How to Questions

How do I find a provider?

You can easily locate a provider by searching this website. If you prefer to speak with a Customer Service representative, please call 1-800-828-9341.

How do I use the plan?

      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.

To view a online video on how to use your plan click here.

How often can I use my benefits?

Your benefits can be used as frequently as described in the benefits description. You may purchase additional items beyond the plan allowance at a discount. How do I submit a claim for reimbursement to Avesis?

Claim forms and mailing instructions are available here.

Provider Questions

Do I have to select a doctor when I sign up for the vision care plan?

No. Once eligible for services, you may choose a provider from the Avesis Provider Directory. 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 doctor will verify your eligibility.

What is the difference between participating provider benefits and non-participating provider benefits?

Members who elect to use a non-participating provider must pay the provider in full at the time of service and submit a claim to Avesis 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.

Can I go to any provider?

You will receive the maximum benefit when you go to a participating provider. Avesis does offer an out-of-network benefit. Your reimbursement is based upon your benefit schedule.

If my doctor is not on the Avesis directory and I still want to go to him/her for my vision services, what can I do?

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.
      You may pay for your services and submit your itemized statement to Avesis for reimbursement according to the Non-Participating Reimbursement Schedule.

Plan Questions

What is covered?

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 within your plan allowance, a discount will be applied.

What type of frames does Avesis cover through my plan?

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 the wholesale cost of the frame (what the doctor pays the manufacturer for the frame) exceeds your plan allowance, you would pay the difference between the cost and the plan allowance.

What type of spectacle lenses are covered?

Avesis covers standard single vision, bifocal and trifocal lenses (plastic or glass). If you choose specialty lenses (e.g., progressive or, hi-index), you will receive a discounted retail price and an allowance to use toward that discounted price.

What are medically necessary contacts?

Medically Necessary Contacts are required 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 a member for medically necessary contacts. Prior approval is required for services.

If I need medical or surgical treatment for eye disease or an eye injury, should I go to an Avesis provider?

No. The Avesis plan does not cover medical or surgical treatment for eye disease or eye injury. You should contact 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.

If I forget my ID card, can I still receive vision care services from an Avesis participating provider?

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.

If I have questions about my Avesis care plan, whom should I call?

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 M- F: 7am - 8pm (EST)