TIER ONE INSURANCE COMPANY (“TIER ONE”)
Last Revised: 03/27/2025
Introduction
This is Tier One’s vision network access plan (“Access Plan”). Tier’s One’s vision network (“Network”) provides access to providers contracted with EyeMed Vision Care, LLC. (“EyeMed”). This Access Plan contains information regarding the accessibility and availability of providers participating in the Network (“Network Providers” or “Providers”), as well as information on the quality and type of services available to Tier One vision customers.
This Access Plan is available for review online at https://aflacadvantage.com/aflac-dental-and-vision/aflac-network-access-plans/default.aspx. For more information, please contact Aflac Benefit Solutions, Inc (“ABS”), Vice President of Network Development and Credentialing at 877-864-0625, or write to: ABS Dental & Vision, Inc., Attn: VP of Network Development, 4919 W. Laurel Street, Tampa, FL 33607.
Network Contracting
Tier One has contracted with Aflac Benefits Solutions, Inc. (“ABS”) to administer the Network provisions of the Vision program. ABS and Tier One contract with EyeMed to access their contracted providers. Tier One monitors the Network to ensure the standards agreed upon are satisfactorily met.
EyeMed is responsible for credentialing their Network providers. All credentialing organizations comply with all state regulations. ABS has oversight responsibility to ensure the credentialing and quality assurance standards are consistent. A delegated credentialing audit is performed for each leased network on at least an annual basis.
Tier One retains oversight and accountability for all services delegated to ABS and EyeMed.
Provider Access
Tier One customers have the freedom of choice in selecting a Network Provider. Customers are not required to designate or choose a primary Provider. Tier One also does not require a referral in order to select or change a Provider.
Comprehensive Listing of Participating Providers
Tier One ensures customers and the general public can access an up-to-date list of Network Providers in a variety of ways.
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Online Provider Directory
Any individual can view the Network’s Provider Directory online. To locate a Provider, an individual will select '’Insight Network” from the Network drop down list located at https://eyedoclocatorashuat.eyemedvisioncare.com/aflacdirect/en. The individual will select Use My Location or enter his/her Zip Code and then click Search. The individual can narrow the search results by the use of filters and can print his/her search results. The Provider Directory is updated daily.
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Customer Service
An individual may contact Customer Service at (866) 945-1353 to find a Provider or to obtain a paper copy of the Provider Directory.
Provider Types by County
The provider types available within each West Virginia county are in the chart below.
Provider Type Available: County Name
- Optometry: Berkeley, Boone, Brooke, Cabell, Gilmer, Grant, Greenbrier, Hancock, Harrison, Jefferson, Kanawha, Logan, Marion, Mercer, Mineral, Mingo, Monongalia, Ohio, Preston, Putnam, Raleigh, Randolph, Ritchie, Roane, Taylor, Upshur, Wayne, Wetzel, Wood, Wyoming
- Ophthalmology: Cabell, Fayette, Kanawha, Ohio, Raleigh
Network Adequacy Process
Network Development and Adequacy
EyeMed is responsible for Network development. EyeMed considers the number of Network Providers in a geographic area and works to maintain a sufficient number of Providers as required by applicable standards. EyeMed chooses Providers based on their access and availability, credentials, cost efficiency and other factors.
Tier One retains responsibility to ensure the Network is consistent with applicable adequacy standards. Tier One will require EyeMed to make reasonable efforts to contract with Providers in rural areas in any state and in areas with recognized maldistribution of optometrists and ophthalmologists.
EyeMed’s vision network includes thousands of independent providers, popular retailers and online options so customers can see who they want to see, where and when they want to see them. EyeMed builds their networks based on how many providers there are in a specific area and the provider's ability to meet network participation standards. They reimburse providers a contractual fee for each service they provide to ensure that they have enough providers available to meet routine vision care needs.
If a customer wishes to nominate a provider to join the Network, the customer can complete a Provider Nomination Form, located at https://www.eyemedvisioncare.com/theme/pdf/microsite-template/EyeMed_Provider_Nomination_Form.pdf. EyeMed’s provider relations team will review the nomination and evaluate the provider against network management rules. If the nomination is approved, the provider relations team reaches out to the provider to discuss joining the Network.
EyeMed requires that Providers offer non-urgent appointments within two weeks of request and that urgent care services be performed the same day as the request.
The Tier One vision plan does not provide for specialty care. Customers should refer to their Policy Schedule to determine routine vision services covered.
Coordination and Continuity of Care
To ensure coordination for members in the event of a provider’s contract termination, the provider is obligated to cooperate and assist us in transferring members to another provider.
Members may contact us to assist them in finding a new vision provider.
Provider Contract Termination
Participating providers are contractually obligated to complete procedures in progress in the event of contract termination, for a period not to exceed 90 days.
With the exception of collecting copayments, deductibles, and amounts exceeding (a) benefit maximums or (b) for noncovered services as provided for in a member’s benefit plan, participating providers will only be compensated for covered services provided to a member and providers will not seek compensation, remuneration, or reimbursement from members or persons acting on members’ behalf, other than for allowable copayments, for covered services even Aflac for any reason, including insolvency, fails to pay the provider.
Plan for Insolvency or Other Inability to Continue Operations
Tier One is part of the Aflac family, a well-established, national provider of life and health insurance products. In the unlikely event Tier One should ever become insolvent or otherwise be unable to continue operations, it would ensure members receive uninterrupted vision benefit coverage through the end of the applicable contract period. Tier One would ensure members receive advanced written notice of any anticipated change to Tier one’s business operations.
Communication with Customers
Consumers may learn about Tier One vision plan benefits by visiting www.myaccount.aflac.com. Customers may review their Tier One vision plan benefits by viewing their policy, visiting the customer service portal or contacting Customer Service at (866) 945-1353.
Customer Satisfaction and Appeals Process
If a customer would like to file a complaint, grievance or appeal the processes to do so can be found in their policy and at https://eyemed.com/en-us/member-bill-of-rights. Customers may also contact Customer Service at (866) 945-1353 to obtain information about their rights.
Quality Assurance Standards
EyeMed has established an extensive Quality Assurance Program to allow EyeMed to identify, evaluate and remedy potential problems relating to access and quality of care.
Needs of a Diverse Population
ABS and Tier One provide services to a highly diverse population. Our goal is to address the needs of our customers, including but not limited to those with limited English proficiency or illiteracy, diverse cultural or ethnic backgrounds, physical or mental disabilities, and serious, chronic or complex medical conditions.
EyeMed’s participating network providers are required to provide services in a culturally competent manner to all customers, including those with limited English proficiency or reading skills, diverse cultural and ethnic backgrounds, physical and mental disabilities and health conditions. Annual cultural competency training is required to help providers and staff members understand how to deliver care across cultures and patients with disabilities.
For claims language assistance, call (866) 945-1353. For alternate formats, call 888-249-5194. Access TTY / RTT services by dialing 711.
For general policy assistance, call 866-990-2668.
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