elcome to OptiCare Vision Plans FAQ page.

GENERAL QUESTIONS

Is it necessary that I give OptiCare Managed Vision, Inc. the name of the provider that I have selected to receive my vision care services?
No. Unlike some benefit plans, it is not necessary to pre-select your provider or to give OptiCare Managed Vision, Inc. the name of your provider prior to receiving services. You need only to select your provider, make your appointment, and identify yourself to the provider as an OptiCare Vision Plan member.

Can I get my eye examination at one location and the materials at another?
Yes. However, each provider will need to make a call to OptiCare Vision Plan Member Services to verify your eligibility.

Do I need to obtain authorization prior to receiving services?
There are no pre-authorization requirements prior to receiving services.

What do I do if there are no in-network providers close to me?
You may select a non-network provider and use your out-of-network benefits. If you wish to nominate a provider to the Panel, call (800) 840-7032 and give the Provider Relations Department representative the name, address and telephone number of the provider you would like to see in the network or you can FAX this information to (252) 451-2182. Your nominated provider will be placed into consideration for panel membership.

Does the OptiCare Vision Plan have a Web Site on the Internet?
Yes, you will find your plan design, eligible dependent coverage, instructions on “how to use the plan,” current provider location listings, out-of-network claim forms, etcetera. http://www.opticarevisionplans.com

HOW TO USE YOUR IN-NETWORK BENEFITS

Do I need to show an I.D. card to the provider to receive my benefits?
Your OptiCare Vision Plan ID card identifies you as a member covered by an OptiCare vision plan and identifies the plan under which you are covered. It is recommended that you show the provider your I.D. card. However, you may receive services without the I.D. card. Simply identify yourself as an OptiCare Vision Plan member with proper personal identification, social security number and the name of your employer. The provider will contact OptiCare to verify your eligibility and benefits.

Do my covered dependents need to have I.D. cards?
No. To use the OptiCare Vision Plan benefits it is not necessary for dependents to have personal I.D. cards. However, for member convenience, OptiCare Managed Vision, Inc. does issue an individual personal I.D. card to each covered member.

Do I need to bring any forms with me to the provider?
There are no forms required for in-network services.

Under what situations do I make payment directly to the in-network provider?
You pay the in-network provider for the following: Your plan co-pay(s); any charges over and above your plan allowance; any service or item that is listed as non-covered by your routine vision plan.

HOW TO USE YOUR OUT-OF-NETWORK BENEFITS

How do I make use of my benefit when using a non-network provider?
First, see your provider and pay for your examination and/or materials. Second, complete the OptiCare Managed Vision, Inc. Out-of-Network claim form. Remember to sign and date the form. Third, attach the provider’s “super bill” (or any other itemized billing or receipt, describing all of the services and materials that were provided to you) to the out-of-network claim form and Mail to: OptiCare Managed Vision, Inc., OON, and P.O. Box 7548, Rocky Mount, NC 27804. You will be reimbursed according to the schedule of allowances for non-network services.

Where do I get an Out-of-Network Claim form?
An Out-of-Network claim form is included in your “member kit” or may be obtained from the OptiCare Vision Plans website. Download a copy now.

Can I use the Out-of-Network form to submit services that I receive from an in-network provider?
No. In-network providers will submit the claim for you. This form is only to be utilized for services received from an out-of-network provider.

How does my Out-of-Network Benefit work?
Exams are reimbursed at up to $38.50 and frames, ophthalmic lenses, contact lenses and contact lens fitting fees are reimbursed according to the schedule on the first page of member brochures and group proposals.