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Vision Plan Benefits
| Davis Vision Plan | The Optional Plan | |||
| Preferred Provider | If you use a participating Davis Vision provider, you will not have to pay anything. Locate a Davis Vision Provider at www.davisvision.com | You may use your own provider; however, you will only be reimbursed up to the maximum allowance listed below | ||
| What the Plan Covers | - Glass or plastic single vision, bifocal or trifocal lenses (You may select two complete pairs of eyeglasses, one for near vision, one for distance vision, in lieu of receiving a bifocal) - Oversize and over diopter (high power) lenses - PGX (photosensitive) glass lenses - Glass grey #3 prescription sunglasses lenses - Progressive addition lenses - Supershield coating for both single vision and multi-focal lenses - Polycarbonate lenses for children and monocular patients The Davis Vision provider will provide detailed information about the options that are available to you under this Plan. (see Summary Plan Description for exceptions). | - Refraction and pathological examination by an optometrist, including the fitting of glasses and the verification of prescription lenses. Maximum $20 - Complete medical eye examination (exclusive of treatment), refraction, and pathological examinations by an ophthalmologist, including the fitting of glasses and the verification of prescription lenses. Maximum $30.00 - Frame (when prescription lenses are required) Maximum $20.00 - Lenses: - Single vision: Single $15.00/ Pair $30.00 - Bifocal: Single $20.00 / Pair $40.00 - Trifocal: Single $25.00 / Pair $50.00 - Repair or replacement of broken or damaged frame or lenses, if it can be satisfactorily shown that the existing frame or lenses cannot be made serviceable: Frame $10.00 / Lenses: as above. |
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| Filing a Claim | There is no need to file a claim. | Pay in full and file for the reimbursable amount within 90 days. Reimbursements are sent to the member not the provider. Click here for a claim form. | ||
| Summary Plan Description | ||||
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