Enhanced Plan
Avesis vision plans will provide more options for your clients. Both the Plus (high option) and Enhanced (low option) plans have many co-pay and benefit frequency options, making it easy to tailor a plan to your client's specific needs.
In-Network Coverage
Examinations
Covered in Full*
Every 12 or 24 months
Standard Lenses
Covered in Full*
Single Vision, Bifocal, Trifocal, Lenticular
Every 12 or 24 months
Frames
$75 - $100
$35 Wholesale Allowance
Every 12 or 24 months
Contact Lenses**
$110 (elective)
Medically Necessary Contact Lenses are covered in full
Every 12 or 24 months
Refractive Laser Surgery
$100 (elective)***
Plus a discount ranging
from 5% to 25%
One-time/Lifetime Benefit
Lens Options
Avesis providers will give members 20% off their usual and customary (UCR) fees
Progressive Lenses
Avesis providers will give members 20% off their UCR fees for plus a $50 allowance
Specialty Lenses
20% off the Providers UCR, plus the corresponding standard lens reimbursement amount
*After co-pay if applicable for plan design chosen
** In lieu of Frames and Spectacle Lenses
*** Allowance can be increased to $300 or $600. Additional premium required.
Out-Network Coverage
Below is a sampling of our base out-of-network reimbursement schedule. These values can be modified to accommodate your client's coverage needs.
Exam | $35.00 |
Standard Single Vision | $25.00 |
Standard Bifocal | $40.00 |
Standard Trifocal | $50.00 |
Standard Lenticular | $80.00 |
Progressive | $40.00 |
Specialty Lenses | Corresponding Standard Lens Reimbursement |
Frame | $45.00 |
Contact Lenses | $110.00 |
Contact Lenses (Med. Necessary) | $250.00 |
Specialty Lenses
Reimbursed up to the corresponding standard lens reimbursement above
Limitations and Exclusions
Limitations: This plan is designed to cover eye examinations and corrective eyewear. It is also designed to cover visual needs rather than cosmetic options. Should the member select options that are not covered under the plan, as shown in the schedule of benefits, the member will pay a discounted fee to the participating Avesis provider. Benefits are payable only for services received while the group and individual member’s coverage is in force.
Exclusions: There are no benefits under the plan for professional services or materials connected with and arising from: 1) Orthoptics of vision training; 2) Subnormal vision aids and any supplemental testing; 3) Plano (non-prescription) lenses, sunglasses; 4) Two pair of glasses in lieu of bifocal lenses; 5) Any medical or surgical treatment of eye or support structures; 6) Replacement of lost or broken lenses, contact lenses or frames, except when the member is normally eligible for services; 7) Any eye examination or corrective eyewear required by an employer as a condition of employment; 8) Services or materials provided as a result of Workers Compensation Law, or similar legislation, required by any governmental agency whether Federal, State or subdivision thereof.