Your Benefits and COVID-19
COVID-19 IMPORTANT BENEFIT UPDATES & ANNOUNCEMENTS
The period of the COVID-19 National Emergency (March 1, 2020 until sixty days after the end of the National Emergency) will not be counted when determining eligibility for enrolling in COBRA benefits. For example, if your COBRA enrollment period was due to expire March 1st, you may still enroll in COBRA benefits until 60 days after the end of the National Emergency. As of this time, the National Emergency has been extended until October 23, 2020.
Due to the COVID-19 National Emergency, the period between March 1, 2020 and December 23, 2020, (sixty days after the end of the National Emergency declaration) will be disregarded when determining your appeal deadline for health and disability plan appeals. As of this time, the National Emergency has not ended. This means that the days that you have to appeal will not be counted during this period.
Due to the COVID-19 National+ Emergency benefit eligible employees who had a qualifying event from March 1, 2020 until sixty (60) days after the announced end of the federal COVID-19 National Emergency are able to enroll in the State’s Group Health Plan however notification of the enrollment is not required within 30 days of the qualifying event. As of this time, the National Emergency has been extended until October 23, 2020.
Any vision benefits that members and their covered dependents receive between July 1 and September 30, 2020, will apply toward any unused 2019 plan year benefits. This will allow members and their covered dependents the ability to make the most of their vision benefits for the 2019 and the 2020 plan years. More details on this special offering are provided below:
Who is eligible for this offering? State of Delaware EyeMed members (employees, pensioners and their enrolled dependents) who:
were enrolled in the EyeMed vision plan on June 30, 2020, and
remain enrolled in the EyeMed vision plan for the 2020 plan year (July 1, 2020 – June 30, 2021), and
did not use all of the 2019 EyeMed plan year (July 1, 2019 – June 30, 2020) vision benefits.
What benefits are included in this offering? Any unused exam, lense allowance, frame allowance, diabetic services or vision therapy benefits from the 2019 plan year (July 1, 2019 – June 30, 2020).
How long do eligible members have to take advantage of this offering? Eligible members have through September 30, 2020 to utilize any remaining 2019 EyeMed plan year vision benefits.
What happens if the member’s enrollment in the EyeMed vision plan terminates prior to September 30, 2020? The offering will not be available to a member who discontinues enrollment in the 2020 EyeMed vision plan on or before September 30, 2020.
Who should I contact if I have any questions about the special offering? Members may contact EyeMed customer service at 1-855-259-0490.
SilverCloud is an online platform with activities and tools to manage emotions and habits during the COVID-19 crisis. Learn how to cope with challenging times, sleep problems, and grief or loss while practicing how to relax and stay hopeful. Visit https://carenow.silvercloudhealth.com/signup/. You will be asked to create an account and need to enter the PIN C@re2020! This program is available for a limited time only – expiring on 8/1/2020)
Effective immediately, there are no member costs (copays, deductibles, and coinsurance) for Highmark Delaware and Aetna members who receive in-network inpatient services for COVID-19 treatment.
Effective January 1, 2020, the Coronavirus Aid, Relief, and Economic Security Act (CARES) permanently reinstates coverage of over-the-counter drugs and medicines without a prescription! In addition, qualifying expenses also now include menstrual care products. Thousands of products, including allergy medicines, antacids, cold, cough and flu medicine, pain and fever relievers, sleep aids, and digestive aids, are now eligible without a prescription.
For more information, you can visit the Statewide Benefit Office Flexible Spending Account page or contact ASIFlex at 1-800-659-3035.
Currently, there is no cost to Highmark Delaware and Aetna members who receive virtual telemedicine services. This applies to members who receive telemedicine through their primary care provider or other physician as well as those who use Highmark Delaware's or Aetna's telemedicine vendors.
If you need telemedicine services for an acute issue, you can use the following vendors provided through Highmark Delaware or Aetna:
- Highmark Delaware Members: Amwell or Doctor on Demand
- Aetna Members: Teladoc
For more information, you can visit the following pages based on your State health plan:
The YMCA of Delaware has received guidance from the Centers of Disease Control and Prevention (CDC) and the Diabetes Prevention Recognition Program (DPRP) to continue delivering the Diabetes Prevention Program (DPP) through virtual sessions. The YMCA of Delaware encourages participants to not only maintain the lifestyle changes they have already made, but to continue their progress through the DPP.
Virtual meeting spaces have been created for all the classes that are in the weekly core phase of the program to continue program delivery and will continue to be covered under the State of Delaware Group Health Insurance Program (GHIP).
Families First Coronavirus Response Act passed on March 18, 2020, requires the State of Delaware Group Health Insurance Plan to cover without any member cost sharing, COVID-19 tests AND health care provider visits (in and out of network), urgent care visits, and emergency room visits that result in an order for or administration of the test. This Act applies to State of Delaware members in an Aetna or Highmark Delaware plan and expands the Group Health Insurance Plan's previous notification on March 6, 2020, that COVID-19 testing would be covered at 100%.
State of Delaware Aetna and Highmark Delaware members have access to telemedicine services through Teladoc (Aetna Members ), Doctor on Demand and Amwell (Highmark Delaware members ) as well as virtual telemedicine services provided by their primary care or other physician. For the next 90 days, all copays and coinsurance for telemedicine will be waived. This is expanded to include members in the Aetna CDH Gold and Highmark Delaware First State Basic plans and to include virtual telemedicine services in all State of Delaware plans.
As part of our commitment to place the highest priority on the health, safety and wellbeing of State of Delaware employees, EAP+Work/Life support services from HealthAdvocate are available to all State of Delaware employees, effective immediately and through September 30, 2020. This means that these services are also available to your temporary, casual seasonal and benefit eligible employees who are not currently enrolled in a State of Delaware Highmark Delaware or Aetna health plan. Also see the attached Health Advocate flyer “Feeling worried about coronavirus?”
100% coverage for COVID-19 testing will be available to members in a State of Delaware State Group Health Plan through Aetna or Highmark Delaware. Copays or coinsurance for COVID-19 testing will be waived.
COVID-19 BENEFIT RESOURCES & INFORMATION
The State of Delaware in partnership with our benefit vendors are offering the following programs to former State of Delaware Group Health Plan members who lost access to coverage during the COVID-19 pandemic.
Express Scripts Parachute Rx℠
Express Scripts is offering a new discount program to help State of Delaware's former health plan members who lost coverage afford their medications and maintain their health without insurance. Express Scripts Parachute Rx℠ is a temporary program to help employees who are unemployed and uninsured as a result of the COVID-19 pandemic obtain prescription drugs at deeply discounted prices at participating pharmacies. Members with questions about Express Scripts Parachute Rx℠ can contact 1-800-939-2142.
State of Delaware's former EyeMed subscribers that terminated between March 31, 2020 and August 31, 2020 will be eligible for the “EyeMed Cares” discount program. EyeMed will send eligible subscribers more information in the mail on the discount program which will also be available to their family members. COBRA subscribers will not be eligible for the discount program unless their COBRA vision benefit terminates during that timeframe. The discount program will run through the end of 2020. For more information, please contact EyeMed's customer service team at 1-855-259-0490.
COVID-19 FREQUENTLY ASKED QUESTIONS BY PROGRAM
Question: What is the date for making COBRA premium payments?
Answer: Payments are considered timely if made no later than 30 days after the first day of the period for which the payment is being made. The time period has now been extended until 60 days after the announced end of the federal COVID-19 National Emergency. As of this time, the National Emergency has been extended until October 23, 2020. ASI COBRA, the state’s administration, has made the necessary system requirement to accept COBRA payments beyond the normal time period. For more information, visit the SBO COBRA page.
Question: I chipped a tooth, but I'm not sure it's an emergency.
Does my state Dental Plan cover teledentistry?
Answer: Yes, both Delta Dental and Dominion Dental are providing coverage for teledentistry. In response to COVID-19. Dominion Dental will allow consultations for limited and problem-focused evaluations, re-evaluations, and physician consultations via teledentistry. Delta Dental will also accept claims for services delivered through teledentistry.
Question: Is there a cost for teledentistry, and how do I submit
Answer: Members with questions regarding their coverage, costs associated with teledentistry, or how to submit a claim for teledentistry should contact their Dental Plan provider.
If you have a question related to your Dental Plan benefits, please email SBO.
Question: Are employees enrolled in the Disability Insurance
Program (DIP) required to file an STD claim?
Answer: All employees enrolled in the DIP are required to file a Short Term Disability (STD) claim with The Hartford if the employee is ill and expects to be out of work for at least 30 calendar days.
(Reference: DIP Rules & Regulations, Rule 5.1)
Question: Are employees enrolled in the DIP who have been
approved to telecommute by their employing organization, eligible to file an STD
- Yes. Active employee means an employee who works on a regular basis in the usual course of State business.
- Employees will be considered actively at work on days they are scheduled to work if they are performing, in the usual way, all of the regular duties of the job on that day.
- Employees will be deemed to be actively at work on a day which is not one of their scheduled work days, if the employee was actively at work on the preceding scheduled work day.
(Reference: STD booklet posted on the Statewide Benefits Office (SBO's) website.
Question: If an employee is quarantined due to exposure to or
diagnosis of Coronavirus (COVID-19), will that be considered a disability and
payable under the Short Term Disability (STD) program?
- Symptom-free quarantine that is either self-imposed or directed does not satisfy the definition of disability in the STD program. Quarantine is not a qualifying medical condition and an employee that has been quarantined and has not tested positive for COVID-19 would not meet the definition of Disability.
- A positive test for COVID-19 is not by itself a disabling condition. An employee would only be considered disabled if they were sick and unable to perform the essential duties of their occupation due to sickness. (Reference: DIP Rules & Regulations – Rules 6.3 & 6.4)
- As with any employee illness, The Hartford will make its coverage determinations based on the specific facts associated with each employee's claim.
Question: If an employee is quarantined but does not test
positive for COVID-19, will the employee be considered disabled and awarded STD
Answer: No. A quarantine is not a qualifying medical condition so the employee would not meet the definition of a disability in the STD program.
Question: If an employee is quarantined and does test positive
for COVID-19, will the employee be considered disabled and awarded STD
Answer: It depends. A positive test for COVID-19 is not by itself a disabling condition. The employee would only be considered disabled if they were sick and unable to perform the essential duties of their occupation due to the sickness.
Question: What is the definition of Total Disability in the STD
Answer: Total disability or Totally Disabled means that an employee is prevented by:
- Mental Condition;
- Substance Abuse;
- Pregnancy; or
- Loss of license due to medical condition;
from performing the essential duties of their occupation, and as a result, the employee is earning 20% or less of their pre-disability earnings.
Question: When should employees who believe they meet the
definition of disability in the STD program, file a claim with The Hartford?
Answer: The current STD claim filing process will remain unchanged and employees are highly encouraged to file their STD claim with The Hartford by the 15th calendar day of absence if they are ill and unable to perform the essential duties of their occupation, to allow sufficient time for The Hartford to obtain medical documentation for a claims determination by the 30th calendar day of absence from work.
(Reference: DIP Rules & Regulations, Rule 9.1.1 and 9.2.1)
Question: If an employee's STD claim is denied or STD benefits
are not extended, can an employee appeal the decision?
Answer: Yes. Employees will be advised of their right to file an appeal by The Hartford.
(Reference: DIP Rules & Regulations, Section 11.0; Appeals – STD Claim Determinations)
If you have a question related to your Disability Insurance benefits, please email SBO.
Question: I'm feeling worried about COVID-19. Does the State offer Employee Assistance Programs + Work/Life Support Services?
Answer: Effective Immediately and through September 30,2020, EAP+Work/Life support Services from HealthAdvocate are available to ALL State of Delaware employees, including temporary, casual seasonal, and benefit eligible employees who are not currently enrolled in a State of Delaware Aetna or Highmark Delaware health plan. Also, for helpful tips, see “Feeling worried about coronavirus?”
Question: How can I learn more about EAP + Work/Life Support
services provided by HealthAdvocate?
Answer: HealthAdvocate is available 24/7 to help you balance the demands of home and work/life. Learn more about EAP services and how to contact HealthAdvocate.
Question: What other resources are available related to
Answer: Other helpful tips and resources are updated frequently and shared on this page under “COVID-19 BENEFIT RESOURCES & INFORMATION”.
If you have a question related to your Employee Assistance Program (EAP) benefits, please email SBO.
Question: Will the Short Plan Year (January 1, 2020-June 30, 2020) or accompanying Grace Period (July 1, 2020 – September 15, 2020) be extended to incur claims?
Answer: On May 12, 2020, the IRS issued a notice allowing employers greater flexibility when administering Flexible Spending Accounts due to the COVID-19 pandemic. The Statewide Benefits Office has made the decision to extend the Grace Period for the six (6) month Short Plan Year from September 15, 2020 until December 31, 2020.
This means employees will now have the time period of January 1, 2020 through December 31, 2020 to incur eligible Health Care FSA and Dependent Care FSA expenses for reimbursement using their short plan year funds. Claims for expenses incurred during this Grace Period will be paid from the oldest year's funds first unless you request otherwise. The deadline to submit claims for the six-month Short Plan Year is January 30, 2021.*
*As per a final IRS rule released on April 28, the deadline to submit claims may be extended through the full period of the National Emergency plus an additional 60 days. At this time, we do not know the ending date of the National Emergency.
Employees concerned with the possibility of remaining funds for the Short Plan Year should review the online FSA Eligible Expenses provided by ASIFlex. Employees can submit for numerous health expenses including:
- Mileage Expenses
- Over the Counter Drugs & Medicines
- Over the Counter Health Care Products
- Menstrual Care Products
- Vision Expenses
Employees may submit for eligible expenses incurred anytime during the Short Plan Year (January 1, 2020 – June 30, 2020) and the extended accompanying Grace Period (July 1, 2020 – December 31, 2020).
Question: Can I make a change or stop my Dependent Care FSA for the Short Plan Year?
Answer: Employees who experience a change in their daycare provider needs or experience a significant change in cost due to school closings may submit an FSA Election Change Form within 31 days of the qualifying event date. COVID-19 related examples include:
- Daycare or Preschool has closed or reduced hours due to COVID-19
- Before/After School Program is not required due to COVID-19 school closings
- Spring Break or other alternate care is not required due to COVID-19
Forms should be submitted directly to the Statewide Benefits Office as soon as possible. Once your need for child care resumes, you may make an additional change to your Dependent Care FSA. You may continue to file for Dependent Care expenses incurred through the end of the Short Plan Year (June 30, 2020), even if you stop your participation.
Question: If I enroll in the Dependent Care FSA effective July 1, 2020 and providers remain closed in the fall, can I change my elections for Dependent Care FSA?
Answer: The continuation of a daycare, preschool or before/after care closure would not be an eligible qualifying event to stop or decrease Dependent Care FSA after Open Enrollment. This is because the original event has already occurred and the request would be more than 31 days from the original qualifying event date.
However, once your need for child care resumes or cost increases, you may make a change to your Dependent Care FSA by completing the FSA Election Change Form within 31 days. This Open Enrollment's election will be for expenses incurred during the Plan Year July 1, 2020 - June 30, 2021 and the Grace Period July 1, 2021 - September 15, 2021.
Employees who experience a change in their daycare provider needs or experience a significant change in cost may submit an FSA Election Change Form within 31 days of the qualifying event date. Examples include:
- Daycare or Preschool reopens and care resumes
- Before/After School Programs reopen and care resumes
- Experience an increase in cost due to change from part time to full time care, summer camp or other alternate care enrollment or change providers
Question: Can I make a change or stop my Health Care FSA?
Answer: Employees may only make a change during the plan year if they experience a qualifying event. Qualifying events include marriage or divorce, change in employment status (that affects eligibility for health insurance), birth or adoption, change in Medicare eligibility or death. FSA plan rules do not allow employees to change or stop their Health Care FSA because they can no longer incur expenses anticipated at the time of enrollment. The Statewide Benefits Office is required to meet all the requirements of the Internal Revenue Service (IRS) and does not have the authority to expand on the FSA Qualifying Events or extend the Plan Year and Grace Period. The Grace Period for the 2020 Short Plan Year is July 1, 2020 through September 15, 2020.
Employees who do experience an eligible qualifying event may submit an FSA Election Change Form within 31 days of the qualifying event date. Forms should be submitted directly to the Statewide Benefits Office.
Question: Will the Grace Period for the 2019 Plan Year be
Answer: No, the Grace Period is set by the IRS and cannot be extended. However, the Statewide Benefits Office is extending the claim submission deadline to June 30, 2020 for the 2019 FSA Plan Year. Claims MUST still have been incurred during the Plan Year(January 1, 2019 – December 31, 2019) or accompanying Grace Period(January 1, 2020 through March 15, 2020).
Question: ASIFlex requested follow-up documentation for one of
my card swipes, but my provider is too busy or is currently unreachable. What do
Answer: ASI Flex has made the business decision to not inactivate debit cards during the immediate crisis. The letters asking for such documentation will soon indicate that the documentation must still be submitted but that ASI will not suspend the card for lack of documentation at this time.
Question: How should I submit my claims?
Answer: ASIFlex, the State of Delaware's provider for the Flexible Spending Account (FSA) Program, has provided additional recommendations for submitting claims during this period, including:
- Use electronic claim filing options: the ASIFlex MobileApp (free on Google Play or the App Store); ASIFlex Online (sign into account detail); or ASIFlex toll-free fax (faxes are received through a secure server)
- GO GREEN and sign up for electronic communications and direct deposit. Employees can sign up by logging into their account or by completing the Go Green form .
- Avoid paper processing and refrain from mailing paper claims.
All questions or concerns regarding the status of your FSA account should be directed to ASIFlex at 1-800-659-3035 or access your account online.
Question: Does the Coronavirus Aid, Relief, and Economic
Security Act (CARES) Act have an effect on my Flexible Spending Accounts?
Answer: Effective January 1, 2020, the Cares Act allows you to use your Health Care FSA for thousands of OTC products without a prescription! Examples include allergy medicines, antacids, cold, cough and flu medicine, pain and fever relievers, sleep aids and digestive aids. In addition, qualifying expenses also now include menstrual care products. Learn More!
Question: Can I change my Health Care FSA election to include
OTC drugs and medicines?
Answer: You cannot change your election now, but you can submit claims for any expenses you incurred January 1, 2020 or later. During open enrollment, you can make a new election taking these eligible expenses into consideration.
Question: How do I submit claims for these items?
Answer: You can submit claims via mobile app, online or by completing a claim form and faxing it toll-free. Remember to provide a copy of the itemized store receipt that shows:
- Merchant name
- Date of purchase
- Itemized description of each product purchased
- Dollar amount paid for each item
Question: Can the ASIFlex debit card be used for OTC drugs and
Answer: Yes. However, merchants will need some time to update their systems for these items to be recognized as eligible. We anticipate that the same merchants who accept cards now for general OTC health care products will accept the cards for OTC drugs and medicines. Please be patient as many merchants are currently understaffed. It is currently anticipated that this process could take up to six weeks.
Question: What if the items do not show as eligible when the
debit card is used?
Answer: Initially, debit cards may not work for these items. If the card cannot be used to purchase these items, the employee can simply snap a picture of the itemized store receipt and submit the claim via the mobile app or file a claim online after scanning the documentation.
If you have a question related to your Flexible Spending Account benefits, please email SBO.
Question: Is the State's Annual Benefits Open Enrollment (May
4-20, 2020) still going to occur?
Answer: Yes, the State is required to hold an annual open enrollment which must take place prior to the start of the plan year. The timing of the annual open enrollment period must allow both benefit eligible employees to make changes and benefit vendors to receive and process any changes before the start of the plan year on July 1st.
Question: Can I enroll a dependent in the State of Delaware
Group Health Insurance Plan (GHIP) if he/she loses employment due to
Answer: According to the Eligibility and Enrollment (E&E) Rule 3.06 , a State employee may enroll a dependent and/or spouse due to loss of employment, in the State Plan without waiting for the next Open Enrollment period as long as the request is made within 30 days of the loss of coverage.
Question: If I am a benefit eligible State employee, covered
under the State plan, but am laid off due to COVID-19, will I still have
Answer: According to E&E Rule 7.01 , coverage ends on the last day of the month in which the employee terminates employment. Coverage under the State plan can be continued under COBRA pursuant to E&E Rule 6.05 .
If a State employee whose position was involuntarily terminated after he/she has been employed for a full year returns to a full-time State position, he/she will be eligible for State Share immediately upon returning. Refer to E&E Rules 8.03 for more information.
Question: Will I still be covered under the State health plan,
if I am a full-time benefit eligible employee (I work 30 or more hours per
week), but my hours are reduced due to COVID-19?
Answer: According to E&E Rule 7.02 , coverage ends as of the end of the month in which the employee ceases to be an eligible employee for coverage (due to some change such as a reduction in the number of hours the employee works). Coverage may be continued under COBRA. Please refer to E&E Rule 6.05 .
Question: Who do I contact if I need to add my spouse/dependent
to my State health plan due to termination from their place of employment and
loss of coverage?
Answer: Contact your Human Resources/Benefits Office within 30 days of termination of coverage to add your spouse/dependent to your State health plan.
Question: If I enroll my spouse/dependent in my State health
plan, due to a qualifying event, when will their coverage become effective?
Answer: Changes in coverage made outside of the annual Open Enrollment period, must be made within 30 days of a qualifying event, pursuant to E&E Rule 4.07 . All forms must be completed and supporting documentation submitted to your Human Resources/Benefits Office within 30 days of the request. If you are enrolling your spouse or dependent due to loss of coverage, the effective date coincides with the date of the loss of coverage.
If you have a question related to your Health Plan benefits, please email SBO.
Question: What are my options for obtaining prescriptions during
the COVID crisis?
Answer: There are ways you can achieve peace of mind with your medications during this time without concern. Here are a few ideas:
- Looking for a longer-term supply? Ask your doctor for a prescription for a 90-day supply of your medication instead of a one-month supply. Your pharmacist can help you obtain the new prescription.
- Want to avoid public places? Use Express Scripts Home Delivery, which can deliver up to 90-day supplies right to your door with free standard shipping.
- Concerned about your medications? Express Scripts pharmacists are available 24/7/365 to answer your questions, offer counseling and support, and even help you transfer your medications to home delivery.
Question: What are options for members to get prescription
refills early during the COVID-19 crisis?
Answer: ESI's disaster medication access policy allows patients to have 3 early refills per prescription during an emergency. The prescription must include available refills and the early refills are subject to clinical review by the pharmacist.
Members also have the option to obtain prescription refills via mail order. Find out more.
In addition, many retail pharmacies are offering a mail order option for members. Encourage your employees to contact their local pharmacy for more details.
Express Scripts has created an exception for CVS, Walgreens and Rite Aid to provide delivery of member's prescription refills, with delivery service available at no additional cost to members. Members should contact the pharmacy for more details.
If you have a question related to your Prescription Plan benefits, please email SBO.
The State’s Vision Plan, administered by EyeMed is required to follow COVID-19 guidance and protocols provided by the Centers for Disease Control and Prevention (CDC), and state and local public health and insurance departments. You can find the most up-to-date information on eye health and COVID-19 on the EyeMed website.
Question: Can I still use my EyeMed benefit?
Answer: Yes. The State Vision Plan benefit administered by EyeMed, is committed to maintaining service and helping members manage through these challenging times. You may receive routine eye care such as your annual eye exam, as well as purchase materials such as frames, lenses, and/or contact lenses in accordance with the State of Delaware vision benefits.
Members will be required to make an appointment in advance. EyeMed strongly encourages you to contact your provider before visiting their office. You can easily find provider contact information or locate a participating provider by accessing the Find a Provider link on State Vision Plan webpage of the SBO website.
For more information, please review the State Vision Plan webpage. If you have any questions, please contact EyeMed’s Customer Care Center at 1.866.939.3633.
Question: What should I expect after I schedule an appointment?
Answer: Eye doctors will be operating with increased safety and sanitation protocols. You can find the most up-to-date information on eye health and COVID-19 on the EyeMed website.
Question: What if I’m high-risk or sick?
Answer: EyeMed understands what a challenge this may be for you and they are here to help. If you have any questions, the EyeMed Customer Care Center is available at 1-866.939.3633.
If you can leave your home but you are high risk...
If you do not have a valid prescription: Many eye doctors are setting aside specific store hours for high-risk patients. Do not just visit an office. Contact your eye doctor to schedule an appointment and make them aware that you are high risk. If you don’t currently have an eye doctor, please review “What are my options for contacting a provider?”
If you have a valid prescription: If you have a valid prescription, you have a couple options. You may set up an appointment to visit an eye doctor. Many eye doctors are setting aside specific store hours for high-risk patients. Do not just visit an office. Contact your eye doctor to schedule an appointment and make them aware that you are high risk. If you don’t currently have an eye doctor, please review “What are my options for contacting a provider?” You may also wish to consider online, in-network options for purchasing new glasses. See “Can I order eyewear/contacts online using my benefits?”
If you are high-risk or sick and can NOT leave your home and need GLASSES:
If you have a valid prescription... your prescription for eyeglasses should be valid unless there’s a documented expiration date. EyeMed’s recommendation is to utilize online, in-network options, including Glasses.com, Ray-Ban.com, LensCrafters.com and TargetOptical.com. See “Can I order eyewear/contacts online using my benefits?”
If you have no eyewear and you have no current prescription... please contact EyeMed’s Customer Care Center directly at 1-866.939.3633 or 1-866.939.3633. You may be eligible to receive an emergency pair of replacement Adlens Adjustable Glasses (subject to availability). These temporary, emergency glasses can be adjusted to switch focus for reading, computer and distance.
If you can NOT leave your home and need CONTACT LENSES:
Please be aware that federal law, Fairness to Contact Lens Consumer Act, mandates the guidelines for issuing and distributing new contact lenses. As it stands today, these federal guidelines may temporarily limit your ability to obtain new contact lenses. Below are a few options:
If you have a valid prescription and it’s less than 12 months since your exam... EyeMed’s recommendation is to utilize online, in-network options, including Contacts Direct, LensCrafters and Target Optical. See “Can I order eyewear/contacts online using my benefits?”
If you have a prescription but it is greater than 12 months since your last exam... your current eye doctor (last office visited) may be able to extend a prior prescription. EyeMed first encourages you to reach out to your current eye doctor (last office visited) to consider your current vision and medical needs and potentially obtain an extended prescription. See “What are my options for contacting a provider?”
If you are unable to reach your current eye doctor for an extended prescription consider utilizing an online, in-network provider, including: Contacts Direct, LensCrafters and Target Optical. You will be asked to complete information online, including submitting your last prescription. Once they receive your information, federal guidelines require them to contact your eye doctor (last office visited) to attempt to deny or approve your order.
If neither of the options above enable you to receive new contact lenses, federal guidelines may prevent you from purchasing new contact lenses. In this situation, you may wish to consider temporarily switching to glasses. Eye glasses may often be able to be produced from a valid prescription older than 12 months so long as it does not include an expiration date, or in the event it does, it has not expired. If you’re interested in new glasses, EyeMed recommends utilizing any of the online, in-network options highlighted above. See “What are my options for contacting a provider?”
If you wear contacts, have no current prescription, do not have glasses and you can’t leave the home due to illness/doctor’s recommendation... unfortunately, you will likely not be able to replace your contact lenses at this time since federal law require a valid prescription less than 12 months old. Please contact EyeMed’s Customer Care Center directly at 1.866.939.3633. If you meet the criteria above, you may be eligible to receive an emergency pair of replacement Adlens Adjustable Glasses (subject to availability). These temporary, emergency glasses can be adjusted to switch focus for reading, computer and distance.
Question: What are my options for contacting a provider?
Answer: EyeMed highly recommends that members call your provider directly to schedule an appointment in advance. The State of Delaware vision members have 24-hour access to provider contact information via EyeMed’s Find a Provider link provider located on the State Vision Plan webpage, EyeMed.com or available mobile app (iPhone and Android). State Vision Plan members may also call EyeMed’s Customer Care Center directly at 1.866.939.3633.
Question: Can I order eyewear online using my benefits?
Answer: Yes. The State of Delaware vision members have multiple options to order prescription eyewear and contact lenses online using your EyeMed benefits. If you meet the qualifications, you have multiple online, in-network options including: Glasses.com, ContactsDirect, Ray-Ban.com, LensCrafters.com, and TargetOptical.com. It’s easy to order, State Vision Plan members benefits are applied automatically, and your glasses will be delivered right to your home. Understanding the circumstances, many of these online providers are offering free expedited shipping and no-cost returns for extra convenience. Check directly with online providers to verify available offers.
Question: What if I visit an out-of-network provider?
Answer: EyeMed highly encourages State of Delaware vision members to use an in-network provider, including available online options - if possible. 97% of EyeMed members use an in-network provider. See, “What are my options for contacting a provider?” or contact EyeMed’s Customer Care Center at 1.866.939.3633. EyeMed will help direct you to an in-network provider, as well as help verify their hours of operation.
If an in-network provider isn’t an option, the best option to assure the fastest turnaround for an out-of-network claim is to submit your claim electronically (verses submitting a paper claim) by signing into your EyeMed online account.
Question: Are telehealth services available for exams?
Answer: No in-home solutions are not available for eye exams. At this point in time, telehealth exams for eye health still require an office visit and are available in very few locations.
Question: What EyeMed service options do I have?
Answer: State Vision Plan members have three service options:
EyeMed’s Customer Care Center is available during normal business hours at 1.866.939.3633.
24/7 service via eyemed.com
Using EyeMed’s self-service tools, State Vison Plan members have access to provider contact information, benefits and eligibility, and more. EyeMed highly encourages you to identify your provider’s contact information via EyeMed’s Find a Provider, and then call the provider office directly to schedule an appointment.
Question: Are laser vision (lasik) centers open during this time, and are there any safety precautions I should be aware of?
Answer: Yes. EyeMed’s partner, LasikPlus, is committed to ensuring the safety of their patients and associates. Visit the LasikPlus COVID-19 Response webpage to learn more about their safety measures.
If you have a question related to your Vision Plan benefits, please email SBO.