Vision Care Plan

This program is sponsored by the State of North Carolina as part of the NCFlex benefits program. Superior Vision Services (SVS) is the plan administrator for the State.

The Vision Care Plan offers the option of full coverage for vision care services and materials from a network of more than 1,800 vision providers that includes ophthalmologists, optometrists and optical companies. Providers in the SVS network also include many optical chains and overnight service locations throughout the state. If your vision care is not provided by the SVS network, you or your provider can contact SVS with the provider's name, address and telephone number to begin the provider nomination process.

All permanent part-time (20-29 hours per week) and full-time (30 or more hours per week) employees can elect coverage for themselves, their spouse and their unmarried dependent children up to age 19 (or up to age 26 if a full-time student).

Premiums for this plan are paid solely through employee contribution as a pre-tax payroll deduction.

Coverage Option	Plan 1 Exam & Materials	Plan 2 Materials Only	Plan 3 Enhanced Exam & Materials
Employee only	$6.84	$5.14	$9.98
Employee and Family	$17.37	$12.72	$25.10

If you are paid on a monthly basis, the full monthly contribution is deducted from each paycheck. If you are paid on a biweekly basis, half of your monthly contribution is deducted from the first two paychecks of the month.

You must enroll within 30 days of your hire date or a qualifying family status change, or during annual enrollment. You may be subject to certain waiting periods if you are a late enrollee.

Summary of In-Network Benefits

Benefit	Plan 1 Exam & Materials	Plan 2 Materials Only	Plan 3 Enhanced Exam & Materials
Vision Exam	$20 copay	n/a	$20 copay
Contact Lens Exam/Fitting Copay	$25 copay standard; covered in full Specialty: up to $50	$25 copay standard; covered in full Specialty: up to $50	$25 copay standard; covered in full Specialty: up to $50
Frames	Up to $100 retail plus 20% discount on overages	Up to $100 retail plus 20% discount on overages	Up to $150 retail plus 20% discount on overages
Frequency of Services
Vision Exam	12 months	12 months	12 months
Lenses	12 months	12 months	12 months
Frames	24 months	24 months	12 months
Contact Lenses	12 months	12 months	12 months

For details on all vision plan options and benefits, including in and out of network benefits, refer to the NCFlex Benefits Highlight book.

Note: If you are enrolled in one of the PPO health plans, remember that your PPO plan provides for in-network coverage for one routine comprehensive eye exam per benefit period, subject to a copay amount. Also, the vision plan does not coordinate benefits with the PPO plans.

If you use in-network providers, you pay the provider directly for any appropriate co-payments or charges above your covered benefits. The in-network provider handles all claims and paperwork, so you don't have to.

When using a non-network provider, you must pay in full and submit a claim with an itemized bill for reimbursement.

Vision claims can be mailed to:

Superior Vision Services, Inc.
Attn: Claims Processing
P.O. Box 967
Rancho Cordova, CA 95741
Phone: 800-507-3800
Fax: 916-852-2277

If you have questions about the benefits offered through this plan, please contact your department's Benefit Specialist.

If you have questions about processing a claim, or have experienced problems in receiving a reimbursement, contact Superior Vision Services at (800) 507-3800.

Benefits Services in the Office of Human Resources is responsible for reviewing and revising as needed the content of this page.

The information contained in this website is not a contract and is subject to change. It should be understood that explanations in this summary cannot alter, modify or otherwise change the controlling legal documents or general statutes in any way, nor can any right accrue by reason of any inclusion or omission of any statement in this presentation. The most current information will always be found at the benefit carriers home page. The Office of Human Resources designs these pages to be as current as possible; however, the benefit information provided herein is always subject to change.