CALIFORNIA - Pacificare Health Systems
CALIFORNIA - Pacificare Health Systems
CALIFORNIA - Pacificare Health Systems
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PART B<br />
<strong>CALIFORNIA</strong><br />
Vision Care Benefit<br />
Benefits<br />
A. VISION EXAMINATION: A $15 Copayment for<br />
a complete analysis, every 12 months, of the<br />
eyes and related restructures to determine<br />
abnormalities.<br />
B. LENSES: $20 Copayment for standard lenses. If<br />
lenses cost more than allowed the Member will<br />
pay the additional charge. The doctor verifies<br />
the accuracy of the finished lenses.<br />
C. FRAMES: The plan offers a wide selection of<br />
frames; however, if the Member selects a frame<br />
which costs more than the amount allowed by<br />
the plan, there will be an additional charge.<br />
Frame allowance is $75 every 24 months.<br />
How to Access Benefits<br />
The selection of a contracting Primary Care<br />
Physician will determine where you will go for<br />
your vision care benefits either through your<br />
contracting medical group/IPA or VSP.<br />
222<br />
Vision benefits include, but are not limited to, the following:<br />
Benefits<br />
vision Examination<br />
A complete analysis of the eyes and related restructures to determine abnormalities<br />
(one every 12 months)<br />
If you belong to one of these contracting<br />
medical groups/IPAs, you will receive your<br />
vision care through your medical group/IPA<br />
listed below. Contact your medical group/<br />
IPA office to arrange an appointment.<br />
Alamitos IPA<br />
Alliance IPA – a Division of <strong>Health</strong>Care Partners<br />
Beaver Medical Group<br />
Encompass Medical Group<br />
Harriman Jones La Palma<br />
Harriman Jones Medical Group<br />
<strong>Health</strong>Care Partners Medical Group/East LA<br />
<strong>Health</strong>Care Partners Medical Group/El Monte<br />
<strong>Health</strong>Care Partners Medical Group/Glendale<br />
<strong>Health</strong>Care Partners Medical Group/LA<br />
<strong>Health</strong>Care Partners Medical Group/Montebello<br />
<strong>Health</strong>Care Partners Medical Group – South<br />
Bay<br />
Lakewood <strong>Health</strong> Plan<br />
Leisure World Managed Care Medical Group<br />
Park Terrace Medical Associates<br />
SCMG – Graybill<br />
Sharp Community Medical Group<br />
Sharp Community Medical Group/Chula Vista<br />
Sharp Community Medical Group/Coronado<br />
Sharp Community Medical Group/Grossmont<br />
Sharp Community/Inland North<br />
Sharp Rees-Stealy Medical Group Inc.<br />
Copayment<br />
$15<br />
This list is subject to change. Please call<br />
Secure Horizons Customer Service at<br />
1-800-228-2144 (TDHI users should call<br />
1-800-685-9355), 7 a.m. to 9 p.m., Monday<br />
through Friday, if you are not certain which<br />
medical group/IPA you currently belong to.<br />
If you do not belong to one of the<br />
contracting medical groups/IPAs above,<br />
you will receive your vision care through<br />
California Vision Service Plan (VSP).<br />
Contact VSP to arrange an appointment.<br />
Call VSP at 1-800-877-7195, for the hearing<br />
impaired, 1-800-428-4833, 7 a.m. to 6 p.m.,<br />
Monday through Friday. Remember to have<br />
your Secure Horizons Medicare Advantage Plan<br />
membership card ready when you call.<br />
n At your appointment, please pay any<br />
applicable copayments for your exam and/<br />
or eyeglasses.
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