Frequently Asked Questions
You can easily locate a provider by going to the Provider Search tab. If you prefer to speak with a Customer Service representative, please call 1-800-828-9341.
- Simply search for a provider using this web site or call our customer service line at 1-800-828-9341 for assistance.
- Schedule an appointment and identify yourself as an Avesis member.
- Pay any copays or additional expenses.
Your benefits can be used as frequently as described in the benefits summary. You may purchase additional items beyond the plan allowance at a discount at a participating provider.
With the Basic plan, your exam, lenses and contact lens benefits will reset every 12 months, while the frame benefit will reset every 24 months.
With the Basic Plus plan, your exam lenses, contact lens, and frame benefits will reset every 12 months.
Claim forms and mailing instructions are available here.
Click Here to Sign up
You are eligible to receive services on the first day of the first month after you sign-up provided you have met any required waiting period required by ASEA.
No. Once eligible for services, you may choose a provider from the Avesis Provider Directory or any other provider of your choice. When calling to make an appointment, please let them know that you are a
member of the Avesis plan. They will ask for your member ID number and then the provider will verify your eligibility.
Members who elect to use a non-participating provider must pay the provider in full at the time of service and submit a claim for reimbursement. Reimbursement
levels are in accordance with the non-participating reimbursement schedule listed on your benefit summary. Non-participating benefits are subject to the same eligibility, availability, frequency
of benefits, and limitation and exclusion provisions of the plan.
Yes, you will receive maximum benefits when you go to a participating Avesis provider. The plan does offer out-of-network benefits. Your reimbursement is based upon your benefit schedule.
You have two options:
- You may contact Avesis with the name, address and phone number of the provider and the Network Development department will contact the provider for recruitment.
(OR)
- You may pay for your services and submit your itemized statement to Avesis for reimbursement according to the Non-Participating Reimbursement Schedule.
Your plan is designed to cover eye examinations and corrective eyewear upon payment of any applicable copayments. Should you choose options that are not covered, a discount will be applied, at a particpating provider.
You may choose from a wide variety of frames within the provider's office. You can stay within your
plan allowance and incur no out-of-pocket expenses. Alternatively, if you select a frame with a wholesale cost (what the provider pays the
manufacturer for the frame) that exceeds your plan allowance, your plan allowance will be applied and a discount of 10% to 40 % will apply to any remaining balance.
The plan covers standard single vision, bifocal, trifocal, and lenticular lenses (plastic or glass). If you choose specialty lenses (e.g., progressive), you will receive a discounted retail price and an allowance to use toward that discounted price. Your plan also has lens options that are covered. To see a full list, please refer to your plans benefit summary.
Medically Necessary Contacts are when a vision care provider has determined that spectacle lenses and frames would not achieve the best vision correction
possible due to a medical condition.
In most cases diagnosis such as:
- Keratoconus
- Corneal trauma
- Post cataract surgery
- Anisometropia
will qualify you for medically necessary contacts. Prior approval is required for services.
No. The Avesis plan does not cover medical or surgical treatment for eye disease or eye injury. We recommend, contacting your health plan for assistance in locating an appropriate
medical vision provider. If you have a medical emergency, call 911 right away or go to the nearest hospital emergency room.
Yes. It is not necessary to have your ID card to receive services from an Avesis participating provider. When you make your appointment with the provider and identify
yourself as an Avesis member, the provider will contact us to verify what services you are eligible to receive.
Please call our Customer Service department at 1-800-828-9341. When you call, please identify yourself as an Avesis member. The Customer Service department office
hours are as follows:
Hours: 7:00am - 8:00pm EST, Monday - Friday