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Davis Vision: Fashion Advantage Plan
Plan year July 1, 2006 - June 30, 2007
Summary of Key Provisions
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In - Network Coverage |
Maximum
Out - of - Network Reimbursement |
| How the Plan Works |
All participants, regardless of age, are eligible for a comprehensive eye
examination, contact lens evaluation and fitting, one pair of eyeglass lenses
and frames OR contact lenses once every 12 months.
NOTE: For current participants that will continue in the program, eligibility
for exams, lenses, and frames will be one year from the date that services were
last obtained.
To obtain In-Network coverage, participants must utilize providers in the Davis
Vision network.
Participants who utilize providers outside the Davis Vision network are
responsible for paying all billed charges and will be subsequently
reimbursed(after submitting claim forms to the carrier)up to the specified
out-of-network schedule allowance as stated below.
All percentages noted below represent the amount that the insurance company
pays. If there is a maximum dollar amount listed, the patient would be
responsible for full charges above that amount if applicable.
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In - Network Coverage |
Maximum
Out - of - Network Reimbursement |
| Examination |
100% |
$32 |
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In - Network Coverage |
Maximum
Out - of - Network Reimbursement |
| Eyeglasses |
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100% for the Fashion selection of frames within the Davis Vision
"Collection" or up to $60 toward the cost of a frame from the provider's own
collection.* |
$30 |
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Standard Lenses -
Single
Bifocal
Trifocal
Lenticular
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100%
100%
100%
100% |
$25
$36
$46
$72 |
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Spectacle Lense Options
Tints, Coatings, etc.
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May be selected at the point of service and are available at fixed
discount prices. |
Not covered |
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In - Network Coverage |
Maximum
Out - of - Network Reimbursement |
| Contacts |
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Contact Lens Evaluation and Fitting (one pair)
Daily Wear
Extended Wear
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100%
100%
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$20
$30
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Standard/Conventional
(one pair)
(hard / soft daily wear) |
100% |
$48 |
Specialty Contact Lenses
(including extended wear, hard/soft bifocal, toric, and gas permeable) |
100% up to $75 |
$75 |
| Disposable Contact Lenses
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100% up to $75
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$75
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| Medically Necessary (with prior approval)
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100%
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$225
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Davis Vision: Fashion Advantage Plan
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| Vision Plan Participation Period |
Enrollment now must remain in effect for a two-year period, unless
you experience a change in family status which qualifies you to request a
change at an earlier date. However, you are permitted to change options within
the plan at the next open enrollment. |
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*
One pair of disposable contact lenses is defined as two boxes.
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