Cleveland Bakers & Teamsters H&W Fund Client Details
The Cleveland Bakers & Teamsters H&W Fund provides the following custom benefits:
Members also have an up to $50 total allowance for any individual or combination of the following lens enhancements ordered on the primary Choice Plan benefit:
Anti-reflective coatings, Polycarbonate lenses, Photochromic or Tinted lenses, Progressive lenses, Scratch-resistant coating, UV coating.
Eligibility
The $50 total lens enhancement allowance is available every other calendar year for all relationships except Children under 12 who are eligible every calendar year.
How to Calculate Patient’s Out-of-Pocket (OOP) Costs
When the patient selects any individual or combination of these lens enhancements, they receive an additional up to a $50 total allowance towards their OOP costs:
- Anti-reflective coatings
- Polycarbonate lenses
- Photochromic or Tinted lenses
- Progressive lenses
- Scratch-resistant coating
- UV coating
Calculate the patient’s OOP expenses for each of the covered lens enhancements ordered above. Patient costs are based on the Choice Plan cost-controls as indicated on the primary authorization.
- Determine the total OOP amount and if it’s $50 or more, deduct the full $50 allowance and bill the patient the difference. If less than $50, then the patient will have no OOP cost for the enhancement(s).
- You will be reimbursed either the $50 allowance or the patient’s OOP expense, whichever is less.
Examples
|
Patient’s OOP is $50 or More |
|
|---|---|
|
1. Determine the total OOP for the covered lens enhancements. |
|
|
Progressive F in Plastic (FA) |
$105 |
|
UV Coating - Backside |
$10 |
|
Total: Important – this is the amount you will bill as your U&C fee for Lenses on Additional Pair. |
$115 |
|
2. Deduct the $50 allowance to determine the Patient’s OOP Total. |
|
|
Patient’s lens enhancement allowance: |
-$50 |
|
Patient’s OOP balance due: |
$65 |
|
Patient’s OOP is less than $50 |
|
|---|---|
|
1. Determine the total OOP for the covered lens enhancements. |
|
|
Scratch Resistant Coating |
$17 |
|
Plastic Dyes - Gradient |
$17 |
|
Total: Important – this is the amount you will bill as your U&C fee for Lenses on Additional Pair. |
$34 |
|
2. Deduct the $50 allowance to determine the Patient’s OOP Total. |
|
|
Patient’s lens enhancement allowance: |
-$50 |
|
Patient’s OOP balance due: |
$0 |
Authorization
For Up to $50 Allowance
To receive reimbursement of the lens enhancement allowance, pull the authorization for Additional Pair. It will reflect eligibility for Lenses only.
For Contact Lens Services
If Contacts shows NO for eligibility, contact VSP to determine if the patient is eligible for Contact Lens Services via Interim Benefits.
Claim Submission
For Up to $50 Allowance
Bill the Lenses only benefit and indicate the patient’s Total OOP expenses as your dispensing fee. See example above for assistance with calculating.
Lab
For Up to $50 Allowance
In the drop-down menu, select Lab 100 for the Additional Pair benefit only.
Explanation of Payment (EOP)
Reimbursement of the up to $50 allowance will be paid under the Additional Pair benefit which you may need to tie back to the patient's primary Choice Plan EOP for reconciliation.
Questions
For assistance concerning these custom benefits, contact VSP at 800.615.1883.