Benefits added in the MAX questionnaire are included in the patient responsibility calculation. Copays applied to the solution display on the upper line of the “Solution” page.


See below for examples of how copays are calculated in Eyemed:


Example 1 - Digital Single Vision (with Package Discount):

Solution:

Calculation Breakdown:

  1. Total U&C Price (in red) = $613.76
  2. Patient Responsibility = (Total U&C – $100 Allowance) – 20%
  3. Patient Responsibility = ($613.76 – $100) – 20%
  4. Patient Responsibility = $411.01 + $10 Package Copay (in blue)
    *Note: The $10 is displayed in the “Copays” line on the “Solution” page
  5. Total Patient Responsibility = $421.01 
    *Note: This is displayed on the “Solution” page under the “Patient Responsibility” column next to “Total”


Example 2 - Lined Bifocal with Frame & Lens Benefit (No Package Discount):

Solution:


Calculation Breakdown:

  1. Total U&C (in red) = $660.70 
  2. Frame Copay calculation:
    1. Frame Copay = (U&C Frame – $100 Allowance) – 10%
    2. Frame Copay = ($190 –  $100) – 10%
    3. Frame Copay = $81 + $15 Frame copay (in blue)
      *Note: The $10 is included in the “Copays” line on the “Solution” page
    4. Total Frame Copay = $96
       *Note: This is displayed on the first line of the “Optician View”
  3. Lens Copay calculation:
    1. Lens Copay = ((U&C DSV Lens – U&C TSV) – $120 Allowance) – 20%
    2. Lens Copay = ($135 - $70) – 120) – 20%
    3. Lens Copay = $12 + $20 Lens copay (in blue)
      *Note: the $20 is included in the “Copays” line on the “Solution” page
    4. Total Lens Copay = $32
       *Note: This is displayed on the second line of the “Optician View”
  4. Total Patient Responsibility = $463.70 (in green)


Example 3 – Digital Single Vision + AR + Frame:


Solution:



Calculation Breakdown:

  1. Total U&C Price (in red) = $623.76
  2. Frame Copay calculation:
    1. Frame Copay = (U&C Frame  – $100 Allowance) – 20%
    2. Frame Copay = ($190  – $100) – 20%
    3. Frame Copay = $72 + $15 (in blue)
      *Note: The $15 is included in the “Copays” line on the “Solution” page
    4. Total Frame Copay = $87
      *Note: This is displayed on the first line of the “Optician View”
  3. Lens Copay calculation:
    1. Lens Copay = ((U&C Lens – TSV U&C) –  20%) –$40 Allowance
    2. Lens Copay = (($135 – $70) – 20% )–$40)
    3. Lens Copay = $12 + $20 DSV copay (in blue) + $15 TSV copay (in blue)
      *Note: the $20 DSV & $15 TSV copays are included in the “Copays” line on the “Solution” page
    4. Total Lens Copay = $47
  4. Total Patient Responsibility = $380.01 (in green)


Example 4 – Progressive Lens + AR + Photochromic + Polycarbonate + UV (No package discount, no frame):

Solution:

Calculation Breakdown:

  1. Total U&C Price (in red) = $619
  2. Progressive Lens Copay calculation:
    1. Progressive Lens Copay = (U&C Progressive Lens – 20%) - $120 Allowance
    2. Progressive Lens Copay = ($225 – 20%) - $120
    3. Progressive Lens Copay = $60 + $90 Tier 4 Premium Progressive copay (in blue)
      *Note: the $90 Tier 4 Progressive copay is included in the “Copays” line on the “Solution” page
    4. Total Progressive Lens Copay = $150
      *Note: This is displayed on the first line of the “Optician View”
  3. AR Copay calculation:
    1. AR Copay = U&C AR – 20%
    2. AR Copay = $175 – 20%
    3. AR Copay = $140
      *Note: This is displayed on the third line of the “Optician View”
  4. Material and Miscellaneous Copay calculation:
    1. Material and Miscellaneous Copays = $40 Polycarbonate copay (in blue) + $75 Photochromatic copay (in blue) + $15 UV Protection copay (in blue)
      *Note: Material and Miscellaneous copays are included in the “Copays” line on the “Solution” page
  5. Total Patient Responsibility = $420 (in green)