Vision benefits
- What is a plan maximum?
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A plan maximum is the maximum amount that Moda Health will pay and is based on the plan coverage that the member chooses.
- What does the term "plan allowable" mean?
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The plan allowable is either the Moda contracted rate that participating providers agree to accept as payment in full or the charges billed by nonparticipating providers. If a provider is contracted, he or she will be listed in the Moda Health online directory and agrees to accept discounted payment for services provided. The difference between the negotiated rate and the billed rate is a write off and cannot be billed to the member.
- Are prescription sunglasses covered under this plan?
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Yes. All tints and prescription lenses are covered on this plan. Polarization is not covered and is the responsibility of the member. Non-prescription sunglass lenses are not covered.
- What is the coverage for frames and lenses under this plan?
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One pair of lenses per plan year is covered for all ages. One pair of frames per plan year is covered for children under 17, and one pair of frames every two plan years is covered for adults age 17 and older.
- If I am double-covered under two OEBB plans, can I get two pairs of glasses?
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Typically, members who are double-covered will be subject to the same frequency limitations of those who are covered under one OEBB vision plan. However, they will have a potential increased benefit maximum to use for covered vision services.
Vision claims will be processed under the member's primary coverage and will automatically be processed under the secondary coverage if there is additional benefit to pay on the claim(s). If the member does not want to coordinate their vision benefits on dual Moda OEBB plans, they can call in advance to request a vision claim not be processed under one of their plans.
If the member does not want to coordinate their benefits, Moda will process all vision claims (exam and hardware) on one plan one year and all vision claims (exam and hardware) on the other plan the next year. Members cannot request. We process hardware on one plan and the exam on the other. If a member calls in the middle of their benefit period and we already have claims on file for that plan year, their request will not start until the next plan year.
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We have exciting news to share. ODS is changing its name to Moda Health.
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