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. For additional details, click on the ‘Vision Plan’ link located here:
- Annual Exam within a 12-month period for $10 in network.
- Out of network reimbursement up to $35.
- Standard plastic lenses – one set within a 12-month period for $25 copay in network.
- Out of network: Single vision lenses up to $30 reimbursement, bifocals up to $45 reimbursement, or trifocals up to $60 reimbursement.
- Frames – one pair within a 24-month period for $0 up to $150 allowance, 20% off balance over allowance for in network.
- Out of network: Up to $75 reimbursement.
- Conventional contacts – One set of lenses within a 12-month period (in lieu of lenses + frames) for $0 up to $150 allowance, 15% off balance over allowance for in network.
- Out of network: Up to $120 reimbursement.
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).
The insurance company is BlueCross BlueShield of Tennessee (BCBST). Request for information concerning 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: BCBST Claims Service Center, 1 Cameron Hill Circle, Suite 0002, Chattanooga, TN 37402-0002.
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:
BCBST Claims Service Center
1 Cameron Hill Circle
Suite 0002
Chattanooga, TN 37402-0002S