10, 2015, and ordered a pair of single-vision prescription eyeglasses and an $80 Frame on March 5, 2015. The Covered Participant had made no previous claims under the Vision Care Program.

Network (participating) Provider

• The Covered Participant made the following copayments to the provider:

1. $20 for the exam 2. $0 for the Frame because the entire allowance was used. (Frame allowance is $150).

• The VCP paid the Network (participating) Provider in this example for the full cost of the Frame and expenses Incurred above the Covered Participant’s copayment amounts.

• The Covered Participant became eligible for a covered eye exam on February 1, 2016 and is eligible for covered Lenses, if needed, on March 1, 2016. The Covered Participant would be eligible for a covered Frame on March 1, 2017.

–  –  –

Example 2 A Covered Participant lost one prescription Contact Lens and ordered a replacement from the provider on April 9, 2015. The charge for this replacement Contact Lens was $40 and the Covered Participant had made no previous claims under the VCP.

Network (participating) Provider

• The VCP provides a Contact Lens allowance of $150 per pair.

• The Covered Participant was not responsible for any copayment.

• The network (participating) provider filed a claim to the Davis Vision for the Contact Lens benefit.

• The Covered Participant has used up the benefit for Lenses in that 12-month period.

The remaining amount is not available for additional expense reimbursement. The Covered Participant became eligible for covered Lenses on April 1, 2016.

Non-Network (non-participating) Provider

• The Covered Participant must pay the Non-Network (non-participating) Provider the full cost of the Contact Lens.

• The Covered Participant filed a Direct Reimbursement Claim and the VCP paid the $40 charge.

• Since the VCP pays for prescription Contact Lenses once in a 12-month period, this $40 claim will be paid in full under the provisions of the VCP.

• The Covered Participant has used up the benefit for Lenses in that 12-month period.

The remaining amount is not available for additional expense reimbursement. The Covered Participant became eligible for covered Lenses on April 1, 2016.

–  –  –

• Comprehensive Vision Examinations – on the date of the exam.

• Lenses or Frames – on the date you order the materials.

IMPORTANT: Sandia retirees are not eligible for the benefits described above.

–  –  –

What the Vision Care Program Does Not Cover The VCP does not cover certain expenses. The following list itemizes most exclusions but is not all-inclusive.

The VCP does not cover care under other benefit plans, such as those of:

• The armed forces of any government,

• Any civil unit of any government,

• Workers’ Compensation or similar law, or

• Any other benefit plan of Sandia.

The VCP also excludes Comprehensive Vision Examinations performed and Lenses and Frames

ordered:

• Before the individual became eligible for coverage under the VCP, or

• After termination of the individual’s coverage.

• Comprehensive Vision Examinations for employees covered by the Kaiser Health Plan - Kaiser Members are required to use their Kaiser Health Plan to obtain Comprehensive Vision Examinations.

• Comprehensive Vision Examinations performed within the year following the last Incurred date for services through a Network (participating) and/or Non-Network (non-participating) Provider.

• Lenses ordered within the year following the last Incurred date for Lenses through a Network (participating) and/or Non-Network (non-participating) Provider.

• Frames ordered within the 24 months following the last Incurred date for Frames through a Network (participating) and/or Non-Network (non-participating) Provider.

Treatments including (but not limited to):

–  –  –

• Drugs or other medications;

• Experimental services or supplies;

• Progressive Lenses and special Lens designs, other than those described in Section 4:

Benefits and Limitations;

• Lenses that do not require a prescription;

• Lens-care kits, cleaning solutions, Lens insurance, and extra fittings;

• Replacement of broken or lost eyewear, outside of the plan breakage warranty provisions



Pages:   || 2 | 3 |


Similar works:

«Health care: Re-framing our thinking Paper for presentation at Australian Health Care Reform Alliance Conference March 2009 Ian McAuley University of Canberra and Centre for Policy Development February 2009 “Timid” is the sharpest summary of the Interim Report of the National Hospital and Health Reform Commission. Its recommendations and options, while including some sound technical reforms such as electronic patient records and more use of nurse practitioners, generally avoid addressing...»

«Department of Education and Children Rheynn Ynsee as Paitchyn Guidance for Schools on the Administration of Medication and Medical Care May 2010 This Document updates the Department of Education and Children’s Administration of Medicines Policy issued in October 2007. This guidance will be reviewed May 2013 This guidance should be read in conjunction with *DfES guide 1448 – 2005 DCLEN, published in March 2005. *This DfES guidance book supersedes other guidance produced to date. Contents...»

«Sociology of Health & Illness Vol. 31 No. 3 2009 ISSN 0141–9889, pp. 441–455 doi: 10.1111/j.1467-9566.2009.01161.x Health-related Original Articlestigma XXX Graham © 2009 UK 1467-9566 0141-9889of Health Ltd Sociology Publishing& the Sociology of Health & Illness/Blackwell Publishing Ltd SHIL Foundation forIllness Oxford, Scambler Blackwell Review article Health-related stigma Graham Scambler Centre for Sociological Theory and Research on Health, UCL, London The concept of stigma, denoting...»

«HANDOUT 11: ORGAN MARKETS AND EXPLOITATION 1: ORGAN MARKETS 1.1 LEGALITY IN THE UNITED STATES In this lesson we will discuss another type of state paternalism which relates to public health: restrictions on free markets for organ sales. Here our concern will be with live organ selling (or a person selling their organs while they are still alive). Although it is legal to make a live organ donation, according the National Organ Transplant Act of 1984 it is illegal to buy or sell a live organ. It...»

«Below are some of the most frequently asked questions patients have about dentistry and oral health issues. If you have any other questions, or would like to schedule an appointment, we would love to hear from you. Q: What should I do if I have bad breath?  Bad breath (halitosis) can be an unpleasant and embarrassing condition. Many of us may not realize that we have bad breath, but everyone has it from time to time, especially in the morning. There are various reasons one may have bad...»

«C L I N I C A L AU D I T Sore throat management of at-risk people bpac nz better medicine Valid to September 2013 Background Lower socioeconomic communities in central and northern regions of the North Island have some of the highest rates of rheumatic fever in the world. Maori and Pacific people living in these areas, aged between three and 45 years are particularly vulnerable to acute rheumatic fever (ARF) due to overcrowding, poverty and decreased access to treatment. Rates of ARF can be...»

«TEI.2 teiHeaderfileDesc titleStmttitleA Dissertation concerning mistletoe: a most wonderful specifick remedy for the cure of convulsive distempers [.] [scia1730] /title/titleStmt publicationStmtpDistributed as part of the Lampeter Corpus/p /publicationStmtsourceDescbibl idno type=estcn001720/idnoidno type=lampT44/6735/idno date1730/date pubPlaceLondon/pubPlace bookSellerDaniel Browne/bookSeller pubFormatoctavo/pubFormat /bibl/sourceDesc/fileDesc profileDescparticDescperson role=author sex=m...»

«DISEASE PAIN MANAGEMENT MANAGED CARE February 2014. © MediMedia USA PTCommunity News Headlines Sonidegib (Odomzo) Gets ‘Thumbs Up’ COVER STORY for Patients With Advanced Basal Cell Hospital-Acquired Infections Carcinoma Fifty-eight percent of subjects show objective response with 200-mg daily dose Rates are far too high, and health plans are big losers. Is it time to institute financial penalties? Bundled Payments May Extend to Joseph Burns Other Services, Payers CMS plans to launch...»

«Aubrey Lewis, Edward Mapother and the Maudsley EDGAR JONES Aubrey Lewis was the most influential post-war psychiatrist in the UK. As clinical director of the Maudsley Hospital in Denmark Hill, London, and professor of psychiatry from 1946 until his retirement in 1966, he exercised a profound influence on clinical practice, training and academic research. Many junior psychiatrists, whom he had supervised or taught, went on to become senior clinicians and academics in their own right. Although...»

«Preventing and Minimising Gambling Harm Six-year strategic plan 2010/11–2015/16 i Preventing and Minimising Gambling Harm: Six-year strategic plan 2010/11–2015/16 Citation: Ministry of Health. 2010. Preventing and Minimising Gambling Harm: Six-year strategic plan 2010/11–2015/16. Wellington: Ministry of Health. Published in May 2010 by the Ministry of Health PO Box 5013, Wellington 6145, New Zealand ISBN: 978-0-478-35963-3 (Print) ISBN: 978-0-478-35964-0 (Online) HP 5108 This document is...»

«Battling Poverty in the Golden State Recommendations for the California Statewide Poverty Commission Melissa Boteach and Jodie Levin-Epstein October 2010 Background The Census’s 2009 poverty data revealed that 43.6 million Americans or 14.3 percent lived in poverty last year. This is the largest number since the Census started keeping track in 1959. Moreover, more than 100 million Americans or 33 percent were low income, barely scraping by and living below 200 percent of poverty, or $44,000 a...»

«Package leaflet: Information for the patient Fostepor Once Weekly 70 mg tablets (sodium alendronate) Read all of this leaflet carefully before you start taking this medicine because it contains important information for you.  Keep this leaflet. You may need to read it again.  If you have any further questions, ask your doctor or pharmacist.  This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as...»





 
<<  HOME   |    CONTACTS
2016 www.dissertation.xlibx.info - Dissertations, online materials

Materials of this site are available for review, all rights belong to their respective owners.
If you do not agree with the fact that your material is placed on this site, please, email us, we will within 1-2 business days delete him.