FEP Intl_FINAL_OPM

FEP BlueVision
®
International Benefits
See Clear Across the Globe with
FEP BlueVision International Benefits
®
Did You Know...
A comprehensive eye exam can detect a number of eye
diseases, as well as signs of systemic conditions such as
diabetes, thyroid disease, high blood pressure and
neurological impairments.
FEP BlueVision helps you care for your family while saving
you money. When making decisions about your eye care,
®
FEP BlueVision is the clear choice.
®
Provider Choice: Federal employees, annuitants and their
eligible family members who choose to travel or live outside
of the United States and Puerto Rico are entitled to
®
FEP BlueVision International Benefits.* Since we do not
maintain a network of providers outside the United States
and Puerto Rico, you may utilize the provider of your
choice. International providers are under no obligation to file
claims on your behalf, so you may need to pay the provider
in full at the time of service and then submit a claim.
Translation and currency conversion services are provided
free of charge. You will be reimbursed for covered services
up to the amounts shown here and in your benefit brochure.
Claim forms are available on our website www.fepblue.org.
Click on “Find A Form”, then “Forms” to find the
FEP BlueVision Claim Form at the bottom of the listing.
Completed claim forms and itemized bills should be sent to:
FEP BlueVision
PO Box 2010
Latham, NY 12110-2010
Claims may also be faxed to (518) 220-6555 or email us at
fepmemberhelp@davisvision.com to let us know you would
like to submit your claim via email. We will respond with
instructions on how to securely submit your claim.
®
Enroll & Travel with FEP BlueVision
For more information, call:
00+1(888)550.BLUE (2583)
or 1(518)220.BLUE (2583)
or TTY 1.800.523.2847
To enroll, visit www.BENEFEDS.com
2016 PREMIUMS
PREMIUMS
BI-WEEKLY
MONTHLY
STANDARD
HIGH
STANDARD
HIGH
$3.83
$5.11
$8.30
$11.07
Self
Self + One
$7.66
$10.23
$16.60
$22.17
Family
$11.48
$15.34
$24.87
$33.24
YOUR BENEFITS*
SERVICES/
MATERIALS
Exam
Single Vision Lenses
WE PAY
WE PAY
(STANDARD OPTION)
(HIGH OPTION)
Up to $60
Up to $60
Up to $72
Up to $72
Bifocal Lenses
Up to $109
Up to $109
Trifocal Lenses
Up to $136
Up to $136
Lenticular Lenses
Up to $136
Up to $136
Contact Lenses
Up to $130
Up to $150
Frames
Up to $130
Up to $150
*This is a summary of the features and benefits of FEP BlueVision. For a complete
description, please refer to your benefit brochure. The discount of laser correction
procedures (LASIK and PRK) is only available through network providers; therefore,
the discount on these procedures is not available for services received overseas.
LIVING FEARLESS IS HAVING
FEP BLUEVISION BENEFITS.
®
Customer Service (Eastern time)
Monday - Friday 8a.m. - 11p.m.
Saturday 9a.m. - 4p.m.
Sunday 12p.m. - 4p.m.
8.15FEPINTL