EmblemHealth has a new partner in place to administer your vision benefits — EyeMed Vision Care with CPS Optical. EyeMed Vision Care with CPS Optical offer a comprehensive network including independent and retail providers, world-class customer service and exceptional value for you and your dependents through additional discounts and savings.
You don’t need to do anything as a result of this change. EmblemHealth, EyeMed and CPS are working to make sure this transition is seamless, so when your group’s new vision plan starts on January 1, 2017, you will have everything you need to receive your vision care.
Effective January 1, 2017, your current vision benefits will change as shown below, once every 12 months. You will receive your new DC37 Med Team ID card during December, 2016. No other benefits are changing under the DC37 Med Team program.
When you get your care from an optometrist in network, you are covered for:
- Examinations. You are covered for one routine eye examination to check if you need corrective lenses. You are not covered for medical treatment of eye disease or injury under this benefit, but you are covered for medical treatment under your regular insurance benefit. Your co-pay will be $0.
- Eyeglasses: One pair of glasses which includes the lenses and the frame.
- Spectacle Lenses: The fitting and dispensing of one pair of spectacle lenses.
- Standard spectacle lenses include:
- Glass or plastic lenses
- Single vision, bifocal or trifocal lenses
- Tinting of lenses
- Non-standard lens options include:
- Standard progressive lenses: $50 copay
- Premium progressive lenses: $50 copay plus 80% of retail minus $120
- Ultra Violet treatment: $15 copay
- Standard plastic scratch coating: $15 copay
- Standard polycarbonate lenses: $40 copay ($0 copay for children under 19)
- Standard anti-reflective coating: $45 copay
- Frames: We will pay an allowance of up to $130 for one frame. If you choose a frame that costs more than this allowance, you pay the difference in cost to the provider.
- Contact Lenses: EmblemHealth will not cover both eyeglasses and contact lenses in the same benefit cycle, but you can get contact lenses instead of glasses during any given cycle. Once contact lenses have been selected and fitted, they may not be exchanged for eyeglasses. You are covered for the fit and follow up of standard contact lenses. You are not covered for the fit and follow up of premium contact lenses. Your contact lenses are covered at 100% up to your allowance of $130. If you choose contact lenses that cost more than your allowance, you pay the difference to the provider.
Keep in mind, that you are not covered for services received from a provider who is not a Participating Vision Provider.