| Services and Materials Paid in Full |
| Eye examination – including dilation as professionally indicated |
One pair of lenses, includes:
|
| UV protective coating |
| Scratch resistant coating |
| Standard anti-reflective coating |
| One pair of frames selected from the Davis Vision Designer Frame Collection (NOTE: Not all frames displayed in a participating Davis Vision provider’s office are part of the Designer Frame Collection. Only those frames that are part of the Designer Frame Collection are covered in full. |
| Materials Requiring Patient Co-Payment | |
| One pair of progressive additional multifocal (in place of standard bifocals): | |
| Standard | $50 |
| Premium | $90 |
| Ultra | $140 |
| Ultimate |
$175 |
| Photogrey lenses (in place of standard lenses) | $20 |
| High-index lenses (in place of standard lenses) | |
| 1.67 |
$55 |
| 1.74 |
$120 |
| Polycarbonate lenses (in place of standard lenses)* | $30 |
| Blended segment lenses (in place of standard lenses) | $20 |
| Polarized lenses (in place of standard lenses) | $75 |
| Anti-reflective coating: | |
| Standard | $0 |
| Premium | $13 |
| Ultra | $25 |
| Ultimate |
$50 |
| Plastic photosensitive lenses (in place of standard lenses), i.e. Transitions | $65 |
| Intermediate vision lenses | |
| Digital single vision lenses |
$30 |
| Trivex lenses |
$50 |
| Scratch protection plan: | |
| Single vision | $20 |
| Multifocal lenses | $40 |
| One pair frames (frames selected from Davis Vision Premier Collection) | $25 |
| Blue light filtering |
$15 |
| One pair frames (frames selected from the Davis Vision Premier Collection |
$25 |
| Collection contact lenses (in lieu of allowance): Materials | $50 |
| Disposable (4 boxes/multi-packs) | |
| Planned replacement lenses (2 boxes/multi-packs) | |
| Evaluation, fitting and follow-up care included | |
| *polycarbonate lenses are covered in full for dependent children, monocular patients, and patients with +/-6.00 diopters or greater |
Other Services
Value Advantage Program: Eligible Fund members may purchase additional eyewear at any time at a discounted wholesale price directly from Davis Vision through the Value Advantage Program. Please contact DavisVision at (800) 406-1656 for more information.
Contact lens allowance: Eligible Fund members who choose not to select a contact lens from the Collection will be eligible for a $74 allowance toward the purchase of non-Collection contact lenses. Please contact DavisVision at (800) 406-1656 for more information.
Mail Order Contact Lenses: Replacement contacts (after initial benefit) are available by logging onto the Davis Vision member website, www.DavisVisionContacts.com. The service provides purchasing online and direct shipping to you.
Davis Vision LASIK Service: Laser vision correction (LASIK) is a procedure that can reduce or eliminate your dependence on glasses or contacts. This corrective service is available to you and your eligible dependents at a special discount with your DavisVision plan. As a Davis Vision member, you may recognize significant savings including 40%-50% off the national average prices of traditional LASIK. Please contact DavisVision at (855) 502-2020 for additional information. The Fund is not recommending or endorsing this procedure, but simply allowing members to access the discount.
