Saturday, February 04, 2012 Search this site

Eye Doctor examining a patient
Vision Plans

Your bargaining or representation unit determines which vision plan you are eligible for. Refer to the table below to determine which plan you are eligible for. Click the plan name to jump to the schedule of benefits for that plan.

Eligible:

  • ElectedOffice
  • Management Employees (including Public Defenders)
  • Confidential Employees
  • Unrepresented Employees
  • LEMU Represented Employees
  • DDAA Represented Employees

Eligible:

  • SEIU Represented Employees
  • LIUNA Represented Employees
  • Public Safety Unit Employees

Medical Eye Services Vision Plan (MES)

Medical Eye Services (MES) provides a vision coverage option for employees represented by SEIU and LIUNA and employees in the RSA Public Safety Unit. You may choose from two plans: Plan 1—With Eye Exam and Eyewear or Plan 2—Eyewear Only. Both plans have no deductible and include discounts for contact lenses. Both MES plans allow you to choose care from in-network or out-of-network providers. When you receive care from in-network providers, the plan pays higher benefits and your out-of-pocket costs are lower.

For more information on how to use you MES Vision Plan, click here.

What's Covered?

The plan pays benefits and offers discounts for most vision care expenses you incur while covered under the plan, subject to the maximum benefit amounts (see below).

 

Medical Eye Services

Medical Eye Services

 
Plan 1 - With Eye Exam and Eyewear
Plan 2 - Eyewear Only

Benefit Durations

Exams
12 months
Not covered
Lenses
12 months
12 months
Frames
12 months
12 months

Contacts

  • Visually Necessary
  • Elective

Eye Examinations

 

12 months

12 months
12 months


100%

 

12 months

12 months
12 months


Not Covered

Eyeglass lenses & frames or contact lenses
100%
100%

Benefit Maximum

In-Network

Out-of-Network

In-Network

Out-of-Network

Eye Examinations

100%

Up to $60 for Ophthalmologist;
or
Up to $50 for Optometrist
Not covered

Eyeglass lenses or contact lenses:

Single vision lenses

Bifocal lenses

Trifocal lenses

Lenticular lenses

*Note: Specialty lenses are not included under this benefit.

 


100%

100%

100%

100%

 


100% up to $ 43

100% up to $ 60

100% up to $ 75

100% up to $120 for monofocal;
or
100% up to $200 for multifocal

 


100%

100%

100%

100%

 


100% up to $ 43

100% up to $ 60

100% up to $ 75

100% up to $120 for monofocal;
or
100% up to $200 for multifocal

Frames

100% up to $75

100% up to $40

100% up to $75

100% up to $40

Contacts (in lieu of frames & lenses)

Visually Necessary

 

Elective


100%

$100 allowance
if chosen in lieu of all other services


100% up to $250

$100 allowance
if chosen in lieu of all other services


100%

$100 allowance
if chosen in lieu of all other services


100% up to $250

$100 allowance
if chosen in lieu of all other services

Vision Service Plan (VSP)

Riverside County offers the Vision Service Plan (VSP) for employees who are Elected Officials, Management (including Public Defenders), Confidential, Unrepresented, DDAA and the Law Enforcement Management Unit. The County provides this plan to you at no cost. You do not need to enroll. The plan pays benefits and offers discounts for most vision care expenses you incur while covered by the plan, subject to the maximum amounts shown below.

Vision Service Plan

 

Benefit Durations

Exams
12 months
Lenses
24 months
Frames
24 months

Contacts

Visually Necessary

Elective

 

 

24 months

24 months

Percentage Payable
Eyeglass lenses & frames or contact lenses
100% after $20 copay

Benefit Maximum

In-Network

Out-of-Network

Eye Examinations

100%

100% up to $42

Eyeglass lenses or contact lenses:

Single vision lenses

Bifocal lenses

Trifocal lenses

Lenticular lenses

 

100%

100%

100%

100%

 

 

100% up to $40

100% up to $60

100% up to $80

100% up to $125

 

Frames

100% up to $115

100% up to $45

Contacts (in lieu of frames & lenses)

Visually Necessary

Elective

 

 

100%

$100 up to $105

 

 

100% up to $210

$100 up to $105

This information is provided for informational purposes only. Actual provisions of the plan will be provided on the certificate of coverage as part of the Summary Plan description.

 

 
 
VSP Out-of-Network Claims:
 
The VSP Out-of-Network Claim Form is for reimbursement when services are received from a provider other than a VSP Doctor.  Please complete an Out-of-Network claim form and mail it to the address on the form, along with a copy of your itemized receipt(s).  In order to process your claim, the following information must be included on the itemized receipt(s):
  • The name of the provider
  • The name of the patient
  • The date of service
  • A complete description of each service provided (Exam, Lens, Frame or Contacts)
  • The amount paid for each service
If you are coordinating benefits with another insurance carrier, VSP will need a complete copy of the Explanation of Benefits from your primary insurance carrier.  The Explanation of Benefits must indicate the service(s) received, as well as the amount paid, denied or applied to your deductible.  This information can be obtained from the provider.
 
In addition to the reimbursement claim form, the information contained on the itemized receipt is needed to ensure accurate and timely payment.  Your claim could be subject to denial if the requested documentation is not received.
 
If you need further assistance, please contact VSP Member Services at (800) 877-7195 (Monday through Friday, from 5 AM to 7 PM, Pacific Time).  You may also visit their website at www.vsp.com for additional information regarding your benefits.
  

 
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