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HEALTH
PLANS
FOPN has
provided services to some
of the best-known names in Health Care in the
state since we first began providing VISION-CARE
and/or EYE-CARE services to Managed-Care Plans &
Programs in Florida. That includes HUMANA, CARE
PLUS, UNITED HEALTH CARE, NEIGHBORHOOD
HEALTH PARTNERSHIP, VISTA HEALTH
CARE and the JMH HEALTH PLAN.
TYPES OF HEALTH
PLANS: Each Health Plan we work with can structure its own menu
of benefits and options for its members. Many Health Plans offer several
different programs in their portfolios. In fact, its not unusual for a
Managed-Care organization to offer:
COMMERCIAL Plans
Healthy Kids Plans
MEDICARE Plans, and
MEDICAID Plans
Commercial Plans
involve health-care services provided for employees or organization
members. Plans can be structured to include services for the immediate
family of a person covered by the Plan.
Healthy Kids Plans are government-sponsored programs for
children, and
Medicare Plans and
Medicaid Plans are also government-sponsored programs.
SCOPE OF SERVICES: The scope of services we offer Health Plans includes:
Routine VISION-CARE Services
Medical EYE-CARE Services
LASER & DIAGNOSTIC CENTERS
AUTOMATED VOICE-RESPONSE Authorizations
CentralizedFINISHING & PRODUCTION LABS
PROVIDER ADMINISTRATION & CLAIMS PAYMENT
QUALITY IMPROVEMENT Programs
UTILIZATION REPORTING Programs
HEDIS REPORTING Programs
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TAILOR-MADE: To meet the needs of individual health plans, we have developed a full menu of possible Vision-Care and medical Eye-Care benefits, choices and options — all of which can be customized to meet a Plan’s specific goals and objectives, and guidelines provided by Plan administrators or Provider Relations directors.
Typically, Vision-Care benefits are divided into:
• EYE-EXAM BENEFITS
•’PRODUCT’ BENEFITS
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CUSTOM-TAILORED BENEFITS: As we have said above, all of our Vision-Care & Eye-Care plans and programs are customized to meet the specific needs of individual Health Plans, administrators and members. The prices shown here are provided for example only, and may not be accurate, current or appropriate for your particular Health Plan’s goals and membership.
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PROGRAM OPTIONS, including co-payments, might look something like the example provided below:
ITEM |
CO-PAY |
Conditions – Comprehensive Eye Exam |
$ 0.00 |
Frames & Lenses – From ’kit’ selection |
$ 0.00 |
Frame Allowance – For frames other than from Network ‘kit’ |
(– $ 34.00) |
Contact Lenses – Standard contact lens exam, onefollow-up visit& one pair of standard contact lenses:
|
$100.00 |
Limited Primary Medical Benefits – per office visit |
$ 5.00 |
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For more information on
any or all of the topics above, please contact the
FLORIDA OPTOMETRIC PHYSICIANS NETWORK
at:
FOPN_Info@FOPN.org
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