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Active Members Information: Vision Plan

Summary

  • Yearly vision exam allowance
  • Standard lenses allowance (spectacle or contact lenses every year); contact lenses maximum plan payment of $150 every year at a participating provider
  • Frames (every two years) -- American or foreign-made frames; maximum $150 allowance at a participating provider

The Vision Program provides you and your eligible dependent(s) with an allowance for a vision examination, lenses and frames or contact lenses in order to achieve normal visual acuity.

The plan uses a panel of participating providers which include ophthalmologists, optometrists and opticians. Services and materials may be provided by a participating provider at minimal cost to you. If you select a non-participating provider, payment will made directly to you according to the established fee schedule.

NVA Offers Active Members the EyeEssentialSM Plan

Your National Vision Administrators (NVA) vision benefit includes coverage for an annual eye exam. Reimbursement for lenses or contact lenses is provided every year. Reimbursement for frames is provided every two years.

There may be times when you would like to purchase another pair of glasses, or you may have lost your glasses and you are not yet eligible for another pair under the Vision Plan. This is where the EyeEssential Plan offered by NVA can help.

After you have exhausted your vision benefits, you are eligible to access the EyeEssential Plan discount on additional purchases. The plan includes significant discounts on materials through participating NVA network providers. With the EyeEssential Plan, you may receive lens discounts of approximately 40%.

The following table shows more detail regarding NVA’s EyeEssential Plan:

NVA EyeEssential Plan Discount – In Network Only
Service Participating Provider Lens Options

Eye Examination:

Contact Lens Evaluation/Fitting:

Lenses:
Single Vision
Bifocal
Trifocal or Lenticular

Frame:		 Member Cost:

Retail less $10

Retail less 10%

Glass or Plastic
$35.00
$55.00
$70.00

Retail less 35%		 Member Cost:

$12 Solid Tint/ Gradient Tint
$50 Standard Progressive Lenses
$75 Polarized Lenses
$65 Transitions Single Vision Standard
$70 Transitions Multi-Focal Standard
$15 Standard Scratch Coating
$12 UV Coating
$35 Polycarbonate
$45 Standard Anti-Reflective
Contact Lenses*:
Conventional
Disposable
Retail less 15%
Retail less 10%

*Discount is not applicable to mail order; however, you may get even better pricing on contact lenses through Contact Fill.

Lens options purchased from a participating NVA provider will be provided to the member at the amounts listed in the fixed option price list above.

Options not listed will be priced by NVA providers at their reasonable & customary retail price less 20%.

For more information, refer to your Summary Plan Description or contact PEBTF.

National Vision Administrators (NVA) www.e-nva.com        1-800-672-7723