Elmira Family Eye Care
From our office in Elmira, Dr. Carole Wilkinson, Dr. Carolyn Barth and Associates has been serving Ontario residents for more than 30 years.
Call us to make an appointment with our eye doctors to talk about your eyeglasses, contact lenses or specialty lens needs. You are also welcome to drop in anytime to browse through our large selection of designer eyeglass frames and sunglasses.
We believe that providing quality eye care to our patients is a two-way street, so please let us know where we can make improvements or what kind of services you would like to see in the future. Your feedback is important to us.
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Vision Insurance Plan
A vision insurance policy is not the same as health insurance. Regular health insurance plans protect you against financial losses due to unexpected eye injuries or disease. Vision insurance, on the other hand, is a wellness benefit designed to provide routine eye care, prescription eyewear and other vision-related services at a reduced cost. Because we provide both medical and routine eye care, you can submit the receipt to your insurance provider for reimbursement according to your plan details. However, we do look after submitting to MCSS for eligible patients. We also will bill OHIP directly.
There are more options for vision insurance today than ever before. Whether your vision insurance plan is one you choose as an additional benefit in your employer health benefits package, or vision coverage you seek on your own through an insurance company or vision benefits provider, there are basics you should understand to make the most of vision insurance.
Understanding Vision Plans and Coverage
The options available to you in vision plans can be a little daunting. If you’ve chosen your vision insurance through your employer, your HR department and the insurance company literature—and websites—are a good place to start to understand what your vision insurance plan does and does not cover. In general, there are two types of vision insurance plans:
Vision Benefits Package
Often purchased as an addition to traditional employer-provided healthcare, this type of vision insurance includes a fixed set of benefits related to eye health and maintenance, such as routine eye exams and testing, discounts for corrective eyewear, even benefits that reduce the cost of eye surgery. Vision insurance like this typically includes a network of participating eyecare professionals who have agreed to honor the plan particulars.
This type of vision insurance plan has evolved over the years to include more personalized choice for the consumer in the form of defined contribution vision coverage—where you, the consumer, choose the particular services and discount offerings based on what you expect your vision expenses to be.
Many of these vision plans involve using pre-tax dollars deducted automatically by your employer in the form of Flexible Spending Accounts, ‘Cafeteria’ Plans, Health Savings Accounts or Health Reimbursement Accounts. Each has particular tax advantages and drawbacks you should discuss in full with your vision plan administrator or provider, and if necessary, a tax professional.
Vision Discount Plans
While similar to traditional vision benefits, this type of vision insurance is generally less flexible than a vision benefits package because it offers flat discounts across the board for a wide menu of vision-related services, including specified discounts on eye exams, eyeglasses and contact lenses, even many surgical procedures.
You agree to pay the difference in cost in full—however these types of plans generally offer lower premiums than traditional vision benefit plans. Vision insurance like this typically includes a “network” of participating eyecare professionals who have agreed to honor the stated discounts within the vision plan, so long as you agree to pay the difference.
Vision Insurance Planning
It may sound confusing at first, but you can plan to use your vision insurance to your maximum benefit by fully understanding what is specifically covered or not covered under your vision insurance plan, and by also discussing options with your eyecare professional to see how best to apply your particular vision coverage to your eyecare expenses.
This planning includes fully understanding any traditional health insurance coverage you may have. Unexpected eye injury, or the onset of certain eye diseases and their related treatments is often covered by your traditional health insurance rather than your specific vision insurance plan.
The point here is—it’s your vision insurance, your vision coverage—understanding your particular vision insurance plan is critical to maximizing those benefits.
Use it or lose it. Vision insurance benefits do expire.
Depending upon the type of vision insurance plan you’ve enrolled in, your vision insurance benefits may expire annually. This means if you don’t “use it” you “lose it” until the next year. Since you are contributing your hard-earned money toward your vision coverage, there’s really no excuse to skip your annual eye exam or see your optometrist should you experience any changes in your vision.
What’s more, many of the defined contribution vision insurance plans (Flexible Spending Accounts in particular) don’t allow for your deposited money to roll over into the next year. If you don’t spend what you’ve allocated, you may be at risk of losing that money entirely.
Think beyond the traditional examination to a second pair of eyeglasses, prescription sunglasses, photochromic lenses, or eyewear that’s specifically designed to fit your lifestyle. All might be within ready reach if you maximize your vision insurance coverage.
Special thanks to the National Eye Institute, National Institutes of Health, for source material that aided in the creation of this website.
Ontario Health Card
Service Ontario in no longer sending reminders for updating health cards. It is now everyone’s responsibility to ensure their health cards are kept up to date. You can renew your health card by going in person to a Service Ontario Centre or in some situations you will be able to renew your health card online at ServiceOntario.ca/RenewCards .
If your appointment is covered by OHIP we require a valid health card. If you come into the office and discover that your health card is no longer valid, we can still see you. HOWEVER, we will need the updated health card information within one week. If we do not get the updated health card information, you will receive a bill for the appointment, this includes children and senior appointments. These exam fees will be re-imbursed once updated health card information is provided.
FAQs of Vision Insurance Plans
Vision insurance is designed to provide routine eye care, prescription eyewear and other vision-related services at a reduced cost. Learn about types of plans, coverage and payment options.
Individuals can buy a vision benefit plan. Vision insurance plans may be available through your place of employment, school district or through social plans like Medicare or Medicaid.
Indemnity health insurance is traditional insurance, which allows policyholders to access medical providers of their choice. Vision insurance is often a value-added benefit included in indemnity health insurance plans, health maintenance organization (HMO) plans and plans offered by preferred provider organizations (PPOs).
An HMO health plan requires its members to access health care only from HMO providers. HMOs provide health care services to plan members at discounted rates. HMOs include a range of health care professionals – doctors, laboratories and hospitals.
A PPO is a network of health care professionals who provide health care services to membership at discounted rates. Plan members may use out-of-network providers, but they usually will pay more for the services rendered.
Vision insurance comes in two forms, a discount vision plan or a vision benefits package.
- Discount Vision Plan: Eye care at fixed discounted rates after an annual premium or membership fee and a deductible are paid.
- Vision Benefits Package: Usually, a vision benefits package requires an annual premium or membership fee, a yearly deductible for each enrolled member and a co-pay each time a member accesses a service.
Discount vision plans and vision benefits packages are custom-designed to meet the different requirements of a wide range of customers, such as unions, big, mid- size and small companies and school districts.
Standard Vision insurance usually includes the following services and products:
- LASIK and PRK vision correction at discounted rates
- Annual eye examinations
- Contact lenses
- Eyeglass frames
- Eyeglass lenses
Usually, services acquired from network providers are more affordable than services from out-of-network providers.
If group vision insurance is available from your employer, you pay for it through payroll deductions or flexible spending accounts.
A flexible spending account, sometimes referred to as a cafeteria plan, allows an employee to use pre-tax dollars to purchase selected health benefits such as vision insurance. This plan saves your money because you receive the full benefit of income that has been set aside for health costs, making it not subject to or reduced by taxation.
If you are self – employed or if your employer does not offer vision insurance then you can expect to be billed monthly or annually.
Privacy Contact Officer: Dr. Carole Wilkinson
This Notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. If you have any questions please contact our office.
We are required by law to:
- Maintain the privacy of your protected health information
- Give you this notice of our duties and privacy practices regarding health information about you
- Follow the terms of our notice that is currently in effect
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
Described as follows are the ways we may use and disclose health information that identifies you (Health Information, or PHI). Except for the following purposes, we will use and disclose Health Information only with your written permission. You may revoke such permission at any time by writing to us and stating that you wish to revoke permission you previously gave us.
We may use and disclose Health Information for your treatment and to provide you with treatment-related health care services. For example, we may disclose Health Information to doctors, nurses, technicians, or other personnel, including people outside our office, who are involved in your medical care and need the information to provide you with medical care.
We may use and disclose Health Information so that we may bill and receive payment from you, an insurance company, or a third party for the treatment and services you received. For example, we may give your health plan information so that they will pay for your treatment. However, if you pay for your services yourself (e.g. out-of-pocket and without any third party contribution or billing), we will not disclose Health Information to a health plan if you instruct us to not do so.
We may use and disclose Health Information for health care operation purposes. These uses and disclosures are necessary to make sure that all of our patients receive quality care and to operate and manage our office. For example, we may use and disclose information to make sure the care you receive is of the highest quality. Subject to the exception above if you pay for your care yourself, we also may share information with other entities that have a relationship with you (for example, your health plan) for their health care operations.
Treatment Alternatives and Health Related Benefits and Services. We may use and disclose Health Information to contact you and to remind you that you have an appointment with us. We also may use and disclose Health Information to tell you about treatment alternatives or health-related benefits and services that may be of interest to you. We will not, however, send you communications about health-related or non health-related products or services that are subsidized by a third party without your authorization.
When appropriate, we may share Health Information with a person who is involved in your medical care or payment for your care, such as your family or a close friend. We also may notify your family about your location or general condition or disclose such information to an entity assisting in a disaster relief effort.
Under certain circumstances, we may use and disclose Health Information for research. For example, a research project may involve comparing the health of patients who received one treatment to those who received another, for the same condition. Before we use or disclose Health Information for research, the project will go through an approval process. Even without approval, we may permit researchers to look at records to help them identify patients who may be included in their research project or for other similar purposes, as long as they do not remove or take a copy of any Health Information.
Health Information may be used for fundraising communications, but you have the right to opt-out of receiving such communications. Except for the exceptions detailed above, uses and disclosures of Health Information for marketing purposes, as well as disclosures that constitute a sale of Health Information, require your authorization if we receive any financial remuneration from a third party in exchange for making the communication, and we must advise you that we are receiving remuneration.
Other uses and disclosures of Health Information not contained in this Notice may be made only with your authorization.
As Required by Law. We will disclose Health Information when required to do so by federal, state or local law.
We may use and disclose Health Information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Disclosures, however, will be made only to someone who may help prevent the threat.
We may disclose Health Information to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. For example, we may use another company to perform billing services on our behalf. All of our business associates are obligated to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.
If you are an organ donor, we may use or release Health Information to organizations that handle organ procurement or other entities engaged in procurement; banking or transportation of organs, eyes, or tissues to facilitate organ, eye or tissue donation; and transplantation.
If you are a member of the armed forces, we may release Health Information as required by military command authorities. We also may release Health Information to the appropriate foreign military authority if you are a member of a foreign military.
We may release Health Information for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
We may disclose Health Information for public health activities. These activities generally include disclosures to prevent or control disease, injury or disability; report births and deaths; report child abuse or neglect; report reactions to medications or problems with products; notify people of recalls of products they may be using; a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
We may disclose Health Information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
If you are involved in a lawsuit or a dispute, we may disclose Health Information in response to a court or administrative order. We also may disclose Health Information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
We may release Health Information if asked by a law enforcement official if the information is:
- In response to a court order, subpoena, warrant, summons or similar process
- Limited information to identify or locate a suspect, fugitive, material witness, or missing person
- About the victim of a crime even if, under certain very limited circumstances, we are unable to obtain the person’s agreement
- About a death we believe may be the result of criminal conduct
- About criminal conduct on our premises; and
- In an emergency to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime.
We may release Health Information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We also may release Health Information to funeral directors as necessary for their duties.
We may release Health Information to authorized federal officials for intelligence, counter-intelligence, and other national security activities authorized by law.
We may disclose Health Information to authorized federal officials so they may provide protection to the President, other authorized persons, or foreign heads of state, or to conduct special investigations.
If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release Health Information to the correctional institution or law enforcement official. This release would be if necessary:
- For the institution to provide you with health care
- To protect your health and safety or the health and safety of others; or
- The safety and security of the correctional institution
You have the following rights regarding Health Information we have about you.
You have a right to inspect and copy Health Information that may be used to make decisions about your care or payment for your care. This includes medical and billing records, other than psychotherapy notes. To inspect and copy this Health Information, you must make your request, in writing, to our office.
If you feel that Health Information we have is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for our office. To request an amendment, you must make your request, in writing, to our office.
You have the right to request a list of certain disclosures we made of Health Information for purposes other than treatment, payment and health care operations or for which you provided written authorization.
To request an accounting of disclosures, you must make your request, in writing, to our office.
You have the right to request a restriction or limitation on the Health Information we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on the Health Information we disclose to someone involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not share information about a particular diagnosis or treatment with your spouse. To request a restriction, you must make your request, in writing, to our office. We are not required to agree to all such requests. If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment.
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you by mail or at work. To request confidential communication, you must make your request, in writing, to our office. Your request must specify how or where you wish to be contacted. We will accommodate reasonable requests.
You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. You may obtain a copy of this notice in our office.
To obtain a paper copy of this notice please request it in writing.
- Right to Electronic Records
You have the right to receive a copy of your electronic health records in electronic form.
- Right to Breach Notification
You have the right to be notified if there is a Breach of privacy such that your Health Information is disclosed or used improperly or in an unsecured way.
CHANGES TO THIS NOTICE
We reserve the right to change this notice and make the new notice apply to Health Information we already have as well as any information we receive in the future. We will post a copy of our current notice at our office. The notice will contain the effective date on the first page, in the top right-hand corner.
If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. All complaints must be made in writing. You will not be penalized for filing a complaint.