State of Texas Vision FAQs

State of Texas Vision provides benefits for one eye exam per covered person per plan year, as well as contact lens fittings, contact lens options, and other eyewear. Benefits include a retail  allowance toward the purchase of either frames or contact lenses. Contact lenses are in lieu of the eyeglass lenses and frame benefit. This allowance can be used once per year for frames OR contact lenses, not both. See details about covered services in your State of Texas Vision Member Handbook or view benefits and resources on the State of Texas Vision website.

Active employees and retirees, not enrolled in Medicare can enroll in State of Texas Vision during their annual Summer Enrollment period or within 31 days of a qualifying life event (QLE). Medicare-eligible retirees can enroll during their annual Fall Enrollment period or within 31 days of a QLE.

There is no waiting period. Coverage for new employees begins during their first month of employment. Coverage for active employees, who sign up during their Summer Enrollment period, begins September 1. Coverage for Medicare-enrolled retirees, who sign up during their Fall Enrollment period, begins January 1. Enrollments due to QLEs are effective the first of the month following the QLE date.

Two ID cards will be mailed to you. The cards are for you and your covered dependents. You  do not need to present an ID card to receive services. Network Providers can verify eligibility and benefits using the patient’s name and date of birth. Additional copies of your ID card are available at no cost to you by creating an account on the State of Texas Vision plan website or  by calling EyeMed Customer Service at (844) 949-2170, TTY: 711. 

You can find providers within the EyeMed network using their online Find a Provider tool . Network providers are available in all 50 states.

Yes; however, keep in mind; if you go to an out-of-network provider, you are responsible for submitting an Out-of-Network Claim Reimbursement Request Form and an itemized receipt by mail or fax.

Yes, you may choose the provider that best matches your needs and preferences. Each provider can contact EyeMed to verify your eligibility and benefits.

The EyeMed’s INSIGHT network includes independent, national and regional retailers and online providers, such as: 

• 1-800 Contacts
• America’s Best Contacts & Eyeglasses
• Befitting.com
• ContactsDirect.com
• Eyemart Express
• Eyeglass World
• Glasses.com
• LensCrafters
• Pearle Vision
• Sam's Club Optical
• Target Optical
• Texas State Optical (TSO)
• Walmart Vision Center

Note: Please call your vision care provider prior to scheduling your appointment  to confirm covered services, available discounts and acceptance of your plan. Providers may practice at multiple locations and not all locations may be contracted as in-network. Network participation by any provider cannot be guaranteed.

Network providers are available in all 50 states. If you or your dependents live or travel out of state, you have access to network providers, including many regional eyewear retailers. Visit the State of Texas Vision website for a list of network providers.

A network provider will submit the claim for you. To receive reimbursement for covered items or services from a non-network provider, you may submit a claim online by creating an account and completing an electronic claim form on the State of Texas Vision website. You will also need to provide a picture of your itemized receipt.  
 
Claims submitted with complete information are typically processed within ten (10) business days and reimbursements are mailed to the participant’s address provided to ERS by the subscriber.

If you are seeking services from a network provider, you will pay your network provider any applicable copay(s), and the cost of services or materials not covered by your plan or exceed your plan’s coverage. Please see the State of Texas Vision Member Handbook for more details.

The $200 allowance can be applied to either frames OR contact lenses, not both.. If you purchase a frame that costs more than $200, you are responsible for paying the difference. If you purchase frames that cost less than $200, you forfeit the remaining allowance. Be sure to ask your network provider about any additional discounts. For more information about discounts, please refer  to the State of Texas Vision Member Handbook.

Yes, the contact lens fit and follow-up exam is a separate evaluation and is a stand-alone benefit. The fit and follow-up exam is either a  $25 or $35 copay depending on your needs. Details are available in your member handbook.

Yes, dilation is included in the comprehensive vision examination at no additional cost, for EyeMed participants, retinal imaging is covered in network; however, you are responsible for 100% of the cost, up to $39. Retinal imaging is not covered if you seek vision services from an out-of-network provider. Additional details can be found in your member handbook

No. For glaucoma treatment and other diseases of the eye, you will need to use the coverage offered through your medical plan. Contact your medical plan  if you have questions about coverage.

Medically necessary contact lenses are provided only for certain conditions. These medical conditions prevent the Participant from achieving a specified level of visual acuity (performance) through the wearing of conventional eyeglasses.  The contact lenses  must be specifically prescribed by the eye doctor to be used for certain conditions. Contact  EyeMed if you have questions about whether your prescription is considered medically necessary.

Different types of lenses have different copay amounts, including solid or gradient tint. Non-prescription lenses of any kind, sunglasses, or contact lenses are not covered.  Find cost information about add-ons such as scratch-resistant coating in the member handbook.

EyeMed offers a discount of 15% off retail or 5% off a promotional price LASIK or PRK service through the U.S. Laser Network.

You may request for a review of any denial, completely or in part, of a claim for services, reduction of benefits, or failure by the plan to make or provide payment for covered services or benefits. EyeMed will review your appeal, provide you a letter of explanation regarding the outcome of their review and provide instructions on how to appeal directly to ERS if the denial is upheld. Refer to the State of Texas Vision Master Benefit Plan Document (MBPD) for details on how to file an appeal.

To file a complaint against a provider, contact EyeMed at (844) 949-2170; TTY: 711 ) toll free. Refer to the State of Texas Vision MBPD for more information on how to file a complaint.

Yes, a TexFlex health care flexible spending account (FSA) or limited-purpose flexible spending account (Consumer Directed HealthSelect^SM participants only) lets you set aside pre-tax income to pay for eligible dental and vision expenses for you and your eligible dependents. See the TexFlex website for more information and a list of eligible expenses for each type of spending account. The TexFlex program is available to benefits-eligible active employees.

No, an improvement in vision is not considered a qualifying life event. You would continue to pay the premiums for the remainder of the plan year until the next annual enrollment period or qualifying life event.

After you leave employment, you may be eligible to continue coverage under COBRA for up to 18 months by paying your premiums directly to ERS. COBRA is limited to the benefits you had when you left employment. If you choose COBRA continuation coverage, you will pay the full cost of your premium(s).