Vision Plan Coverage

The Davis Vision plan provides coverage when you obtain vision care from any provider you wish. Use in-network providers to receive higher coverage and pay less out of your pocket. You receive the highest level of coverage when using Scheie Eye providers. Most services are covered once every 12 months, although you may receive discounts for additional services provided by Davis Vision preferred providers.

	Scheie Eye Providers	Davis Vision Providers	Out of Network
Glasses	Covered once every 12 months
Eye Exam and Refraction	100%	100% after $10 copay	Up to $32 reimbursement
Frames	Up to $100 retail allowance or select from designer frame collection	Up to $65 retail allowance or select from designer frame collection	Up to $30 reimbursement
Standard Lenses
Single	100%	100%	Up to $30 reimbursement
Bifocal	100%	100%	Up to $36 reimbursement
Trifocal	100%	100%	Up to $50 reimbursement
Aphakic/Lenticular	100%	100%	Up to $72 reimbursement
Polycarbonate Lenses
Single	100% if under age 19; discounted prices if age 19 and over	100% if under age 19; discounted prices if age 19 and over	Up to $30 reimbursement
Bifocal			Up to $36 reimbursement
Trifocal			Up to $50 reimbursement
Progressive Lenses	Discounted prices	Discounted prices	Up to $36 reimbursement
Contact Lenses	Evaluation and fitting covered once every 12 months; contact lenses covered once every 12 months in lieu of glasses
Evaluation and Fitting
Daily Wear	100%	100%	Up to $20 reimbursement
Extended Wear	100%	100%	Up to $30 reimbursement
Disposable	100%	100%	Up to $75 reimbursement
Standard Contact Lenses
Medically Necessary	Up to $200 allowance	Up to $200 allowance	Up to $200 reimbursement
Disposable	Up to $80 allowance	Up to $75 allowance	Up to $75 reimbursement
Specialty Contact Lenses	Up to $110 allowance	Up to $75 allowance	Up to $60 reimbursement
Additional Discounts	Discounts available only at the point of purchase
Lens options (e.g., tints)	Discounted prices (tints covered at 100%)	Discounted prices (tints covered at 100%)	Not covered
Additional Eyewear	Discounted prices	Discounted prices*	Not covered
Laser Vision Correction	$1,000 discount	Up to 25% off usual and customary fees or 5% off advertised specials, whichever is less	Not covered

*Members selecting non-covered materials (i.e., second pair of eyeglasses, sunglasses, etc.) will receive up to a 20% courtesy discount and up to a 10% discount on disposable contacts at most participating providers.