Producer FAQs

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Questions and Answers

How can I request an Advantica quote or reach a sales representative?

Contact a sales representative at 866-354-2020 and select option 2 to request a quote, or send an email to info@advanticabenefits.com.

What is the minimum group size for an Advantica plan?

Advantica requires a minimum of 2 employees enrolled in a program.

How many providers are in the Advantica network?

Your clients and their employees will have access to a large network of private practice doctors as well as the nation’s leading optical retail brands. To learn more about providers in your client’s area, visit our provider search.

What benefit plan options are available through Advantica?

Advantica offers multiple plans to meet the unique needs of your client. We offer eye health plans for a wide range of companies – from employers with at least 2 employees – up to and including the largest employers. We have plans available for fully insured, self-funded and voluntary programs. Please visit our Vision Plan Options page to learn more.

Will members have to file claims for benefits?

Members will not need to file claims for services received from in-network providers. If your client’s coverage offers out-of-network benefits and an employee visits an out-of-network provider, he or she will be required to submit an Advantica Member Reimbursement Request Form to be reimbursed for the services and materials.

Will members receive an ID card?

Yes, Advantica members will receive an ID card in the mail upon enrollment. If they have not yet received their ID card or have lost their ID card, members may print a temporary ID card online. They will need to create an account using their date of birth and member ID on their first visit.

What if a member loses his or her Advantica ID card?

In the event of a lost or misplaced member ID card, members should contact our customer service center at 866.425.2323, email customerservice@advanticabenefits.com or print a temporary ID card online.

Will members be required to pay a co-pay when they visit a provider?

Yes, members will need to pay a co-pay, a one-time payment for an eye exam or materials, when they visit an Advantica network provider. Members can determine the co-pay amount by logging in to their online account. They will need to create an account using their date of birth and member ID on their first visit.

Will members be required to pay out of pocket for any materials?

Members will be responsible for additional materials or services not covered within their benefits.

  • Photochromic lenses – included in the Advantica plans with a $60 co-pay
  • Progressive lenses – included in the Advantica plans with a $50 co-pay
  • Tinting – $16 at participating discount providers
  • Scratch coating – $16 at participating discount providers
  • Polycarbonate lenses – covered in full for members under the age 19; available to members over the age of 19 with a $30 member cost at participating discount providers

Will members need a claim form if they see a network provider?

Claim forms are not required for services received from Advantica network providers. Participating providers will file all in-network claims.

How will member claims be paid for out-of-network visits?

Out-of-network providers require members to pay for their services. Members will need to submit an Advantica Member Reimbursement Request Form with a copy of the original receipt to:

Advantica Claims Department
PO Box 8510
St. Louis, MO 63126-0510
Fax: (314) 849-4830 or (800) 501-8432
Out-of-network reimbursements are sent directly to Advantica members within 30 days.

Will members be able to choose contact lenses instead of eye glasses?

Yes, subject to plan frequency and co-pay, members can use their benefit to purchase contact lenses in lieu of eye glasses.

What types of lenses can members and their families purchase? Are progressive lenses covered?

To further meet the needs of our members, Advantica plans allow members to purchase the most popular lens options at controlled costs. We recommend that they discuss the benefits and cost differences with their eye doctor. Advantica offers coverage for photochromic lenses and progressive lenses.

  • Standard Progressive lenses are covered in full after a $50 copay.
  • Photochromic lenses are covered in full after a $60 copay.

Is the Advantica frequency limitation based on date of service, or by group contract year?

Frequencies are based on the group's contract period. For example, if a member of a group with a frequency limitation of 12 months and a contract year starting January 1 purchases a pair of frames on January 15, he or she will not be eligible for benefits for new frames until January 1 of the next year.

What coverage will members have for LASIK?

Advantica has partnered with QualSight® to offer preferred pricing to Advantica members who are interested in laser vision correction. QualSight® has a proprietary network of independent, credentialed ophthalmologists at 800 locations nationwide. They also provide a toll-free telephone number, (877) 718-7661, which is specifically dedicated to Advantica members. Different LASIK procedures are available because every patient is different. There is no charge to the member for the initial consultation appointment and the QualSight® provider will advise the patient as to the best procedure that offers the best possible outcome, based upon their prescription and expectations. Out-of-network benefits are not available.

How can members get more information about LASIK and find out if they are eligible?

For information on LASIK benefits from Advantica through QualSight®, click here. QualSight®, the nation’s largest LASIK program manager, offers a managed laser vision correction program through the National Networks of Credentialed Ophthalmologists.

If a member’s vision is corrected through laser correction, will he or she be able to disenroll from Advantica?

No. Members must remain enrolled in the plan through the enrollment plan year, regardless of which covered vision benefits they use.

Does Advantica mail an explanation of payment after services are received?

Members who visited an out-of-network provider will receive an explanation of payment (EOP) along with their reimbursement check. The EOP also accompanies provider payments for in-network services. Members may access a copy of the EOP by logging in to their Advantica account.

How can members find an Advantica provider?

Provider information is updated and made available to members via:

  • Website. Members can use our online provider search engine to locate a provider. Members can find providers, based on distance from a city, state and ZIP code with a search radius between five and 50 miles. The results can include a printable provider directory and driving directions with a map for easy reference.
  • Email Inquiry Service. Members may email provider location requests to customerservice@advanticabenefits.com. A customer service representative will respond (by telephone or email) within 24 hours of the inquiry.
  • Customer Service/Operations Center.
    • Advantica Vision Customer Service at 866.425.2323
    • Advantica Dental Customer Service at 800.501.3471

What if no network providers are available to members?

If members believe there are no network providers available in their area, they should contact us for assistance. We may be able to help find a network provider who is accessible. If no network providers are available, employees will generally be able to visit an out-of-network provider and obtain reimbursement based on their plan, if their plan includes this option. Please refer to the question above, “How will member claims be paid for out-of-network visits?” for further information about reimbursement for out-of-network visits.

Are there optometrists and ophthalmologists in the Advantica provider network?

Yes. The Advantica provider network includes both optometrists and ophthalmologists.

Can members see one network provider for an exam and purchase glasses through another network provider?

Yes, members may visit one network provider for services and another for materials. Network providers will verify eligibility and plan coverage to obtain authorization to provide services. Note: If the member wants to have his or her prescription filled by a network provider, other than the one who performed the exam, he or she should check with the provider first to ensure that the office will fill another doctor’s prescription.

How can members reach customer service?

Advantica vision customer service representatives are available Monday through Friday from 7 a.m. to 6 p.m. Central Time at 866.425.2323

Advantica dental customer service representatives are available Monday through Friday from 7 a.m. to 5 p.m. Central Time at 800.501.3471

You can also contact us by email at customerservice@advanticabenefits.com.

How can a member request that a vision provider be added to the Advantica network?

We encourage clients and members to request provider recruitment into our/the vision network. Requests may be made directly to our/the vice president of network management, through the assigned Advantica account manager, or online using our provider recruitment form.

By mail:
Advantica Provider Relations
380 Park Place, Suite 150
Clearwater, FL 33759
By fax:
(727) 683-8810
By email:
providerrelations@advanticabenefits.com.

What if a member is dissatisfied with a network provider or the materials received through a network provider?

If members have a complaint, they should contact customer service. Advantica vision customer service representatives are available Monday through Friday from 7 a.m. to 6 p.m. Central Time at 866.425.2323. Advantica dental customer service representatives are available Monday through Friday from 7 a.m. to 5 p.m. Central Time at 800.501.3471

Are out-of-network benefits offered with Advantica plans?

Yes, out-of-network benefits are offered with Advantica plans but are generally reimbursed lower than in-network benefits. Members will also be required to submit an Advantica Member Reimbursement Request Form along with the original receipt, to receive payment after visiting an out-of-network provider.