Medicare AdvantageCoverageMedium impact
Provider News - January 2017
Security Health Plan·Optometry, Ophthalmology·Provider News
Effective date
Jan 1, 2017
We identified it
Jul 15, 2026
Summary
Security Health Plan Medicare Advantage members now have access to routine eyeglasses stipends effective January 1, 2017, varying by plan ($150-$275). Providers must submit claims to Security Health Plan (not patient-paid claims) and choose one of three billing workflows to handle the stipend application and member balance collection.
Action Required
By January 1, 2017: Billing team must implement one of three eyeglasses billing workflows: (1) collect minimum deposit before order and bill member for balance after claim processes; (2) assume full stipend availability, collect remaining balance at order, bill any remainder after claim processes; or (3) charge full amount upfront and reimburse member if claim pays more than charged. Providers must verify member plan type at point of service to determine correct stipend amount (Essence/$175, Spirit/$175, Assurance Rx/$175, Promise Rx/$175, Surety Rx/$150, Ally Rx D-SNP/$275, Secure Saver MSA/no coverage). Update encounter forms or billing software to capture plan name from member ID card. All eyeglasses claims MUST route to Security Health Plan (not direct member billing). Verify member ID card identifies plan name for easy reference. Document chosen workflow in billing procedures. Failure to submit claims to Security Health Plan will result in claims being processed incorrectly or not at all.