Lifetime Assurance Retreatment Plan

LASIK surgeons cannot guarantee their patients will have perfect vision forever. A Lifetime Assurance Plan, however, will assist patients in maintaining their best possible vision with free retreatments when they are medically advisable. If a qualified Eligible Member (see guidelines below) elects to purchase the Lifetime Assurance Plan from a Participating Provider and that Eligible Member requires a refractive surgery retreatment, it will be provided by that Participating Provider at no additional fee.

The Lifetime Assurance Plan is a direct obligation of the Participating Provider to the Eligible Member who purchases the Plan and is not an obligation of LASIK Benefits USA. The Participating Provider is required to continue to fulfill his or her obligations under Lifetime Assurance Plan after termination of their Provider Agreement with LASIK Benefits USA.

What Members are eligible for the Lifetime Assurance Plan?

Lifetime Assurance Plans are available to all Eligible Members who are qualified by an ophthalmologist (see guidelines below) to have a laser vision correction procedure. To maintain eligibility in the Lifetime Assurance Plan, the Eligible Member must obtain annual eye exams from Provider or another qualified vision provider.

How does a Member enroll in a Lifetime Assurance Plan?

Eligible Members can enroll in a Lifetime Assurance Plan by purchasing it from a Participating Provider prior to receiving their laser vision correction procedure. LASIK Benefits USA will make the Eligible Member aware of the program as part of arranging the pre-operative appointment and will include it on both its appointment confirmation and on its follow-up Member survey after surgery. In addition, if the Eligible Member has arranged financing through LASIK Benefits USA, the Lifetime Assurance Plan will be included in the total financing charge. Eligible Members must sign a Lifetime Assurance Plan confirmation stating they understand the conditions of the Lifetime Assurance Plan.

Guidelines

These guidelines relate only to coverage under the Lifetime Assurance Plan and are not guidelines as to whether a retreatment should be performed which is the sole judgment of the Eligible Member and the treating ophthalmologist.

1. A Participating Provider’s ophthalmologist may treat the Eligible Member for correction of nearsightedness, or nearsightedness and astigmatism (but not farsightedness or irregular astigmatism).
2. After the Eligible Member’s initial vision correction surgery (including any first year enhancements in the normal and customary course of treatment) the Eligible Member should have been corrected to 20/40 and have less than 1.00 diopter of astigmatism.
3. Eligible Members treated by the Participating Provider’s ophthalmologist have the option for treatment of their residual refractive errors of 1.00 D or greater so long as the ophthalmologist agrees it is medically advisable. The final decision as to whether or not an Eligible Member should be retreated is made by the Eligible Member with the concurrence of the treating ophthalmologist.
4. Eligible Members that have been diagnosed with certain diseases or eye conditions may not be eligible for the Lifetime Assurance Plan. This includes diseases such as diabetes, active autoimmune, and collagen vascular disorders and eye conditions such as cataracts, glaucoma, diabetic retinopathy, retinal tear, detachment, or macular degeneration. Additionally Eligible Members whose corneas are too thin, have had eye surgery prior to treatment by the Participating Provider’s ophthalmologist, those that have experienced loss of vision as a result of an accident involving trauma to the eye and Eligible Members seeking treatment for presbyopia may not be eligible.
5. The Eligible Member must follow the complete course of post-operative treatment required Participating Provider’s ophthalmologist during the first 12 months after an initial or retreatment vision correction surgery, including post-operative follow-up visits.
6. Following completion of the post-operative treatment period of 12 months, the Eligible Member must have annual eye exams with the Participating Provider’s ophthalmologist or optometrist or other qualified vision provider. If another vision provider is utilized the Eligible Member shall provide evidence of the annual exam(s) to the Participating Provider. Annual exams are not included in this post-surgical care and in rare cases, non-laser treatment may be needed within the first year, for which the Participating Provider may charge a fee.
7. After the Eligible Member’s initial vision correction surgery, if new and/or different technology becomes or is available that the Eligible Member elects to utilize with the concurrence of the Participating Provider’s ophthalmologist, an added charge may be applied for any future procedures or retreatments using the new or different technology.
8. Other than the ophthalmologist’s fees and the per procedure fees of laser manufacturers, this Lifetime Assurance Plan does not cover any additional medical expenses including prescription drugs and medical devices as a result of any procedure provided pursuant to the Lifetime Assurance Plan and all travel costs are the Eligible Member’s responsibility.
9. For the Eligible Member to receive the benefits of this Lifetime Assurance Plan, the Eligible Member must be current in all payments due the Participating Provider for laser vision correction services.

Please keep your original signed copy of this Lifetime Assurance Plan for your records.
Provider Participation may vary.