Optical Benefits

Enhancements to your cover, effective 1 April 2022

Enhancements to Optical Benefits: 1 April 2022

 

Plus, more savings to our members with special arrangements through

• OPSM, Laubman & Pank, Sunglass Hut (Luxottica group)
• Specsavers

OPSM and Laubman & Pank

Enhancements to Optical Benefits

In addition, OPSM is offering after-hour optical services for emergency services personnel find out more here

OPSM is also offering Clarifye advanced digital eye exams, at no additional cost, at selected stores for more information and to locate a store click here

 

Specsavers

Enhancements to Optical Benefits

^waiting periods Annual Maximums, Rollover Maximums and other conditions apply.

Optical Scenarios

Following are some real-life examples of the increased experience for our members under new Optical arrangements.

Luxottica Store

John has bought a pair of glasses. He is replacing a pair bought in 2021.

For $428, he received single vision lenses with add-ons. Member received the 20% Luxottica discount on lenses and add-ons.

John

Item	Fee	Benefit	New Benefit
Frame	$228.00	$110.00	$228.00
Single Vision Lenses	$156.00	$156.00	$122.00
Reflective Coating	$32.00	$32.00	$0.00
UV Coating	$12.00	$12.00	$0.00
Total	$428.00	$310.00	$350.00
Gap		$118.0	$78.00

John has saved $40 out of pocket.    *Annual Limit Reached

Lucy has never owned glasses. As Lucy has access to Rollover Benefits, she received a higher benefit. Member received the 20% Luxottica discount on lenses and add-ons.

Lucy

Item	Fee	Benefit	New Benefit
Frames	$228.00	$110.00	$228.00
Single Vision Lenses	$156.00	$156.00	$156.00
Reflective Coating	$32.00	$32.00	$32.00
UV Coating	$12.00	$12.00	$12.00
Total	$428.00	$310.00	$428.00
Gap		$118.00	$0.00

Lucy has saved $118 out of pocket. 

Specsavers Store

Steven did not claim optical benefit in 2021. As Steven has access to Rollover Benefits, they received a higher benefit.

Two pair purchased – with Rollover

Patient C

Item	Fee	Benefit	New Fee	New Benefit
Frame	$129.50	$110.00	$97.13	$97.13
Progressive Lens	$220.00	$176.00	$165.00	$132.00
Reflective Coating	$56.00	$41.00	$44.80	$35.84
Frame	$79.50	$79.50	$59.63	$59.63
Progressive Lens	$220.00	$176.00	$165.00	$132.00
Total	$750.00	$528.50	$531.55	$456.59
Gap		$176.50		$74.96

Each pair was greater than $149, so eligible for the 25% glasses discount and 20% off the add-ons.

Steven has saved $101.54 out of pocket.

Tully has bought a pair of glasses. They have joined six months ago and do not have Rollover benefits available yet.

One pair purchased

Tully

Item	Fee	Benefit	New Fee	New Benefit
Frame	$159.00	$110.00	$119.25	$119.25
Single Vision Lens	$160.00	$128.00	$120.00	$96.00
Reflective Coating	$49.00	$39.20	$39.20	$31.36
Total	$368.00	$277.20	$278.45	$246.61
Gap		$90.80		$31.84

Pair was greater than $149, so eligible for the 25% glasses discount and 20% off the add-ons.

Tully has saved $58.96 out of pocket.

Update dependent definition: Effective 1 April 2022

Emergency Service Health literature refers to a number of different types of dependents.

Our Fund Rules refer to the Contributor and dependents. Dependents are any spouse/partner and any child of the Contributor eligible to be covered under your policy. 

From the 1 April 2022, the Fund Rules collectively refers to your children eligible to be covered under your policy as “dependent persons” and are made up of the following types:

• Dependent child;
• Non-classified dependent person;
• Dependent student;
• Dependent non-student; and
• Dependent person with a disability.

A dependent child is where your child is aged under 18 and a non-classified dependent person is when your child is aged 18 and over but under 21.  Together, we refer to these two types of dependent persons as younger dependent children (that is, where the child is aged less than 21 years).

A  dependent student is a child of the Contributor who is 21  years and over,  but under 32 years of age, who is considered to be a full time student of a school, college, or university recognised by our Fund.

A dependent non-student is a child of the Contributor who is 21 years and over but under 25 years of age, and not eligible to be a student dependent.

A dependent person with a disability is a child of the Contributor and the child is participating in the National Disability Insurance Scheme (NDIS) and hence holds an active NDIS plan.  The child may be any age 18 years and over, but would only be registered as a dependent person with a disability if they do not meet any of the other dependent person types.

In all cases a child is taken to include a natural child, adopted child, foster child or a child who is a legal ward of the Contributor or their spouse/partner.

Other than for a dependent person with a disability, a child ceases to be eligible as a dependent on a policy if they are married or in a defacto relationship.

Important Information

Once your children reach an age where they are no longer protected by your cover, they can sign up to their own Emergency Services Health policy without any Waiting Period provided they:

• Take out a policy with cover no greater than yours; and
• Join from their 21st birthday (25th birthday for Gold Combined Extended Family or Single Parent Extended Family).

Or, if your children have been covered as a dependent students, provided they:

• Take out a policy with cover no greater than yours; and
• Join from March 1 following a completed study year, or
• Join from the date they left full-time study, or
• If still a student at the age of 31 years, join from their 32nd birthday.

Or, if your children have been covered as a dependent persons with a disability, but they are no longer participating in the NDIS:

• Take out a policy no greater than yours; and
• Join from the date they ceased to participate in the NDIS.

In all these circumstances, your children have two months in which to join with their premiums being calculated from the date they ceased to be an eligible dependent.