Opticare of Utah vision plans are guaranteed issue; no underwriting is required.
Opticare of Utah covers routine, non-medical eye examinations.
Anything not specifically listed on the benefit outline of your selected plan
is not a covered benefit.
Each individual insured and/or dependent(s) is allowed one exam and choice of
one full benefit per year: Glasses or Contacts.
Some prescription frames cannot be discounted by manufacturer's contract, such
as Beausoleil, Face a Face and OSA and Robi. Visit with an Opticare of Utah provider
for details.
After you obtain your primary benefit, you may purchase other merchandise at
discounts offered by the providers
Discounts on non-prescription merchandise are available. There are some limitations
by
manufacturer’s contract (for example: Maui Jim, cannot be discounted).
Details available at provider locations.
Opticare of Utah Vision Plans are stand-alone benefits; there are no coordination
of benefits
with other insurance plans.
This policy is renewable annually but Opticare of Utah reserves the right to
raise monthly premiums
Opticare of Utah Vision Plans are a stand-alone benefits; there are no coordination
of benefits with other insurance plans.
Opticare of Utah reserves the right to cancel your coverage at any time the following
reasons: Nonpayment of premium, fraud or threatening behavior.
LASIK (laser eye surgery) is a discount from the surgeon’s regular charges
and is not a “covered” benefit.
Prices and availability of products and services at providers’ locations
are subject to change.
Multiple coverage for the same person is not allowed.
Any Item listed as a discount in the benefit outline above is a merchandise discount
only and not an insured benefit.
Optical options not listed above: Providers offer discounts on many items and
upgrades not specifically listed on this benefit outline. Call or visit providers
for full details or prices.
Refractive surgery - LASIK: LASIK surgery is not an insured benefit, this is
a discount only. $100 off regular price. Surgery provided Physicians Laser Center,
Salt Lake City, UT. All screening, evaluation, pre & post operative care
provided by Standard Optical.
Reimbursement Procedures
If a location is not specifically listed as an approved network provider on
this brochure or on our website , www.opticareofutah.com, the location is
NOT an approved network provider.
Benefits are different through approved network providers and through non-approved
out-of-network providers.
Before you make any appointments you must be aware of your benefits.
Opticare of Utah will reimburse your billed charges minus co-payments or percentage
discount.
To obtain out-of-network benefits you may go to any provider of your choice,
pay for all services and merchandise, then send your receipt to Opticare of
Utah for reimbursement.
You must include the following information when submitting your receipt: Original
receipt (no photocopies) name, social security number, address and phone number
of the primary insured, date of service and name, social security number of
the person receiving benefits. You may download a claim form from www.opticareofutah.com
ot call us and have one sent to you.
Your claim will be reimbursed within 30 days after Opticare of Utah receives
your claim with all information and receipt.
If you dispute a claim, grievance procedures are as follows: a written complain
may be made to Opticare of Utah 1901 West Parkway Blvd. Salt Lake City, UT
84119. the written complaint may be presented on a grievance statement form
which is available to every enrollee at the time of enrollment, by request.
An Opticare of Utah officer shall review each grievance statement from presented
to Opticare within 15 days of it’s receipt. The Opticare officer shall
contact the complainant and attempt to resolve the complaint through informal
discussions, consultations, or conference and shall notify the complainant
in writing of the resolution of the complaint within 30 days following it’s
receipt. Opticare shall send the to complainant along with the notice of resolution,
a notice that the complainant may appeal Opticare’s resolution of the
complaint by filing a complaint with the Utah State Insurance Commissioner.
Extension of coverage, Opticare provides each enrollee the right to a conversion
policy and/or extend coverage to a contract. If a voluntary or group policy
is terminated, the enrollee may convert this into an individual policy within
30 days of termination.
Conformity of state law, Opticare of Utah, as a Utah Limited Health Plan, conforms
to all State Insurance laws and regulations.
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