Plan Benefits
What are the plan benefits?Examination: 100%
covered once every 12 months. A comprehensive vision examination is provided
by a network optometrist or ophthalmologist. There is no co-payment.
Eyewear: Lenses are 100% covered every 12 months. Frames within the
Spectera selection or allowance are 100% covered every 24 months
Lenses: If prescribed, a pair of single vision or standard multi-focal
lenses.Frames: Your choice from a wide selection of fashionable
frames will be covered.Contact Lenses: In lieu of lenses and a
frame, you may select contact lenses. Spectera offers a wide variety of
contact lenses from many leading manufacturers. Four boxes (12 Pairs) of
disposables are included when obtained from a network provider. A $105
allowance will be applied towards the evaluation, fitting, and purchase of
non-selection contact lenses once every 12 months.Laser Eye Surgery:
Spectera participants receive access to discounted refractive eye
surgery procedures from numerous provider locations throughout the United
States. To find a participating Laser Eye Surgeon in your area, visit:
www.spectera.com.
Network Doctors
Who are the network doctors?
They are licensed doctors who are extensively reviewed and
credentialed to ensure that stringent standards for quality service are
maintained. Spectera provides a 24-hour automated
Interactive Voice Response system. A toll-free call is all that is
necessary to choose from a continuously updated directory of providers.
Call 1-800-638-3120 , select the provider locator option, and key in the
subscriber’s unique identification number and the desired ZIP code. A
list of providers, along with their address and phone number will be
given. Or select the provider locator at
Spectera.com and enter the
subscriber’s unique identification number and ZIP code. A list of
providers, along with their address, phone number, and door-to-door
directions (including mileage) will be displayed.How do I
receive services from a doctor in the network?
- Call the network doctor of your choice and schedule an
appointment
- Identify yourself as Spectera Member
- Provide the office with the member's Social Security number and
the year of birth of any covered children needing services
It's that easy! The doctor's office will verify your eligibility for
services, and no claim forms are required!
Out-of-Network Provider Benefits
To receive reimbursement from a non-network provider, you will need
to mail your itemized receipts, with member's unique identification
number and the patient's date of birth to:
Spectera Claims Department
PO Box 30978
Salt Lake City, UT 84130
Fax: 248-733-6060
Please note: Receipts must be submitted together at the same time for
services and materials purchased on different dates to receive
reimbursement.
Spectera will reimburse you for covered expenses according to the
following schedule.
| |
Eye
examination |
$40.00 |
 |
| |
Single vision
lenses |
$40.00 (per
pair) |
| |
Bifocal lenses |
$60.00 (per
pair) |
| |
Trifocal
lenses |
$80.00 (per
pair) |
| |
A frame |
$45.00 |
Contact lenses
| |
Elective |
$105.00 |
| |
Medically
Necessary |
$210.00 |
To request claim forms, please call 1-800-999-5431.
Exclusions
The following items are not covered by this vision program:
- Medical treatment of eye disease or injury
- Vision therapy
- Special lens designs or coatings, other than those previously
described
- Replacement of lost eyewear
- Non-prescription (plano) lenses
- Services not performed by licensed personnel
Need more information?
Please feel free to visit our website at:
www.spectera.com or call Spectera
Vision at 1-800-638-3120 to:
- Locate a network doctor in your area
- Verify eligibility for yourself or a family member
- Request an out-of-network provider reimbursement claim form
- Speak with a Member Service Representative
- Ask any questions about your vision benefits
Member Service Representatives are available
Spectera’s customer service department at
1-800-638-3120. We are available Monday through Friday, from 8:00 a.m.
to 11:00 p.m., and Saturday, from 9:00 a.m. to 6:30 p.m., Eastern
Standard Time.Sponsored by, and administered on behalf of
the members and dependents of Beverage and Brewery Drivers Local 67 Health
and Welfare Fund.
