Does Special Coordination of Benefits (SCOB) apply to the Optical Plan?
Yes. Members and their spouse/ domestic partner who are also members are entitled to SCOB. This entitles each eligible family member, upon presentation at the same time of two (2) validated certificates, to two (2) covered services, one (1) service under each member's benefit record, whether using a participating provider or the direct reimbursement method. In either event, reimbursement to the provider or the member may not exceed the actual charge for the optical service under SCOB.
If the patient does not want the second service, for example, a second pair of eyeglasses at the same time as the first, he or she can either:
- Use the second certificate toward the out-of-pocket amount of the first service; or
- Use the second service any time within ninety (90) days. After ninety (90) days, you must obtain a new validated certificate.