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State of Texas Vision

ERS will offer a new vision plan beginning Sept. 1, 2016. This new benefit option, called State of Texas Vision, will be available to employees, retirees and their eligible dependents. 

On May 17, the ERS Board of Trustees approved Superior Vision Inc. to administer the self-funded plan.
Whether or not you sign up for State of Texas Vision, your health plan benefits will not change. You can compare co-pays for each plan with the Vision Comparison Chart.

For disease or trauma to the eye, you will need to see a medical doctor. Consult the Master Benefits Plan Document of your health plan for details.
Go to State of Texas Vision website and use the Locate a Provider tool. It lists all of the providers within the Superior National network and includes the services that each offers. The Superior Vision network is the largest in Texas. Network providers are available in all 50 states. 

If your doctor is not listed, you can nominate a provider by submitting the nomination form on the State of Texas Vision website. The credentialing process can take up to 60 days.
If you see an out-of-network provider you will be responsible for submitting a Member Reimbursement Claim Form—along with a detailed receipt—to receive the out-of-network reimbursement outlined in your Member Handbook.

You can nominate a provider who is not currently in the Superior Vision network by submitting the nomination form on the State of Texas Vision website. The credentialing process can take up to 60 days.
Network providers are available in all 50 states. You can access your vision plan using any network provider in the “Superior National” network. Visit the State of Texas Vision website for a list of network providers.
Employees and non-Medicare eligible retirees may enroll during Summer Enrollment for coverage. Outside of Summer Enrollment, you can enroll within 31 days of employment changes or with a qualifying life event (QLE).

Medicare-eligible retirees can elect vision if they have a valid qualifying life event or during Fall Enrollment.
Dependents are in the same enrollment period as the ERS participant through whom they have coverage. You must enroll in State of Texas Vision in order to enroll your dependents in coverage. 
There is no waiting period. Coverage begins on September 1 for participants who sign up during Summer Enrollment or during the first month of employment.
If you sign up during Summer Enrollment, you will receive a packet in late August that includes this information. If you do not receive your packet, call customer services at (877) 396-4128.

After September 1, 2016, you can view and download your ID card by logging on to the State of Texas Vision website. Materials are being added to the site as they are available. 

An overview of your benefits is available in the Vision Comparison handout. Your Member Handbook provides detailed information on the services the plan covers. You can review the member handbook on the State of Texas Vision website for benefits details.

Yes. You choose how you would like to use your benefit. You do not need to see the same provider for exam and materials. You can use online opportunities as well.
In-network retailers include: 
  • LensCrafters
  • Pearle Vision
  • Target Optical
  • Sears Optical 
  • Vision Works
  • Walmart Vision Center
  • Sam's Club Optical
  • Costco Optical 
Dilation is not always required, but when the doctor recommends it, it is a covered part of the eye exam.

Some doctors have high-tech equipment (photos of the retina) which do not require dilation (dilation-free and digital retinal exam). This is not a covered benefit and you will be required to pay for these services. See the Member Handbook for details.
No. For glaucoma treatment and other diseases of the eye, you will need to see a medical doctor. Consult the Master Benefits Plan Document of your health plan.
Plan benefits include a $150 allowance to pay for either eyeglasses or contact lenses. This allowance cannot pay for both glasses and contact lenses. You are responsible for any additional costs above the $150 allowance. Network providers offer discounts for eyeglass lenses, coatings and tinting. Online distributors offer additional discounts. Details are available in the Member Handbook.
If your vision can be corrected with glasses and you make a choice to have contact lenses in lieu of glasses, that is a cosmetic election. Patients with certain medical conditions cannot have their vision corrected with glasses. They must wear contacts. This is categorized as medically necessary lenses. Contact Superior Vision for specifics.
You can use the $150 allowance toward the purchase of prescription sunglasses. The $150 allowance is not available for non-prescription sunglasses. The cost of tinting will be an additional charge. Add on premiums (scratch resistant, coatings, tinting) information is available in your member handbook.
If you use a network provider, you do not need to file a claim. The provider will submit the claim for you.

If you use a non-network provider, you must file a claim for reimbursement. Once Superior Vision receives the claim, reimbursements are generally mailed within 10 business days to the address you have on file with ERS.
You are responsible for paying all co-pays, non-covered items, and/or any amount over the benefit allowance. You are responsible for paying your provider at the time service.
LASIK is not a covered benefit but some providers offer LASIK discounts to State of Texas Vision participants.
To file a complaint against a provider, contact Superior Vision at (877) 396-4128 (TDD – 711) toll-free.
If your claim is denied, you should first call or write Superior Vision to request an explanation. If you want to appeal the decision, you must submit your appeal in writing. ERS will examine your appeal and notify you about the status of your claim.
The TexFlex health care account lets you set aside money on a pre-tax basis – for you and your dependents – for eligible dental and vision expenses. See the TexFlex website for more information.
Starting September 1, 2016, the TexFlex limited flexible spending account (LFSA) will be available to employees who enroll in Consumer Directed HealthSelect. This option helps you save on dental and vision eligible expenses.

TexFlex LFSA lets you set aside money on a pre-tax basis similar to the TexFlex health care flexible spending account (FSA). Only employees enrolled in Consumer Directed HealthSelect are eligible to enroll in an LFSA (retirees are not eligible).
ERS is working on how vision plans offered by some employers will coordinate with State of Texas Vision. More information will be added once it is available. 
Having your vision corrected is not considered a qualifying life event; therefore, you would continue to pay the premiums for the remainder of the plan year until the next open enrollment period or qualifying life event.
After you leave employment, you may be eligible to continue coverage under COBRA for a maximum of 18 months by paying your premiums directly to ERS. COBRA is limited to the benefits you had when you leave employment. If you choose COBRA continuation coverage, you will pay the full cost of your premium(s).

COBRA rates for PY 2017

Benefit Level Monthly Rate
You only $6.82
You & Spouse $13.65
You & Child(ren) $14.67
You & Family $21.49