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Vision Insurance
Always check with your provider's office that the patient is covered. In addition, always verify coverage and costs as details of the plan change periodically.
Please direct all questions to Maura Sesslar directly at (937) 853-5844 or msesslar@usebsg.com and cc Michael Leuci at mleuci@usebsg.com.
Effective March 1, 2020
Anthem Blue Cross and Blue Shield (Anthem)
www.anthembluecross.com - log on, click on My Plan -> Benefits -> View Plan under Vision heading
1-866-723-0515
Mobile app: Sydney Health
Plan name: Blue View Vision
Plan/Group number: 300433
Group name: Valhalla Teachers Association Benefit Fund
The plan year is January 1 - December 31
Each family member enrolled will receive their own card. Social security numbers will no longer be accepted.
*Log in to your online account to access all plan information*
Documents:
Forms:
Out of Network Claim Form (can be filled out electronically by logging in to your account)
Helpful information:
COVID-19 FAQs (VISION only)
International vision care services (requires a log in)
Medical vs Vision coverage
When you receive your card in the mail, the letter attached will state, "You’re covered by Empire BlueCross BlueShield, and this new ID card lets everyone know it. Use it whenever you receive health care. Make sure you destroy your old ID card. Using it could affect how we work on your claims." Disregard this message and DO NOT throw away your Empire Plan medical insurance plan card.
When you log in to your online account, you will see some of your medical information, if you are on our health insurance plan. This is because The Empire Plan is broken down into sub categories, Blue Cross Blue Shield (BCBS) being one of them. If you go to Forms, you will see forms for dental, vision, medical, pharmacy, etc. These are all the forms that BCBS offers, not necessary all of the forms that apply to your coverage. Make sure you are getting your forms from the correct insurance companies.
Eligibility
Employees and their spouse or domestic partner are covered.
Dependent children are covered up to the age of 19 or if a full time student, age 23.
You are responsible for notifying your trustee two months before your child is no longer a full time student (graduates or does not register for the next semester)
After being removed from the plan, if your child enrolls in a full-time program, he/she can be reinstated by contacting your trustee.
Exclusions
No benefits will be paid for services or materials connected with or charges arising from:
orthoptic or vision training, subnormal vision aids and any associated supplemental testing; Aniseikonia lenses;
medical and/or surgical treatment of the eye, eyes or supporting structures;
services provided as a result of any Workers' Compensation law, or similar legislation, or required by any governmental agency or program whether federal, state or subdivisions thereof;
any Vision Examination, or any corrective eyewear required by a Policyholder as a condition of employment; safety eyewear;
plano (non-prescription) lenses;
non-prescription sunglasses;
two pair of glasses in lieu of bifocals;
services or materials provided by any other group benefit plan providing vision care;
services rendered after the date an Insured Person ceases to be covered under the Policy, except when Vision Materials ordered before coverage ended are delivered, and the services rendered to the
Insured Person are within 31 days from the date of such order; or
lost or broken lenses, frames, glasses, or contact lenses will not be replaced except in the next Benefit Frequency when Vision Materials would next become available.
Loss of coverage for the member or any dependent
Reasons include but are not limited to: unpaid leave of absence, child ages out, divorce, resignation, retirement, etc.
In accordance with the provisions of the Consolidated Omnibus Budget Reconciliation Act (COBRA), should your coverage for vision care benefits stop, you and your eligible dependent may be able to continue your vision care benefits pursuant to COBRA.
If your vision care benefits coverage terminates, you will then receive a notice in the mail from Titan, a Third Party Administrator with information and costs to continue your coverage.
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