1. What is covered in a comprehensive eye exam?
At ECPA, our focus is on healthy eyes. All of our scheduled benefit plans include a comprehensive vision examination which includes, but is not limited to: case history, including chief complaint, ocular disease and medical history, visual field screening, refraction and treatment plan.
2. Are contact lens fitting fees included in the vision exam?
Professional contact lens fitting fees are not considered a part of routine eye care and are not included in the vision exam. However, members who receive a contact lens fitting from a provider who also dispenses their contact lenses can apply the access of their materials benefit, if any, toward the cost of the fitting. It is important to remember that contact lenses must be purchased from the same provider who performed the fitting, and that only the balance of the materials benefit, after purchasing contact lenses, can be applied towards the fitting fee.
3. Are disposable contact lenses covered?
Typically, contact lenses are available every 12 or 24 months in lieu of spectacle lenses and frame, depending on your plan. When purchasing disposable contact lenses, members must use their entire allowance in a single purchase. It is important that members use their entire allowance at one time, since subsequent purchases within the same eligibility will be denied until the member becomes eligible again.
4. Can members purchase contact lenses and glasses?
Members who choose the contact lens benefit elect to receive contact lenses in lieu of frames and spectacle lenses. However, members are entitled to purchase additional materials, like glasses, from ECPA providers at ECPA contracted Preferred Pricing. These purchases can be made as frequently as desired. Preferred Pricing allows ECPA members to purchase high quality eyewear at special pricing that ECPA has negotiated on their behalf. There is no paperwork to fill out. At the time of purchase, members simply pay the provider the Preferred Pricing in full. Members are welcome to ask the provider to show them the savings they received using their ECPA membership card.
Preferred Pricing is not available from non-ECPA providers.
5. Does ECPA cover non-prescription items like sunglasses?
ECPA does not cover items that are not necessary for vision correction. However, ECPA members will receive savings when purchasing sundry items, including non-prescription sunglasses through Preferred Pricing, available to them only from ECPA providers.
6. Are high index lenses covered under the lens benefit?
High index lenses are lenses that are specially processed to be thin. Since high index lenses are cosmetic, they are not covered by the lens benefit. However, ECPA providers will use Preferred Pricing to determine the cost, ensuring that each ECPA member receives a savings on this feature.
7. How can a member find out what benefits are available to them and how often?
Members can call ECPA's automated Easy Access Automated Service Line at
1-800-843-3272, 24 hours a day, 7 days a week for information on benefits and providers.
8. Do members have an ECPA identification number?
Yes. The subscriber's social security number is his/her ID number for all eligible members of his/her family.
9. Do members have to use ECPA providers?
Most programs offer non-ECPA provider coverage, but members will receive lower benefits than if they use ECPA providers. Please refer to your Agreement for Services to determine if non-panel benefits are available to your employees.
10. Do members need to complete claim forms?
ECPA providers complete the paperwork and send it directly to ECPA. Members pay their applicable co-payments, any excess charges above their benefit allowances, and any charges for non-covered services and materials. There are no claim forms to complete.
Non-ECPA providers may provide members with a completed claim form for submission, although it is not necessary for reimbursement. Members must submit a fully itemized original invoice in lieu of a completed claim form, together with a copy of their ECPA card directly to ECPA claims for reimbursement.
11. How often can members use their benefits?
The frequency of benefits appears on the card carrier that accompanies the ECPA card that is provided to all members.
Once the member's benefits are exhausted, he/she is entitled to purchase materials from ECPA providers at ECPA contracted Preferred Pricing, as frequently as desired. There is no paperwork to fill out. At the time of purchase, members simply pay the provider in full according to the Eye Care Plan of America Preferred Pricing.
Preferred Pricing is not available from non-panel providers.
12. Does ECPA offer a provider directory?
ECPA does not offer a provider directory because they are continuously adding to their provider network to give members as much choice and flexibility as possible. Provider information is available around-the-clock through ECPA's advanced, Easy Access Automated Service Line 1-877-650-4251 (option 5), or employees can access ECPA’s website by visiting the Vision Care section at www.coreplusbenefits.com. This site always contains the most accurate, up-to-the-minute Provider information.
13. Will ECPA add providers to their network at the members request?
ECPA's Provider Network is the largest and most comprehensive of its type. ECPA strives to maintain a 2,000:1 ratio of members to providers. Generally, ECPA focuses it's network development activities to areas where there is critical mass of members and the number of ECPA providers is limited.
14. Who do members call if they need further information?
Members are encouraged to call ECPA's Easy Access Automated Service Line at 1-877-650-4251 (option 5). The automated system will give members
