Page 14 - Benefits Enrollments Guide - Hospice of WS

Voluntary Vision Benefits

Group# HPCCWINS01

Community Eye Care
Voluntary Vision
Non-network
Network Provider
Provider
Copays:
Eye Exam $10 see below

Materials $25 see below

Frequency of Services:

Eye Exam Once per 12 Months

Lenses Once per 12 Months

Frames Once per 12 Months

Materials Benefits:

Single Vision The member submits
$130 allowance;
Bifocal Lenses a claim to CEC & is
members who exceed
Trifocal Lenses allowance are eligible reimbursed for the

Lenticular Lenses for 20% discount on cost of the exam and

Frames glasses and 10% eyewear, minus the

Elective Contact Lenses (Professional discount on contact copay, up to the
Fees & Materials) amount of their
lenses when visiting
allowance. There is no
Medically Necessary Contact Lenses most CEC network out-of-network

(Professional Fees & Materials) providers penalty.

How to Use the Benefit:

1. Select a provider from the CEC provider network (www.cecvision.com) or call 888-254-
4290
2. Call the provider to make an appointment & let them know you have CEC coverage
3. See the doctor and select your eyewear

Disability Benefits

Group# 405206

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