FREE ELECTRONIC LIBRARY - Dissertations, online materials

Pages:   || 2 |

«CICV Benefits Consortium Vision Plan 01/01/2010 Anthem Blue Cross and Blue Shield Blue View Basic Vision Care Member Certificate Your vision care ...»

-- [ Page 1 ] --

CICV Benefits Consortium

Vision Plan


Anthem Blue Cross and Blue Shield

Blue View Basic Vision Care Member Certificate

Your vision care benefits are provided through a group insurance policy issued by Anthem Blue Cross

and Blue Shield to go along with the health benefits provided by your employer’s self-funded health

plan. This member booklet fully explains your vision care benefits and how you can maximize them.

Treat it as you treat the owner’s manual for your car - store it in a convenient place and refer to it whenever you have questions about your vision care coverage.

Important phone numbers Member Services 804-358-1551 in Richmond 800-451-1527 from outside Richmond Si necesita ayuda en español para entender este documento, puede solicitarla sin costo adicional, llamando al número de servicio al cliente.

(If you need Spanish-language assistance to understand this document, you may request it at no additional cost by calling the customer service number.)

Hours of Operation:

Monday-Friday 8:00 a.m. to 6:00 p.m. ET Saturday 9:00 a.m. to 1:00 p.m. ET

Visit us on-line at:

www.anthem.com Key words There are a few key words you will see repeated throughout this booklet. We’ve highlighted them here to make the booklet easier to understand. In addition, we have included a Definitions section on page 17 that lists the various words referenced. A defined word will be italicized each time it is used.

We, us, our, Anthem Anthem Blue Cross and Blue Shield.

Covered persons You and enrolled eligible dependents.

You The enrolled employee.

Your vision care plan Anthem vision care plan.

Copayment The fixed dollar amount you pay for some covered services.

Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Virginia, Inc.

V-INTRO (7/07) Coinsurance The percentage of the allowable charge you pay for some covered services.

Table of contents page How your vision care plan works.................................................. 1 Choose a vision care provider................................................... 1

–  –  –

Your vision care plan provides vision care services within a special network of vision care providers. You will receive benefits based on where you receive vision care services and the limits stated in the Summary of benefits (see page 2) and related exclusions. This section of your vision care booklet details how to access and make the most of your vision care benefits.

Carry your ID card Your Anthem Blue Cross and Blue Shield ID card identifies you as a member. When you show your ID card to your vision care providers, they will file your claims for you in most cases. Carrying your card at all times will ensure you always have this member information with you when you need it.

Choose a vision care provider To receive in-network benefits, you should receive care from a licensed optometrist, ophthalmologist, or optician that participates in the Blue View Vision Network. Refer to your participating provider listing to choose a vision care provider with a location that is convenient for you.

Many participating providers offer complete vision care services while others may offer only partial services such as dispensing eyeglasses or contact lenses. Follow the key in your provider listing to see which services each provider offers.

–  –  –

Out-of-network care Out-of-network care is vision care services received from a provider who does not participate in the Blue View Vision Network. Out-of-network care is covered at a lower level of benefits than in-network care. When you seek care from a licensed optometrist, ophthalmologist, or optician, you will receive a set dollar allowance for covered services as stated in the Summary of benefits (see page 2).

V-WORKS (7/06)

–  –  –

To help care for your eyes, your vision care plan includes benefits for one routine eye examination per covered person per calendar year.

In order to receive the highest level of benefits, you should seek care from a Blue View Vision participating provider.

Summary of benefits This chart describes your covered services and payment responsibility for care received in-network and out-of-network. For out-of-network care, you will be responsible for the difference between the allowance and the provider’s charge.

A list of services that are not covered begins on page 3.

–  –  –

V-EXCL (1/10) 4 - What is not covered

• for diseases contracted or injuries caused because of war, declared or undeclared, voluntary participation in civil disobedience, or other such activities.

–  –  –

We consider the charge to be incurred on the date a service is provided. This is important because you must be actively enrolled on the date the service is provided. Also, the dates of service will affect your payment allowances and other minimums described in the Summary of benefits and in this section.

–  –  –

If you go to a non-participating provider, we may choose to pay you. We will pay only after we have received an itemized bill and all the information we need to process the claim.

In the event that payment is made directly to you, you have the responsibility to apply this payment to the claim from the non-participating provider. In all cases, our payment relieves Anthem of any further liability for the service.

–  –  –

V-CLAIMS (7/06) 6 - Claims and payments Timely filing of claims Written notice of a claim is to be made within 20 days after the occurrence or commencement of any loss covered by the vision care plan. However, failure to give this notice shall not invalidate or reduce any claim if the notice is given as soon as reasonably possible. Claim forms will be furnished to you if needed within 15 days after this written notice.

Written proof of loss must be furnished within 90 days after the date of service. A proof of loss is not complete unless it is properly filed and contains all information that Anthem needs to process the claim. Failure to furnish the proof of loss within this time frame will not invalidate or reduce any claim if the proof of loss is given as soon as reasonably possible. However, no claim will be paid if we receive the proof of loss more than 15 months after the date of service, except in the absence of legal capacity of the covered person. All benefits payable for a claim will be payable within 60 days after receipt of the proof of loss.

When your claim is processed In processing your claim, your vision care plan may use protocols, guidelines or criteria to ensure that coverage determinations are consistently applied. Claims filed as outlined in the “When you must file a claim” paragraph of this section will be processed within 30 days of receipt of the claim. We may extend this period for another 15 days if we determine it to be necessary because of matters beyond our control. In the event that this extension is necessary, you will be notified prior to the expiration of the initial 30-day period.

Your vision care plan may deny a claim for benefits if information needed to fully consider the claim is not provided. The denial will describe the additional information needed to process the claim. The claim may be reopened by you or your provider furnishing the additional information. You or your provider must submit the additional information to us within either 15 months of the date of service or 45 days from the date you were notified that the information is needed, whichever is later. Once your claim has been processed by your vision care plan, you will receive written notification of the coverage decision. In the event of an adverse benefit determination, the written notification will include

the following:

• the specific reason(s) and the plan provision(s) on which the determination is based;

• a description of any additional material or information necessary to reopen the claim for consideration, along with an explanation of why the requested material or information is needed;


• a description of your vision care plan’s appeal procedures and applicable time limits.

–  –  –

Recovery of overpayment Anthem shall have the right to recover any overpayment of benefits from persons or organizations that

we have determined to have realized benefits from the overpayment:

• any person to, or for whom such payments were made;

• any insurance company;

• a facility or provider; or

• any other organization.

You will be required to cooperate with us to secure Anthem’s right to recover the excess payments made on your behalf, or on behalf of covered persons enrolled under your family coverage.

–  –  –

You are eligible for vision care coverage if you are a participant in your employer’s group health plan.

Your eligible dependents covered under the group health plan are also eligible for vision care coverage.

For more specific information on eligibility, please refer to your group health plan’s member booklet.

Ending coverage

When a covered person ceases to be eligible or the required premiums are not paid, the covered person’s coverage will end. Unless otherwise agreed to in writing by Anthem, the covered person’s coverage ends on the last day of the month for which payment is made. The covered person’s coverage ends on the last day of the month during which eligibility ceases.

V-ENR Important information about your vision care plan

–  –  –

You may examine, without charge, at your plan administrator’s office and at other specified locations, all plan documents. These include insurance contracts, copies of all documents filed by the plan with the Department of Labor (such as detailed annual reports), and plan descriptions.

You may obtain copies of all plan documents and other plan information by writing to your plan administrator. The administrator may make a reasonable charge for the copies.

–  –  –

Assistance If you have questions about your plan, contact your Plan Administrator. If you have questions about this statement about your rights under ERISA, contact the nearest Area Office of the Employee Benefits Security Administration, Department of Labor, listed in your telephone directory. You may also contact the Division of Technical Assistance and Inquires, Employee Benefits Security Administration, U.S.

Department of Labor, 200 Constitution Avenue, N.W., Washington, D.C. 20210.

Employer premiums Your employer is responsible for paying a monthly premium by the first day of the month for which coverage is purchased. We will allow employers a 31 day grace period to pay monthly premiums, except for the first month’s premium. During this grace period, coverage will continue unless we receive a written notice of termination from your employer. We will notify your employer at least 15 days prior to terminating the group policy for non-payment of a monthly premium. Anthem is not responsible for costs you incur during any period (other than the grace period discussed above) when your employer fails to pay full premiums.

Changes in the vision care plan We may amend this vision care plan by giving your employer at least 30 days written notice. Any amendment to the vision plan will change covered services to covered persons on the effective date of the change. Your employer and Anthem may mutually agree to amend or reduce benefits at any time.

Complaint and appeal process In order for your vision care plan to remain responsive to your needs, we’ve established both a complaint process and an appeal process. Should you have a problem or question about your vision care plan, a Member Services representative will assist you. Most problems and questions can be handled in this manner. You may also file a written complaint or appeal with us. Complaints typically involve issues such as dissatisfaction about your vision care plan’s services, quality of care, the choice of and accessibility to your vision care plan’s providers and network adequacy. Appeals typically involve a request to reverse a previous decision made by your vision care plan. Requests regarding claim errors, claim corrections, and claims denied for additional information may be reopened for consideration without having to invoke the appeal process.

Important information about your vision care plan - 11

Complaint Process

Upon receipt, your complaint will be reviewed and investigated. You will receive a response within 30 calendar days of your vision care plan’s receipt of your complaint. If we are unable to resolve your complaint in 30 calendar days, you will be notified on or before calendar day 30 that more time is required to resolve your complaint. We will then respond to you within an additional 30 calendar days.

Important: Written complaints or any questions concerning your vision care plan may be filed to the

following address:

Anthem Blue Cross and Blue Shield Attention: Member Services P.O. Box 27401 Richmond, VA 23279 Appeal Process Your vision care plan is committed to providing a full and fair process for resolving disputes and responding to requests to reconsider coverage decisions you find unacceptable. Types of appeals


• internal appeals are requests to reconsider coverage decisions of pre-service or post-service claims.

Pages:   || 2 |

Similar works:

«The Role of Alcohol Dehydrogenase Genes in the Development of Fetal Alcohol Syndrome in Two South African Coloured Communities Dhamari Naidoo Division of Human Genetics National Health Laboratory Service and, School of Pathology, University of Witwatersrand Johannesburg South African A dissertation submitted in the Faculty of Health Sciences, University of Witwatersrand, in fulfilment of the requirements for the degree of Masters of Science in Medicine. i Declaration I, Dhamari Naidoo, hereby...»

«A report on the Healthy Eating Healthy Living Project for adults with Learning Disabilities in six Scottish pilot sites June 2011 Dorothy A. Morrison Healthy Living Project Lead Contents: 1. Introduction/Summary Page 3 2. Background Page 3 3. Main Aims of the Project Page 5 4. The Pack and How it was Delivered Page 6 5. Pilot sites Page 7 6. Project Aims, Objectives and Outcomes Page 9 7. Development of Training Manual to support delivery Page 14 8. Additional Outcomes Page 16 9. Key issues...»

«Surgery Guide For patients of Crittenton Hospital Medical Center inside • Pre-Admission Guide • Day of Surgery follow us • Pain Control After Surgery • Recovery facebook.com/CrittentonHospital • twitter.com/GetCrittenton Dear Patient, Thank you for choosing Crittenton Hospital Medical Center for your upcoming procedure. We value your confidence and will do everything we can to make your visit here the best it can be. You can help us care for you by reviewing the information in this...»

«BQA Prevention and Indications for Treatment Steve Wikse, DVM College of Veterinay Medicine August 2004 Disorder: Abortions Prevention: There are many infectious causes of abortion including the viruses of infectious bovine rhinotracheitis (IBR) and bovine viral diarrhea (BVD), the bacteria of brucellosis, vibriosis and leptospirosis, and the protozoans of trichomoniasis and neosporosis. Prevention is directed against the specific causes of abortion and discussed under the specific diseases....»

«Responsible Office/Division: Document Page 1 of 11 Office of the Center Director Number: CDRHOCD015 Process Owner: Version Number: Effective Date: CDRH Associate Director for Policy 2.0 March 26, 2014 Center for Devices and Radiological Health Standard Operating Procedure (SOP) Level 1, Immediately in Effect Guidance Documents on Premarket Data Issues TABLE OF CONTENTS: A. Purpose B. Background C. Premarket IIE Document Procedures D. Effective Date E. Appendices A. PURPOSE This document...»

«THE IMPACT OF DIABETIC FOOT ULCER ON HEALTH RELATED QUALITY OF LIFE (HRQL) AND EMPLOYMENT AMONG RURAL DIABETIC POPULATION IN SOUTH KERALA Sithara S Pillai Dissertation submitted in partial fulfillment of the requirement for the award of the degree of Master of Public Health Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology Thiruvananthapuram, Kerala, India October 2012 Acknowledgments I am grateful to God Almighty for giving me...»

«The illusion of agency : The influence of the agency of an artificial agent on its persuasive power Midden, C.J.H.; Ham, J.R.C.Published in: Persuasive 2012: Design for Health and Safety. The 7th International conference on persuasive technology, 6-8 June 2012, Linkoping, Sweden Published: 01/01/2012 Document Version Publisher’s PDF, also known as Version of Record (includes final page, issue and volume numbers) Please check the document version of this publication: • A submitted manuscript...»

«Lausanne World Pulse, P.O. Box 794, Wheaton, Illinois, USA, 60187 Email: info@lausanneworldpulse.com A free, monthly online publication that provides you with evangelism and mission news and information. March 2009 PUBLISHER’S MEMO Authenticity in the Christian Life? By Naomi Frizzell In this month’s issue of Lausanne World Pulse, author Nina Gunter asks the hard question, “Is heart impurity threatening our lives?” Drawing a parallel between having a healthy heart physically and having...»

«Basic Plan Preferred Provider Organization Evidence of Coverage Effective January 1, 2016 – December 31, 2016 A Self-Funded Plan Administered Under the Public Employees’ Medical & Hospital Care Act (PEMHCA) HOW TO REACH US Important: For all members outside of the United States, contact the operator in the country you are in to assist you in making a toll-free number call. CUSTOMER SERVICE For information regarding Protected Health Information: For medical claims status, claim forms,...»

«101 USES FOR THE YOUNG LIVING® THIEVES® PRODUCTS Welcome to the Wonderful World of Thieves® Thieves® Oil Blend was created based on research of a group of 15th century thieves in France who protected themselves by rubbing themselves with cloves, rosemary, and other aromatics while robbing plague victims. This Young Living proprietary blend was university tested and found to be highly effective in supporting the immune system and good health. This proprietary blend has also been documented...»

«Immunosuppressive Myeloid Cells in Breast Cancer and Sepsis Bergenfelz, Caroline Published: 01/01/2014 Link to publication Citation for published version (APA): Bergenfelz, C. (2014). Immunosuppressive Myeloid Cells in Breast Cancer and Sepsis Department of Laboratory Medicine, Lund University General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing...»

«Solvent Impregnated Resins (SIRs) for the recovery of low concentration ethers and phenols from water Burghoff, B.DOI: 10.6100/IR640709 Published: 01/01/2009 Document Version Publisher’s PDF, also known as Version of Record (includes final page, issue and volume numbers) Please check the document version of this publication: • A submitted manuscript is the author’s version of the article upon submission and before peer-review. There can be important differences between the submitted...»

<<  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.