Vision Insurance

Plan Administrator. This Vision Plan is administered by Rhodes College, 2000 North Parkway, Memphis, TN 38112 whose Internal Revenue Service Employer Identification Number is EIN620476301. The Plan Number is 504. The Plan year is July through June. This is a full insured plan. Information regarding Plan eligibility, enrollment, cost, and the procedure for applying for benefits is contained in this section. The Certificate of Coverage includes a description of benefits under the Plan and the conditions under which these benefits are available to insured individuals.

Eligible Participants. All full-time employees have the option to purchase vision insurance coverage for themselves and their dependents.

Date Eligible for Coverage. Each employee becomes eligible for vision coverage under the Plan the first day of the month following the date of employment with Rhodes.

Date Eligible for Dependent Coverage. A dependent shall become eligible for coverage on either (a) the first day that the employee becomes eligible for coverage and satisfies the definition of eligible dependent coverage or (b) the day a covered employee first acquires an eligible dependent.

Benefits Provided. All services must be rendered by a provider in the First Look Vision Network.

• $10 annual exam
• $25 materials copay for glasses and lenses every 2 years
  • Single vision lenses, line bifocals or trifocals
  • Frames up to $120
  • Elective contact lenses up to $120
• Average 30% discount for all other materials

Plan Premiums

There is a charge for vision insurance coverage that is paid through payroll deduction. At the employee’s option, vision insurance premium payments may be deducted through the flexible benefits program (pre-tax option).

Currently the insurance company is Starmount Life Insurance Company. Request for information concerning Starmount Life Insurance Company contract terms, condition and interpretation thereof, claims thereunder, any requests for review of such claims and service of legal process may be directed in writing to: Starmount Life Insurance Company, 8485 Goodwood Blvd., P.O. 98100, Baton Rouge, LA 70898-9100.

The requirements for being covered under this Plan, the provision concerning termination of coverage, a description of Plan benefits (including any limitations and exclusions which may result in reduction or loss of benefits) are explained in the Certificate of Coverage.

Written notice of a claim must be sent within 30 days or as soon as reasonably possible. Typically the In-Network Vision provider will handle all claims and administrative services for you. Should you need to file a claim from an out of network provider, you must provide the claimant’s name, the policyholder’s name (if different), and the group policy number. You may submit a claim form or an itemized receipt for services to:

Starmount Life Insurance Company
Attn: Claims
P.O. Box 14389
Baton Rouge, LA 70898-4389