Vision Insurance

¹ Centers for Disease Control and Prevention. “Keep an Eye on Your Vision Health.” Last reviewed 10.1.2020. Accessed 12.4.2020. https://www.cdc.gov/visionhealth/resources/features/keep-eye-on-vision-health.html.

AFLAC VISION – QNV1000 SERIES

In 2021, for all states that have approved the Aflac dental and vision insurance products, coverage will be underwritten by Aflac. In New York, coverage will be underwritten by Aflac New York.

Aflac WWHQ | 1932 Wynnton Road | Columbus, GA 31999.

Applies to Policy Series QNV1000. In Arkansas, policy form QNV1100MAR. In Idaho, QNV1100MID. In Oklahoma, policy form QNV1100MOK. In Oregon, policy form QNV1100MOR and QNV1100MORS. In Texas, policy form QNV1100MTX.

In 2020, Aflac dental and vision insurance coverage is underwritten by National Guardian Life Insurance Company (NGL). National Guardian Life Insurance Company is not a member of the Aflac family of insurers. National Guardian Life Insurance Company is not affiliated with The Guardian Life Insurance Company of America a/k/a The Guardian or Guardian Life. Aflac dental and vision products may not be available in all states. National Guardian Life Insurance Company | Madison, WI.

Applies to Policy Series NVIGRP 5/07 and NVIGRP 11/13. In Pennsylvania, policy form NVIGRP 7/08-PA. In Texas, policy form NVIGRP 11/13 TX (R).

Please see coverage documentation applicable to your situs state for further details. State references refer to the state of your group.

Benefits and/or premiums may vary based on the state and benefit option selected. The plan has limitations and exclusions that may affect benefits payable. The plan may contain a waiting period.

Refer to the policy and certificate for complete benefit details, definitions, limitations and exclusions. This is a brief description of coverage and is not a contract. Read your certificate carefully for exact terms and conditions as well as a complete list of the Schedule of Benefits payable under the plan.

Notice to Consumer: This is a limited benefit plan and provides vision benefits only. Aflac’s contracts of insurance, including Aflac’s network dental and vision plans, provide limited-scope and/or supplemental benefits only and do not constitute comprehensive health insurance coverage. Aflac’s contracts of insurance do not satisfy the requirement of minimum essential coverage under the Patient Protection and Affordable Care Act (ACA) and are not designed to meet any of the essential health benefit requirements mandated by the ACA or federal law, including pediatric oral or vision care services. Aflac’s contracts of insurance are not an alternative to, or a substitute for, comprehensive health insurance coverage and should only be used to supplement comprehensive health insurance coverage.

Limitations and Exclusions for Arizona

Limitations

• Eyeglass lenses and frames are paid in lieu of the contact lenses benefit.
• Contact lenses are payable in lieu of eyeglass lenses and frames.
• Coverage for a late entrant or re-enrollee is limited to the vision exam benefit during the first 24 months after such person’s effective date of coverage.
• Dilation is covered in full under the vision exam benefit only if required by state law or done for one of the following conditions: central vision loss, photopsia, floaters, high myopia, diabetes or history of ocular surgery, ocular trauma or ocular disease.

Exclusions

No benefits are payable for any of the following conditions, services, procedures and/or materials, unless otherwise specifically listed as a covered benefit in the Schedule of Benefits:

• Replacement frames and/or lenses, except at normal intervals when covered services or materials are otherwise available;
• Plano lens or non-prescription lenses or sunglasses;
• Orthoptics, vision training and any associated supplemental testing;
• Frame cases;
• Low (subnormal) vision aids or aniseikonic lenses;
• Medical and surgical treatment of the eyes;
• Charges incurred after (a) the policy ends; or (b) the insured person’s coverage under the policy ends, except as stated in the policy;
• Any eye examination or corrective eyewear required by an employer as a condition of employment;
  • In Arkansas, this exclusion does not apply.
• Services and materials provided by another vision plan except for coordination of benefits;
  • In Utah, this exclusion does not apply.
  • In Ohio and South Dakota, coordination of benefits does not apply.
• Services for which benefits are paid by worker’s compensation;
• Benefits provided under the employee’s medical insurance except for coordination of benefits;
  • In Ohio and South Dakota, coordination of benefits does not apply.
• Blended bifocal lenses;
• Groove, drill or notch, and roll and polish;
• Two pairs of glasses, in lieu of bifocals, trifocals or progressives;
• Coating on lenses (factory scratch coat, anti-reflective, sunglass colors, etc.);
• Cosmetic items;
• Faceted lenses;
• High-index lenses;
• Laminated lenses;
• Oversize lenses – any lens with an eye size of 61mm or greater;
• Photochromic (transition) lenses;
• Polaroid lenses;
• Polished bevel lenses;
• Polycarbonate lenses, except for insured members under 19;
• Prism lenses;
• Slab-off lenses;
• Tints (except pink tint #1 and #2);
• Ultra-violet tint or coating;
• Additional cost for contact lenses over the allowance;
• Additional cost for a frame over the allowance;
• Progressive power lenses;
• In Texas:
  • Services and procedures performed by an ophthalmologist, optician, and optometrist who is the insured person, or a family member.

No benefits are payable for services performed by a member of the insured person’s family. Insured person’s family is limited to a spouse, siblings, parents, children, grandparents, and the spouse’s siblings and parents.

Limitations and Exclusions for Idaho

• Eyeglass Lenses and Frames are paid in lieu of the Contact Lenses benefit.
• Contact Lenses are payable in lieu of Eyeglass Lenses and Frames.
• Dilation is covered in full under the Vision Exam benefit ONLY if required by state law or done for one of the following conditions: central vision loss, photopsia, floaters, high myopia, diabetes or history of ocular surgery, ocular trauma or ocular disease.

Exclusions

No benefits are payable for any of the following conditions, services, procedures and/or materials, unless otherwise specifically listed as a covered benefit in the Schedule of Benefits:

• Replacement frames and/or lenses, except at normal intervals when Covered Services or Materials are otherwise available;
• Plano lens or non-prescription lenses or sunglasses;
• Orthoptics, vision training and any associated supplemental testing;
• Frame cases;
• Low (subnormal) vision aids or aniseikonic lenses;
• Medical and surgical treatment of the eyes;
• Charges incurred after (a) the Policy ends; or (b) the Insured Person’s coverage under the Policy ends, except as stated in the Policy;
• Any eye examination or corrective eyewear required by an Employer as a condition of employment;
• Services for which benefits are paid by Worker’s Compensation;
• Blended bifocal lenses;
• Groove, Drill or Notch, and Roll and Polish;
• Two pairs of glasses, in lieu of bifocals, trifocals or progressives;
• Coating on lenses (Factory scratch coat, anti-reflective, sunglass colors, etc.);
• Cosmetic items;
• Faceted lenses;
• High-Index lenses;
• Laminated lenses;
• Oversize lenses – any lens with an eye size of 61mm or greater;
• Photochromic (Transition) lenses;
• Polaroid lenses;
• Polished bevel lenses;
• Polycarbonate lenses, except for Insured Members under 19;
• Prism lenses;
• Slab-off lenses;
• Tints (except Pink tint #1 and #2);
• Ultra-violet tint or coating;
• Additional cost for contact lenses over the allowance;
• Additional cost for a frame over the allowance;
• Progressive power lenses

No benefits are payable for services performed by a member of the Insured Person's family. Insured Person's family is limited to a spouse, siblings, parents, children, grandparents, and the spouse's siblings and parents.