basic vision coveragechevron vision program

closeup of man wearing glasses in an open office

enrolled in a chevron medical HMO?

As a reminder, if you are enrolled in a Chevron Medical HMO Plan, basic visions coverage is provided as part of your Medical HMO. Contact your HMO claims administrator directly for information about your basic vision coverage.

the basics

  • If you are enrolled in the Medical PPO Plan, the High Deductible Health Plan (HDHP), the High Deductible Health Plan Basic (HDHP Basic), or a Global Choice Plan, then you’re also automatically enrolled in the Chevron Vision Program for basic vision coverage at no additional monthly premium to you. VSP is the claims administrator for basic vision coverage.
  • The Chevron Vision Program is a preferred provider organization (PPO) health plan, so you can choose to see any provider you choose, network or out-of-network, but using a network provider saves you money.
  • Your basic vision coverage includes 100 percent coverage for preventive care services, as specified by the Affordable Care Act, when you see a network provider. Routine preventive care service includes an annual comprehensive eye exam, including dilation as needed, per calendar year. Contact VSP to understand what’s available. Learn more about preventive care.
  • Your basic vision coverage also includes discounts on eyeglasses, contact lenses, accessories and laser vision correction, all of which are available only from network providers.
  • If you need additional coverage, the voluntary Vision Plus Program provides additional prescription eyewear coverage at an additional payroll deduction that goes beyond your basic vision coverage. 
  • The benefits provided by the Chevron Vision Program are governed by the insurance contract with VSP and are described in the Evidence of Coverage. You should carefully review the Evidence of Coverage to verify what is covered before obtaining services. It also describes the program’s exclusions and limitations and explains how to obtain care, file a claim (if necessary) and appeal a denied claim. For a copy of the Evidence of Coverage, contact VSP or login to the VSP website.

how to at-a-glance

If you're eligible to participate, your enrollment in the Chevron Vision Program is automatic when you enroll in the Medical PPO, HDHP, HDHP Basic or Global Choice Plans.

Tip: When you enroll in health benefits on the BenefitConnect website or through the HR Service Center, know that your election is not immediate with each of the claims administrators. You must wait until your coverage is activated with the claims administrators for your coverage to display in the plan administrator's system.

  • If you enroll during open enrollment, your coverage is fully activated on January 1 of the new year.
  • If you enroll mid-year as a new hire or due to a qualifying life event, please allow at least 7 business days for BenefitConnect/HR Service Center to process your enrollment election with the claims administrators. Know that this could take slightly less or slightly more days, depending on when you enrolled. If you have questions about your election, contact the HR Service Center. (Choose the option for Benefits, then Health coverage.)
You are required to verify the eligibility of any new dependents you enroll in your Chevron health plans. You have up to 60 days to obtain and submit requested documentation that verifies your dependent(s) are eligible to participate in Chevron’s health benefits. If you don’t provide acceptable documentation by the deadline, your dependent(s) will be disenrolled from coverage. Learn more about this process.

A network is a group of independent medical providers that have agreed with your health plan claims administrators to charge contracted fees for services provided to plan members. The VSP provider network is made up of primarily private-practice vision providers across the United States. All VSP private practice doctors provide exams and have materials, such as glasses and contacts, available in their office. 

Retail chain network providers 
VSP members can choose to see a VSP doctor, a participating retail chain provider, or an out-of-network provider. You can choose to visit a Retail Chain Affiliate Provider for added convenience and additional retail locations. These providers are network providers, so network benefits will apply. Retail Chain Affiliate Providers include Visionworks, WisconsinVision, Heartland Vision, Rx Optical and Cohen's.

What happens when I use an out-of-network provider?
You still have the option to see an out-of-network provider for exams or to purchase materials, if you desire, but note that the out-of-network benefit will apply. You may be responsible for paying your vision provider the full amount and submitting a claim to VSP after the visit to request reimbursement.

A note about Costco
We know many employees use Costco for their prescription eyewear. Costco is an out-of-network provider, so out-of-network benefits will apply. But, unlike other out-of-network providers, Costco can submit your claim to VSP. In addition, out-of-network coverage with Costco includes standard progressive lenses fully covered after a $40 copayment.

If you visit a network provider, your provider will usually handle all claims and paperwork for you. If you visit an out-of-network provider you may have to pay the cost out-of-pocket and/or be billed directly from the provider. To be reimbursed for covered services, you’ll have to file a claim form with the claims administrator.

To ensure timely payment, you should file your claim as soon as you can. You must file a claim for payment of benefits no later than 365 days from the date in which service was provided. If you don’t file a proper claim with VSP within this timeframe, benefits for that service will be denied.

Your Chevron Vision Program coverage ends when your Chevron medical plan ends. Active employee medical coverage, if enrolled, continues until the last day of the month in which your employment ends. 

  • You can elect COBRA coverage for you and your covered dependents for your medical plan, which will include continued access to prescription drug and basic vision coverage. If  you timely elect COBRA coverage, your coverage will be retroactive to the date your active employee coverage ended. If you wish to continue medical coverage (and therefore basic vision coverage), you must make an election to continue it.
  • Medical - and basic vision - coverage is available to eligible retirees. If you're eligible for retiree health benefits, there are different decisions and actions required of you. 
    • See if you're eligible for retiree health benefits on BenefitConnect. Go to I need to… on the top navigation, then choose Retiree medical eligibility.
    • Learn about health benefits available to eligible pre-65 retirees here.
    • Learn about health benefits available to eligible post-65 retirees here.

If you are enrolled in the Global Choice Plan (U.S.-Payroll Expatriate) or the Global Choice Plan (Expatriates in the U.S.), then you’re also automatically enrolled in the Chevron Vision Program for basic vision coverage.

  • If you receive covered services outside the U.S., the nonpreferred (out-of-network) level of benefits will apply. You will also need to pay for the service and file a claim for reimbursement later.
  • However, if you use a VSP preferred provider while you're in the U.S., the preferred provider level of benefits will apply for covered materials and services.

plan documents

The summary plan descriptions (SPD) provides specific details about your benefits, such as eligibility, covered services and participation rules. If there recent updates to the SPD since the last publication date, look for the summary of material modification (SMM) included in the very front of the book.

If you are enrolled in the Medical PPO Plan, HDHP, HDHP Basic or the Global Choice Plan (U.S.-Payroll Expatriates), you’re also automatically enrolled in the Chevron Vision Program for basic vision coverage in the U.S. 

If you are enrolled in the Global Choice Plan (Expatriates in the U.S.), you’re also automatically enrolled in the Chevron Vision Program for basic vision coverage for expatriates on assignment in the U.S.

If you are enrolled in a Medical HMO Plan, basic vision coverage is provided as part of your medical plan coverage. Contact your HMO plan or see your medical plan summary plan description for information about your basic vision coverage.

The documents listed below are called a summary of material modification (SMM). An SMM explains recent updates to your plan that are not yet captured or updated in your summary plan description (SPD) since the last publication date. Be sure to review the SMM for an understanding of important plan updates.

Review the benefit summary and highlights to understand basic information about your plan, such as benefits, copayments, deductibles, coinsurance and plan contact information.

contacts

The HR Service Center manages your enrollment in and eligibility for this benefit plan. For all other questions regarding your coverage, contact the claims administrator. A claims administrator manages the administration of your plan — for example, claims, account balances, ID cards, what's covered and what's not, provider networks, phone numbers, the administrator's website or mobile app, and more. 

chevron vision program

  • Eligibility  U.S. Payroll Employees, U.S. Payroll Expatriates, Expatriates in the U.S.
  • Enrollment  Enrollment is automatic when you enroll in the Medical PPO, HDHP, HDHP Basic or Global Choice Plans
  • Claims Administrator  VSP Vision Care (VSP) 
  • Group Number  30021085
  • Network name  VSP Choice
  • Phone (Inside U.S.) 1-800-877-7195 
  • Phone (Outside U.S.) 1-916-851-5000 (Press '0' for operator assistance)
  • Website  www.vsp.com
  • Mobile App   VSP Vision Care app from the Apple App Store or Google Play
  • Claim Form  Forms Library
  • Address  Vision Service Plan │ Attention: Claims Services │ P.O. Box 385018 │ Birmingham, AL 35238-5018

This web page provides only certain highlights about changes of benefit provisions. It is not intended to be a complete explanation. If there are any discrepancies between this communication and the legal plan documents, the legal plan documents will prevail to the extent permitted by law. Oral statements about plan benefits are not binding on Chevron or the applicable plan. There are no vested rights with respect to Chevron health care plans or any company contributions towards the cost of such health care plans. Rather, Chevron Corporation reserves all rights, for any reason and at any time, to amend, change or terminate these plans or to change or eliminate the company contribution toward the cost of such plans. Such amendments, changes, terminations or eliminations may be applicable without regard to whether someone previously terminated employment with Chevron or previously was subject to a grandfathering provision. Some benefit plans and policies described in this document may be subject to collective bargaining and, therefore, may not apply to union-represented employees.