State of Texas Vision

State of Texas Vision offers one comprehensive eye exam per covered participant per plan year, and contact lens fittings, contact lens options and other eyewear. A Contact Lens Fitting exam has its own copay and is separate from the eye exam copay. Benefits include a retail allowance toward the purchase of either frames or contact lenses. This allowance can be used for frames OR contact lenses, not both.

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.

No.

You will get two ID cards by mail for you and your covered dependents. You don't 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 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.  The network includes independent optometrists, ophthalmologists, and dispensing opticians.

Yes, you can go to an out-of-network provider, however, you’re responsible for submitting an Out-of-Network Claim Reimbursement Request Form and an itemized receipt by mail or fax.

Yes.

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

• 1-800 Contacts
• America’s Best Contacts & Eyeglasses
• ContactsDirect.com
• Eyemart Express
• 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 can't 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.

A network provider will submit the claim for you. To receive reimbursement for covered items or services from a out-of-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'll also need to upload 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’ll pay your network provider any applicable copay(s), and the cost of services or materials not covered by your plan or that exceed your plan’s coverage.

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.

Yes, the contact lens fit and follow-up exam is a separate evaluation and is a stand-alone benefit.

Yes, dilation is included in the comprehensive vision examination at no additional cost. Retinal imaging is covered in network, but, you are responsible for 100% of the cost, up to $39. Retinal imaging isn’t covered if you seek vision services from an out-of-network provider.

No. For glaucoma treatment and other eye diseases, use your medical plan.

Medically necessary contact lenses are provided only for certain conditions that prevent a person from seeing at a specified level of visual acuity even when wearing glasses. 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 costs for 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 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 for the outcome of the review and 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'll pay the full cost of your premium(s).