AMERICAN FAMILY LIFE ASSURANCE COMPANY OF COLUMBUS (“AFLAC”)
Last Revised: 03/27/2025
Introduction
American Family Life Assurance Company of Columbus (“Aflac”) establishes a written Access Plan for its participating provider network servicing its members. The network consists of access to providers contracted with Davis Vision, Inc.(referred to herein as “Davis Vision” or “Network”). Aflac Group Vision members have access to all providers within the Network. This Access Plan contains information regarding the accessibility and availability of participating providers within the Network, as well as information on the quality and type of services available to Aflac Group Vision members. This Access Plan is also available online at https://www.aflac.com/aflac-dental-and-vision/aflac-network-access-plans/default.aspx
For more information, please contact the Vice President of Network Development and Credentialing at 813-440-4965, or write to Aflac Benefits Solutions, Inc., Attn: VP of Network Development, 4211 West Boy Scout Blvd., Suite 295, Tampa, FL 33607.
Network Contracting
Aflac has contracted with Aflac Benefits Solutions, Inc. (“ABS”) to administer the Network provisions of the Group Vision program. In addition, Aflac has contracted with SKYGEN USA LLC (“SKYGEN”) to maintain its provider data management systems and maintain the provider directory. ABS and Aflac contract with Davis Vision to access their contracted providers. Aflac monitors the Network to ensure the standards agreed upon are satisfactorily met.
Davis Vision is responsible for credentialing their Network providers. All credentialing organizations comply with all state regulations. ABS has oversight responsibility to ensure the credentialing and quality assurance standards are consistent. A delegated credentialing audit is performed for each leased network and with SKYGEN on an annual basis.
Aflac retains oversight and accountability for all services delegated to ABS and SKYGEN.
Criteria Used to Build Network
The Network considers many factors when adding providers. Every provider must be licensed, maintain adequate professional liability insurance, operate in compliance with all laws and regulations, comply with state board orders, complete all credentialing and recredentialing requirements, and comply with provider agreements, policies and procedures.
Network Adequacy
ABS monitors the availability of providers in the Network by analyzing statistics indicating current employee locations and provider utilization. Monitoring is done monthly through GEO-Access reports that compare the number of providers to the number of members/employees in a given county. Members may request that Aflac send network provider recruitment information to their current providers.
If a network adequacy issue exists, Aflac will provide benefits for the member to receive covered services at the office of an out-of-network general or specialist provider at the same plan allowance as if they utilized a network provider. To request an exception, a member may call the toll-free number on their member ID card for prior approval to see an out-of-network provider. If a network adequacy issue is confirmed, claim payment will be adjusted to ensure the member’s network benefit level is applied to all covered services. The member’s portion of the coinsurance will be based off of the Maximum Allowable Charge (MAC) for the area to ensure the member’s out of pocket costs will be no more than if they had been treated by a participating provider.
Specialty Care Providers
The Aflac Group Vision Plan does not provide for specialty care. Please refer to the Aflac Vision Plan Schedule of Benefits for the routine vision services covered for members.
Referrals
Aflac members have the freedom of choice in selection of a provider and referrals are not required. Members are not required to designate or choose a primary vision provider.
Comprehensive Listing of Network Providers
Aflac ensures members have access to a list of participating Network providers. Any member of the public, including Aflac Group Vision members, can access the online Provider Directory at https://www.aflac.com/about-aflac/providers/dental-provider-search.aspx. To locate a provider, a user will enter their address or City/State/County, then select “Search Now.” The member can narrow the search results by selecting a Provider Specialty type, entering in a provider’s name or practice name, and select the gender. Additional search fields are available including language. The Provider Directory is updated in real time. Aflac Group Vision members can also access their Provider Directory through the member portal.
Any member of the public can access the online Provider Directory; it is available to nonmembers without a login required.
Anyone can request a printed directory or ask for assistance by calling toll-free, 800-999-5431. A request for a printed copy of the provider directory will be completed within five business days.
Ongoing Monitoring
Aflac’s vision network meets Colorado’s adequacy requirements. Aflac’s vision plan provides access to at least one vision provider for at least 90% of our customers within the maximum road travel distance required for each county. Colorado designates each county as one of five geographic types or classifications:
Geographic Type: Maximum Road Travel Distance
- Large Metro: 10 miles
- Metro: 20 miles
- Micro: 35 miles
- Rural: 60 miles
- CEAC (Counties with Extreme Access Considerations): 85 miles
Using GEO-Access reporting, Aflac measures, tracks, and trends network adequacy against the required access standards on a monthly basis in each county/state for each provider type. The reports compile information such as the number of members and their geographic distribution, distance to providers in their closest residential proximity, the percentage of providers accepting new patients, after-hours clinic availability and appointment standards, as well as the type of care (emergency, urgent care, or routine care).
Aflac’s national standards with respect to member accessibility to participating providers are:
- Urban - provider within 30 miles from a member’s residence
- Suburban - provider within 60 miles from a member’s residence
- Rural - provider within 90 miles from a member’s residence
This standard may be modified based on a state’s regulation, if more stringent, or on state and local geographic conditions, such as specialists and member population in the area. The target of participating providers may be geographically distributed differently depending upon the density of population.
The above listed targets are statewide measures, considering rural, urban, and suburban areas. While these targets take into consideration less populated rural areas where a supply of providers is limited, Aflac may require the Network to exceed these targets in urban areas. Aflac will require the Network to make reasonable efforts to contract with providers in extremely rural areas in any state as well as geographic areas with recognized maldistribution of specialists. Service areas are generally approved for an entire state.
This standard may be modified based on a state’s regulation, if more stringent, or on state and local geographic conditions, such as specialists and member population in the area. The target of participating providers may be geographically distributed differently depending upon the density of population.
The above listed targets are statewide measures, considering rural, urban, and suburban areas. While these targets take into consideration less populated rural areas where a supply of providers is limited, Aflac may require the Network to exceed these targets in urban areas. Aflac will require the Network to make reasonable efforts to contract with providers in extremely rural areas in any state as well as geographic areas with recognized maldistribution of specialists. Service areas are generally approved for an entire state.
Evaluation of performance indicators and diligent monitoring of network and enrollment changes assist in identifying any hotspots where member need is high and network concentrations are not in sync. This analysis is the foundation of an informed recruitment strategy, making sure that members have access to optimum high quality general and specialty vision care.
Provider Directory Audit
To maintain a high degree of data accuracy, the provider directory content is verified and updated at least annually or in accordance with state law. Any necessary updates are completed within 24 hours to two business days of receiving updated information.
Members can report a discrepancy in the provider directory by calling Davis Vision’s toll- free number on their member ID card or by sending an email to provider.relations@aflac.com.
Records of the provider directory audit are retained in compliance with Aflac’s corporate record retention schedule.
Needs of Special Population
Aflac has developed various services that are designed to address the special needs of members with limited English proficiency or literacy, diverse cultural and ethnic backgrounds, and with physical or mental disabilities. Our goal is to provide services to members in a manner sensitive to the cultural background, religious beliefs, values and traditions and to those with limited English proficiency or those with physical or mental disabilities. If a member requires special accommodations, they can contact us at the toll-free number on their member ID card or by using RTT 711.
Telehealth Services
Aflac’s vision plan does not currently offer telehealth vision services; however, we will follow any state or federal emergency orders requiring them.
Communication with Covered Members
Members are informed about their Aflac Group Vision Plan benefits through enrollment materials, the certificate of coverage and a secure member portal. Members may seek care from any provider and no prior authorization is required for obtaining emergency services. ABS participating providers are required to have 24-hour telephone access and schedule emergency appointments within 24 hours. Callers who contact us for emergency care are instructed to seek assistance from any licensed provider and if the member does not have a current provider, we will assist the member in finding a provider.
If a member would like to file a complaint, grievance, or appeal with Aflac, the process to do so is on their Explanation of Benefits and in their Certificate of Insurance. Members may also contact us at the toll-free number on their member ID card.
Coordination and Continuity of Care
To ensure coordination for members in the event of a provider’s contract termination, the provider is obligated to cooperate and assist us in transferring members to another provider.
Members may contact us to assist them in finding a new vision provider.
Provider Contract Termination
Participating providers are contractually obligated to complete procedures in progress in the event of contract termination, for a period not to exceed 90 days.
Aflac will make a good faith effort to provide written notice of termination of discontinued providers within fifteen (15) business days, or otherwise as soon as practicable, to all members who are seen on a regular basis (within the past 12 months) by the provider or that receive primary vision services from the provider. Since routine vision providers are not assigned to members, members are encouraged to check the status of an optometrist or ophthalmologist before receiving care.
With the exception of collecting copayments, deductibles, and amounts exceeding (a) benefit maximums or (b) for noncovered services as provided for in a member’s benefit plan, participating providers will only be compensated for covered services provided to a member and providers will not seek compensation, remuneration, or reimbursement from members or persons acting on members’ behalf, other than for allowable copayments, for covered services even Aflac for any reason, including insolvency, fails to pay the provider.
Plan for Insolvency or Other Inability to Continue Operations
Aflac is a well-established, national provider of life and health insurance products. In the unlikely event Aflac should ever become insolvent or otherwise be unable to continue operations, it would ensure members receive uninterrupted vision benefit coverage through the end of the applicable contract period. Aflac would ensure members receive advanced written notice of any anticipated change to Aflac’s business operations.
Quality Assurance Standards
Aflac has established a Quality Assurance Program to identify, evaluate and remedy potential problems relating to access, continuity, and quality of care. The Quality Assurance Program follows basic principles of quality improvement with a team approach of clinical leaders, subject-matter experts, and day-to-day leadership to measure and monitor processes.
Methods for Evaluating Consumer Satisfaction with Services Provided
Aflac monitors member satisfaction through the analysis of member complaints, grievances and appeals. Aflac analyzes, tracks, and trends all complaints, grievances, and appeals and works to rectify any company or provider issues that appear to be trending.
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