Vision Plan Highlights

Vision Services In-Network Out-of-Network1
Comprehensive Exam
(every 12 months)
$10 copay Up to $40
Spectacle Lenses*
(Every 12 months)

Covered in full after $10 copayment

Single-vision, lined bifocal or trifocal lenses

Up to:

$40 single vision
$60 bifocal
$80 trifocal
$100 lenticular

Frames
(every 12 months)

$140 retail allowance plus 20% off balance

OR

Covered in full;  frame from Davis Vision Collection*($195 value)

 OR

FREE frame at Visionworks

Up to $50

Contact Lens Evaluation/Fitting/Follow Up

(every 12 months)

Collections Contacts: Covered-in-full after $10 copay      OR

Non Collection Contacts:

- Standard Covered in Full after $10 Copay

- Specialty $60 allowance with 15% off less $10 copay

 

Contact Lenses -

if you do not choose eyeglasses

(every 12 months)

Covered in full: any contact lenses from Davis Vision's Contact Lens Collection      OR

$130 retail allowance plus 15% off balance

 

$105 elective

$225 visually required

Value-Added Features

Mail Order - replacement contacts (after initial benefit) through Davisvisioncontacts.com

Laser Vision Correction - Discounts of up to 25 percent off providers fees or 5 percent off advertised specials. One-time/lifetime allowance of $500 is available. For info, call Davis Vision at (877) 923-2847

Claims:

Vision Care Processing Unit, P.O. Box 1525; Latham, NY 12110

1 You may receive services from an out-of-network provider, although you will receive the greatest value and maximize your benefit dollars if you select an in-network provider. If you choose an out-of-network provider, you must pay the provider directly for all charges and then submit a claim for reimbursement. Claim form can be found on the member portion of the website at www.davisvision.com; use client code 7955.