Below are answers to commonly asked member questions. Please keep in mind that your Evidence of Coverage (EOC) or Certificate of Insurance defines the specific benefits of your plan.

VISION FAQs
Q18: How do I receive benefits under my vision plan?
Q19: How do I get a vision exam if I'm on the Flexible Choice 2 (Materials Only) Plan?
Q20: How long do I have to wait to get an appointment with my vision care provider?
Q21: What is the procedure for emergency visits?
Q22: Does my plan cover contact lenses?
Q23: What is the difference between "medically necessary" and "cosmetic" contact lenses?
Q24: Can I get glasses and contacts?
Q25: Do the plans limit the kind of eyeglass frames I can choose?
Q26: What about extras, such as anti-scratch coating, oversize lenses and special tints?
Q27: Does your provider list include all types of eye care professionals? What's the difference between an ophthalmologist, an optician and an optometrist?

VISION FAQs

Q18: How do I receive benefits under my vision plan?
When you are ready to make an appointment with a Vision provider, select a participating provider from the directory supplied. You may also refer to our DocSearch on our website. Remember to identify yourself as a Health Net Vision member when you make your appointment. Indemnity vision plan members may choose to see providers not listed in the directory, but you may be subject to additional out-of-pocket costs.

Q19: How do I get a vision exam if I'm on the Flexible Choice 2 (Materials Only) Plan?
Vision exams are not covered under Materials Only Plans. You must get your vision exam through your medical plan, or from your vision care provider. Once you receive your new eyewear prescription, you can use your Flexible Choice 2 Plan to obtain your prescription eyewear benefits from a participating Vision provider.

Q20: How long do I have to wait to get an appointment with my vision care provider?
You should be able to schedule a routine appointment (unless you are requesting a specific time or day of the week) within two to three weeks. Emergency visits should be scheduled within 24 hours.

Q21: What is the procedure for emergency visits?
A contracted vision provider shall provide services for urgent or unexpected conditions that occur after-hours. Occasionally, a member loses or breaks their eyewear or contact lenses when Participating Vision Providers in the area are not reasonably accessible or when the Member is traveling outside of the Vision Plan's Service Area. In the event you require such Emergency Vision Care, you may seek the services of any vision provider. Typically, you must file a claim form within 60 calendar days from the date expenses are incurred to receive reimbursement for any out-of-pocket expenses incurred in an emergency. The member will be responsible for any applicable copayments and any amounts in excess of the maximum emergency services allowances of the plan. Please see your Evidence of Coverage booklet or Certificate of Insurance for specific plan details.

Q22: Does my plan cover contact lenses?
All Health Net vision plans offer a contact lens allowance that can be used instead of the frame and lens benefits. However, you may be responsible for charges that exceed your plan's benefit allowance, such as a provider's fee for fitting your contact lenses.

Q23: What is the difference between "medically necessary" and "cosmetic" contact lenses?
"Medically necessary" contacts are a covered benefit for members that have one of four medical conditions: (1) Aphakia resulting from cataract surgery or trauma; (2) Visual acuity problems that cannot be corrected with spectacles to 20/70 or better in the better eye with spectacle lenses; (3) Anisometropia of 4 diopters or more, where contact lens correction will improve visual acuity to 20/70 or better in the poorer eye; (4) Keratoconus. Most standard contact lens purchases are classified as "cosmetic" or "elective" because the patient has a choice between wearing contacts or glasses. Please note that the allowances for cosmetic or elective contact lenses are different from allowances for medically necessary lenses. Our plans offer generous allowances for both types of contact lenses.

Q24: Can I get glasses and contacts?
This will vary by your specific plan coverage. In most cases, you may decide to use your benefit towards contacts instead of frames and lenses. Please refer to your Evidence of coverage booklet for specific plan allowances.

Q25: Do the plans limit the kind of eyeglass frames I can choose?
Typically, our vision plans offer a frame allowance. If you wish to minimize your out-of-pocket costs, choose a frame style that is within your plan's frame allowance; the frame will then be fully covered by the Plan. If you choose eyeglass frames that are more expensive than the frame allowance, you will be responsible for an additional cost. There are many plans and variations of this allowance so please refer to your Evidence of Coverage booklet for the specific benefit details of your plan.

Q26: Does your provider list include all types of eye care professionals? What's the difference between an ophthalmologist, an optician and an optometrist?
The network of vision care providers includes optometrists (ODs), opticians (RDOs), and ophthalmologists (MD/DOs). All providers are carefully credentialed before they are admitted to our network. See below for a description of each. Optometrists (ODs): Doctors of Optometry are primary health care providers who examine, diagnose, treat and manage conditions and some diseases of the human eye and visual system. Optometrists are qualified to provide comprehensive eye examinations. Ophthalmologists (MD or DO): Physicians who specialize in the treatment of diseases and disorders of the eye. Ophthalmologists are qualified to provide comprehensive eye examinations, treat and manage conditions and diseases of the human eye and visual system, and perform eye surgery.

Registered Dispensing Optician (RDO): Opticians, registered with the state Medical Board, who sell, dispense and/or fabricate eyeglasses in accordance with the prescriptions of optometrists and ophthalmologists. Opticians are not qualified to provide eye examinations.

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