Avesis Introduction

With over 30 years of experience building solutions for more than 6500 employer groups, over 20 health plans, and numerous state and government affiliations, Avesis is recognized as a company who delivers quality vision care at affordable premiums to more than 3.6 million members.

Organizations have different needs. Avesis offers hundreds of plan designs that have been created over the years to fit the demands of a diverse workforce. One of the defining elements of the success of the Avesis vision care solution is our flexibility to customize a plan to meet the vision care requirements of any organization.

Avesis members have access to one of the most comprehensive vision care networks in the industry. By contracting with over 25,000 providers from private practice and retail chains, Avesis can deliver excellent coverage, a high quality of care, and nationwide choices to our members. READ MORE

Our members receive one of the best values in vision care. They also have a benefit that is easy to use. With convenient online tools and friendly customer service staff readily available, members can get the most out of their vision care benefit and maximize their chances of remaining healthy.

Quick Avesis Facts

  • In Business Since 1978
  • Independent Providers and Chain Providers
  • Over 25,000 Providers Nationwide
  • Millions of Members Covered
  • Underwriter is rate A- by AM Best Rating MORE
  • Multiyear Rate Guarantee
  • Straightforward Underwriting down to 5 Lives
  • Easy-to-use web tools for all users

Vision Plan Introduction

The Avesis plans are designed to provide your clients with some of the most flexible design options in the industry. Each plan provides coverage for vision examinations, spectacle lenses, frames, contact lenses. and even LASIK.

Employer groups can choose to offer these sought after benefits on an employer paid, 50/50 or the option that is fast becoming the most popular among employers - voluntary.

Materials Only and Exam Only plans are also available for employer groups who offer a vision exam or materials coverage bundled within their medical package. These options will complete the employer's offering, providing members with a full service vision care package.

LASIK surgery has been a popular procedure over the past few years. Avesis is one of the few carriers that offer plan members an option of using a one-time/lifetime funded option toward LASIK services. When using one of Avesis contracted surgeons, members can receive up to a 25% additional discount on LASIK services prior to the funded allowance being applied.

In addition, members will receive unlimited discounts for any purchase made through an Avesis participating provider.

Advantage Enhanced

The Advantage Enhanced plans is a great (low option) introductory plan, best suited for groups who may be looking to install their first vision benefit offering. This option provides coverage for:

  • Vision Examinations
  • Standard Lenses
  • Frames
  • Contact Lenses
  • LASIK

Advantage Plus

The Advantage Plus plans (high option) provide the best coverage options. With a higher allowance for materials, the member can maximize their vision correction choices.

  • Vision Examinations
  • Standard Lenses
  • Frames
  • Contact Lenses
  • LASIK

The Avesis Approach

Up until now, you may have view all managed vision care companies to be pretty much the same. Each has a contracted network of providers, coverage for exams, vision correction materials and variety of price points and coverage levels. While this is true, not all is created equal among the carriers. See below to see how Avesis can be your trusted partner when offering group vision care to your clients.

Our Commitment

Since we have brokers, agents and consultants across the country, Avesis has several regional office locations that allow us to provide a more personal touch to helping our partners market and sell group vision. We have seasoned sales professionals and an Account Management team that are readily accessible to you and your clients.

Who We Cover

Employers today range in all sizes and have requirements that may fit the Avesis model and some that may not. Our current clients range in size to as few as five enrolled to as many as 30,000. With a diverse client mix such as this, Avesis understands how to structure the correct plan designs and effectively administer accounts for practically any industry or company size.

Experienced Vision Professionals

The core of our success centers on the decades of industry knowledge gained at every level of the organization. From sales, to customer service, claims and provider recruiting, Avesis team members are all highly trained with years of experience to support their day to day activities. Our long standing values of giving our customers the care and support they expect has allowed us to have a minimal turn rate, with a high percentage of long term customers. In fact, a high percentage of new Avesis business comes from organizations who were dissatisfied with the level of service provided by their former carrier.

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

$100 - $150

$50 Wholesale Allowance

Every 12 or 24 months

Contact Lenses**

$130 (elective)

Medically Necessary Contact Lenses are covered in full

Every 12 or 24 months

LASIK

$150 (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 $130.00
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.