The Avesis Vision Plans

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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 and contact lenses. In addition, members will receive unlimited discounts for any purchase made through an Avesis participating provider. Material only plans are also available.

LASIK surgery has been a popular procedure over the past few years. Avesis plan members have an option of using a one-time/lifetime funded option toward LASIK services. Members can receive additional discounts on LASIK services by using one of the Avesis contracted surgeons.

Enhanced Vision Plan

Below is an example of the Avesis Advantage Enhanced Plan

Click Here to View The Avesis Plus Plan

	In-Network	Out-of-Network
Eye Examination	Covered in full	Reimbursed up to $35.00
Spectacle Lenses
Standard Single Vision Standard Bifocal Standard Trifocal Standard Lenticular Progressive Specialty	Covered in full Covered in full Covered in full Covered in full Up to 20% off retail, plus $50 allowance 20% off retail, plus corresponding standard lens reimbursement	Reimbursed up to $25.00 Reimbursed up to $40.00 Reimbursed up to $50.00 Reimbursed up to $80.00 Reimbursed up to $40.00 Corresponding standard lens reimbursement
Lens Options	Preferred Pricing	N/A
Frame	$35 Wholesale Allowance	Reimbursed up to $45.00
Contact Lenses
Elective Medically Necessary	$110 Allowance Covered in full	Reimbursed up to $110.00 Reimbursed up to $250.00
LASIK	$100 Allowance	Reimbursed up to $100.00

Preferred Pricing - Average Savings of 20% off the providers usual and customary fees.

Frame Wholesale Allowance - Approximately $75-$100 retail frame can be obtained when using this plan. All allowances are applied after applicable materials copayment is met.

Contact Lenses - Are in lieu of spectacle lenses and frame. The contact lens allowance is applied after the member receives the Avesis Preferred Pricing when using in-network providers. Contact Lenses are not subject to any copayments.

Medically Necessary Contacts - Require prior approval from Avesis. Copayments are not applicable.

LASIK Surgery - The Avesis Plus Plan offers a $100 allowance towards LASIK services.

Out-of-Network - Copayments are not applicable to out-of-network reimbursements.

Benefit Frequency - Options for either 12 or 24 Months

LASIK

The Avesis plans include a funded option for LASIK services. Allowance amounts of $100 or $150 are available depending on which plan is selected.
Avesis even has plan options for allowances of $300 or $600 to use towards LASIK services.

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.

Plus Vision Plan

Below is an example of the Avesis Advantage Plus Plan

Click Here to View The Avesis Enhanced Plan

	In-Network	Out-of-Network
Eye Examination	Covered in full	Reimbursed up to $35.00
Spectacle Lenses
Standard Single Vision Standard Bifocal Standard Trifocal Standard Lenticular Progressive Specialty	Covered in full Covered in full Covered in full Covered in full Up to 20% off retail, plus $50 allowance 20% off retail, plus corresponding standard lens reimbursement	Reimbursed up to $25.00 Reimbursed up to $40.00 Reimbursed up to $50.00 Reimbursed up to $80.00 Reimbursed up to $40.00 Corresponding standard lens reimbursement
Lens Options	Preferred Pricing	N/A
Frame	$50 Wholesale Allowance	Reimbursed up to $45.00
Contact Lenses
Elective Medically Necessary	$130 Allowance Covered in full	Reimbursed up to $130.00 Reimbursed up to $250.00
LASIK	$150 Allowance	Reimbursed up to $150.00

Preferred Pricing - Average Savings of 20% off the providers usual and customary fees.

Frame Wholesale Allowance - Approximately $100-$150 retail frame can be obtained when using this plan. All allowances are applied after applicable materials copayment is met.

Medically Necessary Contacts - Require prior approval from Avesis. Copayments are not applicable.

LASIK Surgery - The Avesis Plus Plan offers a $150 allowance towards LASIK services.

Out-of-Network - Copayments are not applicable to out-of-network reimbursements.

Benefit Frequency - Options for either 12 or 24 Months