What are the rules for using my DHMO dental plan in an emergency?

What vision services does Kelsey-Seybold provide, and where do I need to take my daughter for her eye exam?

Does the HMO medical plan cover immunizations I have to have when traveling out of the country?

Q. My family is covered under the DHMO dental plan. My son needed emergency dental care. What are the rules for using my dental plan in an emergency?

A: The DHMO requires you to select a general dentist to coordinate your dental care. If you are within 75 miles of your general dentist when you have an emergency, contact the dentist, who will make reasonable arrangements for your emergency dental care. All dentists in the DHMO provide access to emergency dental services 24 hours a day, seven days a week.

If you are more than 75 miles from your general dentist, or you cannot reach your dentist or National Pacific Dental Customer Service, you may get emergency dental services from any licensed dentist. If you are required to pay the bill, seek reimbursement from National Pacific Dental. You will be responsible for the DHMO copayment for the service you received.

For more information, contact National Pacific Dental, (800) 232-0990, or benefits customer service, (888) 205-9266 or (713) 837-9400.

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Q: My family’s HMO medical coverage is provided through Kelsey-Seybold Clinic. My daughter needs a routine eye exam and may need prescription glasses. I am confused about the vision services Kelsey provides, and where I need to take my daughter for her eye exam.

A: The HMO plan’s vision coverage is through Cole Managed Vision. The optometrist’s visit includes a $3 copayment for an eye exam and discount prices for prescription glasses. Cole Vision’s network of providers includes Pearl Vision, JC Penny, Sears and Target Optical.

Kelsey-Seybold Clinics provide specialty care visits, such as visits to an ophthalmologist - not routine eye examinations for prescription glasses. If a Kelsey-Seybold optometrist performs a routine eye exam on your daughter, you will pay for this service.
You can find a Cole Vision provider online at www.colemanagedvision.com or by calling (800) 228-2020. Be sure to have your plan number, 57001.1, available when contacting Cole Vision.

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Q: My family is planning to travel out of the country the first of the year and there are several immunizations we must have before traveling. Does the HMO medical plan cover those immunizations?

A: The immunizations required for travel are not covered by the city-sponsored medical plans.

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Pulse readers get answers to benefits questions from the Human Resources benefits division's customer service representatives. Elizabeth Rodriguez answers your questions in this issue.