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Step 1
Step 2: Comparison
Vision Comparison
Step 2 Your Vision Cost Comparison Enroll Now
Employee Only Annual Premium $60.72 $63.60
Employee and Family Annual Premium $146.52 $159.12

Frequency Frequency Frequency
Eye Examination
Once every calendar year Once every calendar year
Spectacle Lenses
Once every calendar year Once every calendar year
Frame
Once every calendar year Once every calendar year
Contact Lens Evaluation, Fitting & Follow-Up Care
Once every calendar year Once every calendar year
Contact Lenses (in lieu of eyeglasses)
Once every calendar year Once every calendar year

In-Network Benefits Copayment Copayment
Eye Examination
$0 $0
Frames
$0 $10
Spectacle Lenses
$10 $10
Contact Lenses and Contact Lens Evaluation, Fitting & Follow-Up Care (in lieu of eyeglasses)
$10 $10
Eyeglass Benefit - Frame Allowance
Plan Coverage Plan Coverage
Any frame at any In-Network Provider
Up to $130 at ANY In-Network Provider
OR
Up to $180 (at Visionworks locations only)
Up to $130
Select frames
Davis Vision's Collection Frames (available only at participating private practice providers)
Fashion & Designer - Covered-In-Full (retail value up to $160)
Premier Frames - $25 Copay (retail value up to $195)
N/A
Discount on any overage costs
20% (at participating network providers) 30% (at participating network providers)

Eyeglass Benefit - Lenses & Lens Options
Member Charges Member Charges
Clear plastic/glass single-vision, bifocal, trifocal or lenticular lenses (any Rx)
$0 $0
Solid Tint
$0 $13
Gradient Tint
$0 $15
Scratch-Resistant Coating
$0 $0
Polycarbonate Lenses (Single and Multi-focal)
$0 $0
Ultraviolet Coating (Plastic)
$12 $16
Ultraviolet Coating (Glass)
$12 $23
Anti-Reflective (AR) Coating (Standard)
$35 $40
Anti-Reflective (AR) Coating (Premium)
$48 $80
Anti-Reflective (AR) Coating (Ultra/Platinum)
$60 $90
Progressive Lenses (Standard)
$50 $70
Progressive Lenses (Deluxe)
$90 $110
Progressive Lenses (Premium)
$90 $150
Progressive Lenses (Ultra/Platinum)
$140 $250
High-Index (Single Vision)
$55 $30
High Index (Single Vision Spectratlite or 1.60)
$55 $40
High Index (Single Vision 1.66)
$55 $54
High Index (Multi-Focal)
$55 $50
High Index (Multi-Focal Spectratlite or 1.60)
$55 $60
High Index (Multi-Focal 1.66)
$55 $69
Glass Photochromic Lenses (Single Vision)
$20 $20
Glass Photochromic (Multi-Focal)
$20 $30
Non-Glass Photochromic (Single Vision)
$65 $50
Non-Glass Photochromic (Multi-Focal)
$65 $65
Scratch Protection Warranty
$20 Single/ $40 Multifocal $10
Contact Lens Benefit (in lieu of eyeglasses)
Contact Lenses: Materials Allowance
Plan Coverage Plan Coverage
Covered Selection Contact Lenses, including Evaluation, Fitting & Follow Up Care (CLEFFU)
Included (retail value up to $200)
Disposable - 4 boxes/multi-packs
Planned Replacement - 2 boxes/multi-packs

Included - Contact Lens Evaluation, Fit & Follow-up Care (retail value up to $60)
Included Up to 4 boxes
Contact Lens Allowance and Evaluation, Fitting & Follow-up Care (CLEFFU)(in lieu of glasses)

$105 allowance

15% discount (CLEFFU)

$105 allowance
Medically Necessary Contact Lenses (with prior approval)
Included Included

Out-of-Network Reimbursement Schedule Plan Pays Plan Pays
Eye Examination
$40 $40
Frame
$45 $45
Single Vision Lenses
$40 $40
Bifocal/Progressive Lenses
$60 $60
Trifocal Lenses
$80 $80
Lenticular Lenses
$80 $80
Elective Contact Lenses
$105 $105
Medically Necessary CL
$225 $175

Other Services
Participating Retailers
Visionworks, Costco, Sam's Club, Walmart, For Eyes and others: For network details visit www.davisvision.com. America's Best, Costco, Eyeglass World, For Eyes, Visionworks, Walmart, Sam's Club and others. Visit www.myuhcvision.com for more.
Participating Private Practice Providers
Yes Yes
Breakage Warranty
INCLUDED at no cost for frames and lenses for one year from delivery date. N/A

 

Disclaimer:

This tool is designed to give you a general idea of what your out-of-pocket vision costs might be in the coming plan year under the two vision plans offered by M-DCPS. Your specific annual costs will depend on the services you use, the vision providers you access and the area in which you receive care and services. Please refer to the plan documents or contact the plans directly for payment information, limitations and treatment schedules related to your specific needs. If the plan documents differ from the information on this site, the plan documents will take the place of this site.