Eye Exam / Vision Care

I would recommend sam's club for your eye exam if you wear contacts, as it is in network, under the $150 deductible, and the cheapest i can find that does glasses and contacts fittings. but of course you have to have a membership....

The post below provides a good explanation of the benefits under the current (2007-2008) BCBS plan. The 2008-2009 Student Medical Insurance Plan will be through United Healthcare/Student Resources, and will be a copay-based plan rather than a coinsurance-based plan. So please keep in mind that the benefits as outlined below are valid until mid-August; after that, the plan will change.

You can always find the most up-to-date SMIP information here, including a presentation given to the GPSC General Assembly explaining the changes you will see next year.

maybe we need a more clear explanation of our benefits than the bcbs booklet gives, because i see a lot of confusion re: health insurance.

i'm just going to address in-network coverage here since most of us are able to access bcbs providers. you can call your provider to be sure they are in the bcbs network.

basically, we have a $150 deductible that we have to pay out of pocket before the insurance pitches in anything at all. (they will only apply covered services toward the deductible.) not all covered services are going to contribute to your deductible, so you should look that up before making an appointment.

once you've met the $150 deductible, if you meet it at all, then the insurance will pay 80% of your bill (again for covered services only) and you will be responsible for 20%,. for instance, i paid $90 out of pocket for my eye exam and will probably not even meet the deductible this year. but if i paid $160 for that same exam, the insurance would pay 80% of the $10 over the deductible. i would be responsible for $150 + (0.2x$10) or $152.

if you're very unfortunate and have a lot of medical expenses, the coinsurance max is there to spare you some. this means that after you've paid $1500 in coinsurance (that's your 20% portion, the deductible is not included), then the insurance will pick up 100%. but not all covered services are subject to the coinsurance max, so you have to look that up.

the glasses/contacts reimbursement is fairly easy. there is a claim form to fill out, and you include a copy of your receipt. here is the form (pdf)
https://www.bcbsnc.com/pdfs/forms/claims/BE236.pdf

here is a link to the booklet (pdf, 683 kb) so you can read more about it yourself. empower yourself, learn about your health insurance benefits :)
https://www.gallagherkoster.com/brochures/1380.pdf

i hope those links work, and i hope that cleared some things up!

i calle bcbs and was told to get my eye exam at duke eye center.  i scheduled an appointment and was told by the people at the desk that my eye exam should not cost more than $150 dollars----- apparently this 150 is our student health deductible and the entire exam was billed as $263 dollars (and that was without fittings for contacts).  so i had to pay $150 out of pocket to cover the bill and paid $200 for new contacts, upon which you have to file with bcbs to get the $100 back.  save you receipts!  i would suggest going to target for an eye exam, as it should only cost $70---- or something less than the outrageous bill i was given.  i was really upset with the eye center and the insurance company for not suggesting, as a poor graduate student, that i go somewhere else for the eye exam.  

we don't have 100% coverage after we meet the deductible, so i'm assuming that it's not actually "free" if your deductible is met, but covered at 80%.

free happens when you meet the out of pocket max of $1500. but even then not everything is free.

I called Blue Cross/ Blue Shield to find out about this.  Basically you can have your eye exam at any optometrist's office that takes BC/BS.  There is a list of doctors on their web site: http://www.bcbsnc.com

The eye exam is not "free" but it is covered -- meaning that if you've met your deductible, it is free; otherwise it goes toward your deductible for the year.

The $100 eyewear benefit is an allowance, meaning that you can get your eyewear at any optical store and then fill out the BC/BS form and submit it with a receipt to get your refund.  Again, your deductible applies.