85 Nice to see you Hello, State of North Carolina NCFlex Welcome - - PowerPoint PPT Presentation

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Nice to see you

State of North Carolina NCFlex

Hello,

Welcome to EyeMed

EyeMed 101

Confidential Notice: This document contains privileged information and is for the sole use of the intended recipient(s). Disclosure or distribution to and review or use by any unauthorized Luxottica EyeMed associate(s) and external parties is prohibited.

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• What’s included within your vision benefits
• How EyeMed makes it easy for members
• Who to call for specific issues
• Why vision health is important
• What you need to know

The comprehensive eye exam

Confidential Notice: This document contains privileged information and is for the sole use of the intended recipient(s). Disclosure or distribution to and review or use by any unauthorized Luxottica EyeMed associate(s) and external parties is prohibited.

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The exam includes:

• Dilation (if needed)
• Case history
• Patient observation
• Clinical diagnostic testing, including binocular function
• Refractive status
• Color vision testing
• Stereopsis testing
• Assessment, diagnosis and treatment plan

Our providers conduct comprehensive eye examinations to diagnose or detect existing conditions of the eye and vision system. Our standards follow those established by the American Academy of Ophthalmology in the “Preferred Practice Patterns” & the American Optometric Association in Clinical Practice Guidelines.

When should a member visit their medical doctor?

For any eye disease or serious condition that may be found during their eye exam.

Confidential Notice: This document contains privileged information and is for the sole use of the intended recipient(s). Disclosure or distribution to and review or use by any unauthorized Luxottica EyeMed associate(s) and external parties is prohibited.

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In-Network Schedule Core Basic Enhanced

Exam Copay Exam $20 $20 $20 Standard Contact Lens Fit/Follow retail price $20 $20 Premium Contact Lens Fit/Follow retail price $20 Copay, 10% off retail price, then apply $55 allowance $20 Copay, 10% off retail price, then apply $55 allowance Frame 35% off retail $125 Allowance, 20% off balance over $125

$200 Allowance, 20% off balance

• ver $200

Lens Copay Single $50 $0 $0 Bifocal $50 $0 $0 Trifocal $105 $0 $0 Standard Progressives $135 $50 $50 Premium Progressives 20% off retail Tier 1 $70 Copay Tier 2 $80 Copay Tier 3 $95 Copay Tier 4 $50 Copay, 20% off retail less $120 Allowance Tier 1 $70 Copay Tier 2 $80 Copay Tier 3 $95 Copay Tier 4 $50 Copay, 20% off retail less $120 Allowance Lens Options UV $15 $15 $15 Tint $15 $15 $15 Standard Scratch $15 $13 $13 Polycarbonate $40 $40 $40 Standard Anti-Reflective $45 $45 $45 Premium Anti-Reflective 20% off retail Tier 1 $57 Copay Tier 2 $68 Copay Tier 3 20% off retail Tier 1 $57 Copay Tier 2 $68 Copay Tier 3 20% off retail Contact Lens Conventional 15% off retail price Disposable 0% off retail price $120 Allowance

$175 Allowance

Frequency Exam Once every 12 months Once every 12 months Once every 12 months Lenses or Contacts Unlimited Once every 12 months Once every 12 months Frame Unlimited Once every 24 months Once every 12 months

Vision Benefits Overview

Understanding the lens benefit

Progressive lenses Other lens options

• Offer a full range of vision

correction

• Free of the distinct line often

seen on bifocal and trifocal lenses

• Seamless progression of

corrective strength:

− Look up for help seeing distances − Look straight ahead for immediate

• bjects

− Look down to see close-up items

• All options fall within two types:

− Standard − Premium

• Fixed pricing and discounts on

additional lens options

• Members can opt for standard

lenses or lenses with multiple add-ons

• Coverage for things like

polycarbonate, anti/reflective, tint, UV, etc.

Standard lenses

• Single vision
• Prescribed for those who need

correction for one field of vision (either far away OR up-close)

• Multifocal
• Lenses that contain correction

for two or more fields of vision

• Include bifocal and trifocal

lenses

More on progressive lenses

Features Customization Cost Standard

• General purpose
• Traditionally processed

Premium Tier I

• Softer design
• More reading comfort
• Traditionally processed

Premium Tier II

• Increased adaptation
• Traditionally processed

Premium Tier III

• Improved adaptation
• Increased clarity at any

distance

• Digitally processed

Premium Tier IV

• Sharpest level of vision

based on design and personal measurements

• Digitally processed

Confidential Notice: This document contains privileged information and is for the sole use of the intended recipient(s). Disclosure or distribution to and review or use by any unauthorized Luxottica EyeMed associate(s) and external parties is prohibited.

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More details on how your benefits work

Your frequency is based on: Calendar Year

So, if a member receives an exam today, they are eligible again 1/1/2018. Past services will not be carried over. All benefits will reset effective 1/1/2018.

Contacts are in lieu of lenses only

That means members are entitled to a full pair of glasses (frame & lenses) OR contacts and frames (members would then receive a 20% discount on their lenses)

40% additional pair discount – the best, most flexible in the industry 15% off LASIK 40% off hearing exams and discounted, set pricing on hearing aids 20% off any remaining frame balance 15% off any balance over the conventional contact lens allowance 20% off any non-covered item

Extra discounts for members

Confidential Notice: This document contains privileged information and is for the sole use of the intended recipient(s). Disclosure or distribution to and review or use by any unauthorized Luxottica EyeMed associate(s) and external parties is prohibited.

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*In-network only. May not be available on all plans. Confirm if your provides this option.

Confidential Notice: This document contains privileged information and is for the sole use of the intended recipient(s). Disclosure or distribution to and review or use by any unauthorized Luxottica EyeMed associate(s) and external parties is prohibited.

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And online:

Your network: INSIGHT + WalMart

99,000

Providers nationally

3,200

Providers in NC

• Fully integrated with your benefits
• Huge selection of frames, lenses

and contacts

• Free shipping
• Award-winning 3D try-on

technology at Glasses.com

Confidential Notice: This document contains privileged information and is for the sole use of the intended recipient(s). Disclosure or distribution to and review or use by any unauthorized Luxottica EyeMed associate(s) and external parties is prohibited.

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Locating a provider

Go to the vision plan section at NCFLEX.org There will be a direct link to the provider locator Download and use the EyeMed Members App (available for iPhone and Android) Check the listing of the closest providers on the Welcome Packet Call the Customer Care Center

Available 9/1/2017

State of North Carolina Toll Free Number: 866-248-1939

Confidential Notice: This document contains privileged information and is for the sole use of the intended recipient(s). Disclosure or distribution to and review or use by any unauthorized Luxottica EyeMed associate(s) and external parties is prohibited.

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• View benefits and eligibility status*
• Download ID cards and EOBs
• Locate a provider
• Schedule your eye exam (available at

many provider locations)

• Download OON claim form
• Check claim status
• View vision wellness information
• Review LASIK information

Member Website Features

*NOTE: due to HIPAA regulations, members will not be able to view dependents over the age of 18

Members will access the NC Flex custom website through the link at NCFLEX.org or by visiting www.eyemedvisioncare.com/NCFlexoe

9/30/2017: Provider locator and OE information available 1/1/2018: Members may register to:

Confidential Notice: This document contains privileged information and is for the sole use of the intended recipient(s). Disclosure or distribution to and review or use by any unauthorized Luxottica EyeMed associate(s) and external parties is prohibited.

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• Ability to view ID card
• Benefit details
• Provider locations with directions

EyeMed Members App

Downloa d it today:

• Exam and contact refill reminders
• Ability to load and save prescription
• View additional special offers

Available for Apple devices on the App Store and through Google Play for Android

• Provider Locator
• Plan Benefits
• ID Cards
• Claim Form
• Claim Status
• Laser Surgery information

They can self-serve with our IVR:

Simply state "Agent" or “Customer Service” in order to be directly routed to a live representative

Confidential Notice: This document contains privileged information and is for the sole use of the intended recipient(s). Disclosure or distribution to and review or use by any unauthorized Luxottica EyeMed associate(s) and external parties is prohibited.

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Live reps available:

Monday – Saturday: 7:30 – 11 p.m. EST Sunday: 11 – 8 p.m. EST

Ongoing member support with

• ur Customer Care Center

866-248-1939

Confidential Notice: This document contains privileged information and is for the sole use of the intended recipient(s). Disclosure or distribution to and review or use by any unauthorized Luxottica EyeMed associate(s) and external parties is prohibited.

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The claims process

In-network Out-of-network

• 1. Member locates a provider and

schedules appointment

• 2. When they arrive, they identify

themselves as an EyeMed member

• 3. They pay any applicable co-pays at

the time of service

• 4. That’s it – no paperwork. Network

providers always file the claim

• 5. Members can view their EOB through

eyemed.com

• 1. Member downloads our OON claim

form from eyemed.com

• 2. They receive and pay for services at

their choice of provider

• 3. They’ll complete the OON claim form

and submit with an itemized receipt

• 4. That’s it – we’ll mail them a

reimbursement check and their EOB

Finally, let’s just talk

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Any questions?

Learn more at eyemed.com

PPT-1608-C-573