Programs

Avēsis administers a full suite of essential healthcare insurance benefits and programs designed to promote and manage member health and well-being. It’s our mission to build long-term partnerships and deliver valuable, innovative healthcare strategies—one member at a time.

Avēsis has a full suite of essential healthcare benefits and programs designed to promote and manage member health and wellbeing. It’s our mission to build long-term partnerships and deliver valuable, innovative healthcare solutions—one member at a time.

Commercial Vision

We offer two programs for the commercial client. The Avēsis Advantage Plan, our fully insured, standalone program, is offered through brokers and agents to all employer groups and associations, regardless of their size.

Our second is a private label, risk-sharing program, distributed through large managed care and insurance company alliances. Both programs deliver savings to the sponsors and members.

Essential Pediatric Vision

The Avēsis Pediatric Vision Program satisfies the essential health benefits requirement under PPACA. Our Family Vision Plans are the right choice to bring value-added benefits to small group offerings. This program is available for small group and individual markets.

Medicaid Vision

Avēsis has an eye care insurance plan designed exclusively for Government Benefits Administration. We offer administrative insurance services to millions of members throughout the country and can launch efficient programs that meet state guidelines for quality of care. Our experience with ever-changing Medicaid requirements makes administering these programs a breeze, and our Medicaid-specific networks exceed the minimum access requirements of every state we service.

Medicare Advantage Vision

Avēsis delivers value-added vision benefits to a portion of the Medicare Advantage market. Because aging can contribute to a decline in vision health, seniors may have a need for vision-related services. Many Medicare Advantage plans offer these essential benefits to their members. With our vision care program, Avēsis offers Medicare plans the benefit of our 40+ years of experience.

Medicare and Medicaid Hearing

Hearing loss affects the quality of life of millions of Americans. That’s why our hearing care plans are so valuable as a part of complete wellness. Avēsis will customize innovative hearing programs and networks for our clients’ needs, so our health plan partners can rest assured that our members' ears are in good hands.

MMP Hearing

MMP coordinates care for individuals who are eligible for both Medicaid and Medicare (dual eligible or Medicare-Medicaid enrollees). MMP will usually have a unique ID card. Avesis serves MMP members in multiple states and administers hearing benefits on a plan-by-plan basis.

Commercial Discount Plan

Through a special arrangement with Amplifon, Avesis vision members are entitled to discounts on hearing aids, batteries, and more. See our member flyer by clicking here.

For a detailed overview of the plan, please click on the following link https://www.amplifonusa.com/lp/avesis.

Avēsis, a wholly owned subsidiary of The Guardian Life Insurance Company of America, offers the energy and experience you’d expect from a 25-year-old government healthcare benefits administrator, and the innovation you’re looking for. Combined with the strong values and financial strength of our parent company, we ensure that millions of Medicaid and Medicare Advantage enrollees get the right care at the right time in the right place.

Today we efficiently manage care for more than 7.5 million covered lives through our contracts with states and health plans. Our team helps ensure our clients meet their regulatory obligations, while satisfying network providers, reducing costs, and contributing to the improvement of the country's overall health.

We perform three sets of core services for our state and health plan clients:

Operations:
Every aspect of our work is driven by our three corporate values: do the right thing, people count, and we hold ourselves to high standards. This is particularly true for our government operations team, made up of nearly 550 U.S.-based employees who manage core administrative functions like claims processing, utilization review, multi-lingual contact center, and HIPAA-compliant portals.
Clinical and Quality Management:
We do the right thing, which means managing dental and eye care benefits to help ensure your members achieve optimal health. Every day, licensed clinicians in the office and in the field help ensure the care your members receive is compliant with state and federal standards, as well as your benefit plans and clinical goals.
Network Management:
The success of the Medicaid and Medicare Advantage programs we help manage is built on the strength of our provider networks. All are fully compliant with state and federal requirements for government programs, meeting credentialing, access, and appointment standards. With our commercial networks as our starting point, we can build networks in all 50 states.

We invite you to explore case studies and other insights from our Medicaid and Medicare Advantage teams.

You can also contact us to learn more about how we help you achieve your goals for your government programs.

SecureADVANTAGE — Supplemental Gap Policy

MMP coordinates care for individuals who are eligible for both Medicaid and Medicare (dual eligible or Medicare-Medicaid enrollees). MMP will usually have a unique ID card. Avēsis serves MMP members in multiple states and administers hearing benefits on a plan-by-plan basis

The result may be a sizeable reduction in overall premium with little impact to employees’ out-of-pocket expenses.

Programs

Commercial Vision

Essential Pediatric Vision

Medicaid Vision

Medicare Advantage Vision

Medicare and Medicaid Hearing

MMP Hearing

Commercial Discount Plan

Operations:

Clinical and Quality Management:

Network Management:

SecureADVANTAGE — Supplemental Gap Policy

Useful Links

Vision

Dental