MES Vision

Obtaining Services is Easy!

Follow these simple steps:

Select a provider. Select a provider by visiting www.MESVision.com. Obtaining services from a participating provider will maximize your benefits.
Make an appointment. Call the participating provider of your choice to make an appointment and inform them of your vision coverage.
You’re done! Your doctor will take care of the rest. The Participating provider will contact MESVision to verify your eligible benefits and submit a claim for payment for services covered by your plan.
If covered services are received from a non-participating provider, you are responsible for paying the provider in full. Your or the provider must submit the itemized bill and copy of your prescription with the claim form to MESVision. Reimbursement will be made to the insured person up to the schedule of allowances shown for non- participating providers.

Summary of Vision Benefits:

Copay:                                       $10.00 Exam
Comprehensive Vision Exam:    Once every 12 months
Lenses*    One Pair every 24 months
Frame: One frame every 24 months
Contact Lenses*                        One pair every 24 months

*Lenses are available at 12 months if there is the following change:
a change in prescription of .50 diopter or more in one or both eyes:
a shift in axis of astigmatism of 15 degrees;
or a difference in vertical prism greater than 1 prism diopter.

Comprehensive Examination	Covered	Up to $40.00
Single Vision Lenses	Covered	Up to $30.00
Bifocal Lenses	Covered	Up to $50.00
Trifocal Lenses	Covered	Up to $65.00
Polycarbonate Lenses ***	Up to $85.00	Up to $55.00
Progressive Lenses	Up to $89.50	Up to $65.00
Aphakic Monofocal	Covered	Up to $125.00
Aphakic Multifocal	Covered	Up to $125.00
Frame*	Up to $120.00	Up to $40.00

Contact Lenses **

Medically Necessary	Covered	Up to $250.00
Cosmetic or Convenience	Covered	Up to $120.00

The policy provides full coverage for covered services when you go to a Participating Provider of the MESVision network. If covered services are provided by a Non Participating Provider, charges will be paid, but not to exceed the above schedule of allowances.

Discounts: A 20% discount is available for cosmetic extras, such as tints, coatings and other add-on charges to standard lenses, after covered services are rendered. The discount may be applied to charges for the fram or contact lenses (except disposable or replacement contact lenses) over the stated allowances. The 20% discount also applies to additional pairs of glasses and/or pairs of standard contact lenses. To determine whether a provider offers the 20% discount, and insured individual can review their participating provider directory, call MESVision or visit www.MESVision.com. Discounts are available through TLCVision for conventional and custom LASIK procedures with the TLCVision Advantage Program.

If you have any questions about your vision benefits, please contact medical Eye Services at: PO Box 25209 Santa Ana Ca 92799, 800-877-6372 or www.MESVision.com.

Limitations:

Contact Lenses and fitting except as specifically provided: Eyewear when there is no prescription change, except when benefits are otherwise available; Non-standard lenses, including, but not limited to; Progressive, photochromic, hi-index, polycarbonate, occupational lenses, beveled, faceted, coated of oversize; Tints other than pink or rose #1 or #2, except as specifically provided; Two pairs of glasses in lieu of bifocals, unless prescribed; New-patient intermediate examinations; When and enrollee selects a different provider to perform the intermediate examination, the Enrollee will be responsible for the difference between the intermediate examination allowance and the comprehensive examination allowance. To maximize benefits, the patient should return to the original provider; Non- prescriptions (Plano) eyewear, except when specifically covered.

Exclusions:

Any eye examination required by the employer as a condition of employment; Any covered services provided by another vision plan; Conditions covered by Worker’s Compensation; Contact lens insurance of care kits; Frame cases; Covered services which began prior to the Enrollee’s effective date or after benefits have been terminated: Charges from which the Enrollee is not legally obligated to pay; Covered Services required by any government agency or program federal, state or subdivision thereof; Covered Services performed by a Close Relative of by an individual who ordinarily resides in the Enrollee’s home; Covered services obtained from a Non-Participating Provider; Medical or Surgical treatment of the eyes; Orthoptics, vision training of subnormal or low vision aids; Services that are experimental or investigational in nature; Services for treatment directly related to any totally disabling conditions, illness or injury; Lenses or frames which are lost, stolen or broken will not be replaced, except when benefits are otherwise available: In connection with war or any act of war whether declared or undeclared; a condition or accident occurring while on full-time active duty in the armed forces or any country or combinations of countries.

*Participating providers allow a selection of frames that retail up to $120.00 with lenses that fit an eye size less than 61 millimeters or above, the charge for the oversize lenses is your responsibility. “The retail frame allowance will be converted to wholesale or warehouse equivalent prices at category 5 or 6 provider locations (please refer to the Plan’s website at www.MESVison.com). The wholesale or warehouse equivalent may be approximately 30% less than the retail frame allowance, please confirm this benefit before ordering your eyewear”

**This benefit is in addition to the comprehensive vision examination, but in lieu of lenses and frame. If contact lenses are for cosmetic or convenience purposes, the Policy will pay up to $120.00 toward the contact lens evaluation, fitting costs and materials. Any balance is your responsibility. If contact lenses are medically necessary, they are a fully covered benefit. Approval from MESVision is required. Please refer to your Policy if you require additional information.
***For dependent children through age 18

This is a brief outline of the plan and is not to be accepted or construed as a substitute for the provisions of the contract.