Coverage For Your Vision Care Needs.
An annual eye exam is about much more than healthy vision. It can help identify the early signs of serious health conditions like diabetes and high blood pressure.
Our Premiere Vision plan offers access to thousands of network providers nationwide through EyeMed Vision Care’s “Select” Network of independent providers and retail chains.Visit EyeMedVisionCare.com/Locator for participating locations in your area.
Applying is simple and can be completed in minutes
Premiere Vision At A Glance
100% coverage for routine eye exam
Discounts on contact lenses and additional savings from EyeMed2
Large network of providers to choose from. For a list of participating providers, visit eyemedvisioncare.com and choose the “Select” vision network
Coverage is available for the whole family - you, your spouse and your kids
Affordable premiums that do not increase as you get older with individual coverage for $9.00 per month
Did You Know?
1 Type I services for Premiere and Basic plans are covered at 100% in-network and 80% non-network. | 2
Type II services for Premiere plan are covered at 80% in-network and 60%
non-network. Type II services for Basic plan are covered at 50% for both in-network and non-network.
INSURED VISION PLAN1
Network Provider
Non-Network Provider
For a list of participating providers, visit EyeMedVisionCare.com and choose the “Select” network | 1 Per insured, per 12 month period.
ADDITIONAL SAVINGS FROM EYEMED VISION CARE1
In addition to your insured vision plan benefits, you have access to the following discounts through EyeMed where you pay:
MONTHLY PREMIUMS
The chart above is only an illustration of benefit and premium options per insured per 12 month period.
1 EyeMed is a discount program only and not insurance. This program provides discounts only at certain contracted providers. You are obligated to pay all fees at the time of service,
but will receive a discount from those providers who have contracted with EyeMed. The program does not make payments directly to the providers of services.
Notice to Our Customers About Supplemental Insurance
Notice to Our Customers About Supplemental Insurance
• The supplemental plan discussed in this document is separate from any health insurance coverage you may have purchased with another insurance company.
• This plan provides optional coverage for an additional premium. It is intended to supplement your health insurance and provide additional protection.
• This plan is not required in order to purchase health insurance with another insurance company.
• This plan should not be used as a substitute for comprehensive health insurance coverage. It is not considered Minimum Essential Coverage under the Affordable Care Act.
Other Important Information
EXCLUSIONS AND LIMITATIONS
Benefits will not be provided under the Policy for expenses associated with the following:
Orthoptic or vision training and any associated supplemental testing | Plano lenses | Lens coating | Two pair of glasses, in lieu of bifocals or trifocals | Medical or surgical treatment of the eyes | Any type of corrective vision surgery, including LASIK surgery | Any eye examination, or any corrective eye wear, required by an employer as a condition of employment | Any services or supplies when paid under any Workers’ Compensation or similar law | No-line bifocal or progressive lenses | Photochromic, transition or polycarbonate lenses | Lenticular lenses | Sub-normal vision aids or non-prescription lenses | Services rendered or supplies purchased outside the U.S. or Canada, unless the insured person resides in the U.S. or Canada and the charges are incurred while on a business or pleasure trip | Eyeglasses when the change in prescription is less than .5 Diopter | Experimental or investigational or non-conventional treatment or device | Eyeglass lens treatments,
including “add-ons”, UV coating, anti-reflective coating, scratch resistant coating, tinting or edge polishing | Oversized lenses | High index lenses of any material type | Fitting for contact lenses | Follow-up visits | Charges incurred after the Policy has terminated or coverage has ended.
From EyeMed:
Orthoptic or vision training, subnormal vision aids, and any associated supplemental testing | Aniseikonic lenses | Medical and/or surgical treatment of the eye, eyes or supporting structures| Corrective eye wear required by an employer as a condition of employment, and safety eye wear unless specifically covered under plan | Services provided as a result of any Workers’ Compensation Law | Plano non-prescription lenses and non-prescription sunglasses (except for 20% discount) | Services or materials provided by any other group benefit providing for vision care| Two pair of glasses in lieu of bifocals or trifocals
Coverage Information:
COVERAGE BEGINS: Chesapeake requires evidence of insurability before coverage is provided. Once Chesapeake has approved your application and you have paid your premium, coverage will begin on the Policy date shown in the Policy schedule.
RENEWABILITY: Your Policy is conditionally renewable, subject to Chesapeake’s right to discontinue or terminate the coverage as provided in the termination of coverage section of the Policy.
PREMIUM CHANGES: Chesapeake reserves the right to change the table of premiums, on a class basis, becoming due under the Policy at any time and from time to time; provided, Chesapeake has given you written notice of at least 45 days prior to the effective date of the new rates. Such change will be on a class basis.
TERMINATION OF COVERAGE: Your coverage will terminate and no benefits will be payable under the Policy: At the end of the month for which premium has been paid | If your mode of premium is monthly, at the end of the period through which premium has been paid following our receipt of your request of termination | If your mode of premium is other than monthly, upon the next monthly anniversary day following our receipt of your request of termination. Premium will be refunded for any months paid beyond the termination date | On the date of fraud or material misrepresentation by you | On the date we elect to discontinue this plan, we will give you at least 90 days notice before the date coverage will be discontinued. You will be offered an option to purchase any other coverage that we offer without regard to health status | On the date we elect to discontinue all coverage in your state, we will give you and the proper state authority at least 180 days notice before the date coverage will be discontinued | Your dependent’s coverage will terminate at the end of the month following the date such dependent ceases to be an eligible
dependent.
For a complete listing of benefits, exclusions and limitations, please refer to your Policy. In the event of any discrepancies contained in this brochure, the terms and conditions contained in the Policy documents shall govern. The information contained herein is accurate at the time of publication. This brochure provides only summary information. Vision Insurance Preferred Provider Organization (PPO) Policy, Form CH-26120-IP (01/12) OON FL.
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SureBridgeInsurance.com (800) 815-8535
About Us
SureBridge is one of the leading brands of supplemental insurance coverage in the United States,helping to provide financial security for Americans of all ages and their families. Our comprehensive portfolio of products is available from licensed insurance agents in 46 states and the District of Columbia and is available through HealthMarkets Insurance Agency Inc., as well as through other unaffiliated insurance distributors. SureBridge policyholders can receive direct cash benefits for expenses caused by unexpected medical issues, sustained illnesses, and end-of-life challenges.
The SureBridge portfolio includes dental, vision, and other insurance plans that complement an individual’s health insurance. These plans help provide an additional layer of protection in the event of accidental injury, catastrophic illness, hospitalization, or cancer.
SureBridge® is a registered trademark used for both insurance and non-insurance products offered by subsidiaries of HealthMarkets, Inc. Supplemental insurance products arevunderwritten by The Chesapeake Life Insurance Company®. Administrative offices are located in North Richland Hills, TX. Products are marketed through independent agents/producers.Insurance product availability may vary by state.
About Us(termlifemutual):-
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