|
Blossom 4 Health Plans "As featured on Public Access Television" Toll Free 800-237-0391 FAX 818-368-0215 Serving California for over 22 Years |
Vision Plan of America
We are now featuring a Vision Plan for Individuals & Families
|
BENEFITS |
COSTS |
FREQUENCY |
| Complete Eye Exam and Prescription |
NO CHARGE |
Each 12 Months |
| Lenses (Medically Necessary-Ophthalmic) |
NO CHARGE |
Each 12 Months (if needed) |
|
SINGLE VISION LENS |
NO CHARGE |
Each 12 Months (if needed) |
|
BIFOCAL LENS |
NO CHARGE |
Each 12 Months (if needed) |
|
TRIFOCAL LENS |
NO CHARGE |
Each 12 Months (if needed) |
| Frame (Standard -VPA Metal or ZYL) |
NO CHARGE up to $60 retail |
Each 24 Months (if needed) |
COSMETIC CONTACT LENSES are available in addition to your Basic Benefit( See Schedule of Extras provided at your doctor's office) or, if desired in lieu of all other services, $100 applies to the doctor's usual and customary package fee. Package fee= examination, fitting, follow-up and contact lenses. Cosmetic Contact lenses are available each 24 months if a change is indicated.
MEDICALLY NECESSARY CONTACT LENSES are available each 24 months if a change is indicated. A $75.00 co-payment us paid by the member to the provider which included : A special contact lens examination, follow-up visits and Medically necessary lenses.
| Number of Subscribers | COST |
| Individual | $109.00 + one time non-refundable fee of $5.00 |
| Member + 1 Dependent | $190.00 + one time non-refundable fee of $5.00 |
| Family | $240.00 + one time non-refundable fee of $5.00 |
LIMITATIONS:
Extra Cost: This plan is designed to cover your visual needs rather than cosmetic materials. If you select any of the following, there will be a extra charge:
blended lenses;
contact lenses (except where noted elsewhere herein)
progressive multifocal lenses
photochromic lenses or tinted lenses (except where noted elsewhere herein)
coated lenses
laminated lenses
a frame that costs more than the plan allowance( Schedule of Extras applies)
Orthoptics or vision training and any associated supplemental testing at reduced fees.
NOT COVERED: There is no benefit for professional services or materials connected with:
Plano Lenses
Two pairs of glasses in lieu of bifocals.
Lenses and frames furnished under this program which are lost or broken will not be replaced except at the normal intervals when services are other wise available
Medical or surgical treatment of the eyes
Any eye examination, or corrective eye wear required by an employer as a condition of employment.
List Of Doctors In Plan (choose a doctor from the list in your area and record the code number)
Select your Vision Plan of America doctor by county
Please read Explanation of Benefits: Vision Plan Explanation
To download an application Vision Plan Application
|
Blossom 4 Health Plans "As featured on Public Access Television" Toll Free 800-237-0391 FAX 818-368-0215 Serving California for over 22 Years |
Vision Plan of America
We are now featuring a Vision Plan for Individuals & Families
|
BENEFITS |
COSTS |
FREQUENCY |
| Complete Eye Exam and Prescription |
NO CHARGE |
Each 12 Months |
| Lenses (Medically Necessary-Ophthalmic) |
NO CHARGE |
Each 12 Months (if needed) |
|
SINGLE VISION LENS |
NO CHARGE |
Each 12 Months (if needed) |
|
BIFOCAL LENS |
NO CHARGE |
Each 12 Months (if needed) |
|
TRIFOCAL LENS |
NO CHARGE |
Each 12 Months (if needed) |
| Frame (Standard -VPA Metal or ZYL) |
NO CHARGE up to $60 retail |
Each 24 Months (if needed) |
COSMETIC CONTACT LENSES are available in addition to your Basic Benefit( See Schedule of Extras provided at your doctor's office) or, if desired in lieu of all other services, $100 applies to the doctor's usual and customary package fee. Package fee= examination, fitting, follow-up and contact lenses. Cosmetic Contact lenses are available each 24 months if a change is indicated.
MEDICALLY NECESSARY CONTACT LENSES are available each 24 months if a change is indicated. A $75.00 co-payment us paid by the member to the provider which included : A special contact lens examination, follow-up visits and Medically necessary lenses.
| Number of Subscribers | COST |
| Individual | $109.00 + one time non-refundable fee of $5.00 |
| Member + 1 Dependent | $190.00 + one time non-refundable fee of $5.00 |
| Family | $240.00 + one time non-refundable fee of $5.00 |
LIMITATIONS:
Extra Cost: This plan is designed to cover your visual needs rather than cosmetic materials. If you select any of the following, there will be a extra charge:
blended lenses;
contact lenses (except where noted elsewhere herein)
progressive multifocal lenses
photochromic lenses or tinted lenses (except where noted elsewhere herein)
coated lenses
laminated lenses
a frame that costs more than the plan allowance( Schedule of Extras applies)
Orthoptics or vision training and any associated supplemental testing at reduced fees.
NOT COVERED: There is no benefit for professional services or materials connected with:
Plano Lenses
Two pairs of glasses in lieu of bifocals.
Lenses and frames furnished under this program which are lost or broken will not be replaced except at the normal intervals when services are other wise available
Medical or surgical treatment of the eyes
Any eye examination, or corrective eye wear required by an employer as a condition of employment.
List Of Doctors In Plan (choose a doctor from the list in your area and record the code number)
Select your Vision Plan of America doctor by county
Please read Explanation of Benefits: Vision Plan Explanation
To download an application Vision Plan Application
Call for FREE Information
packet
Toll Free 1- 800
-237-0391