Vision Benefits
Overview of the vision benefits available as part of ERIE's benefits package.
Claims Administrator: Davis Vision
Website: davisvision.com | Phone: 1-800-999-5431
Vision
Benefits | In-Network Coverage | Out-of-Network |
|---|---|---|
Benefits Benefit Frequency (per member) | In-Network Coverage Benefits are provided once every calendar year for exams and either lenses and frames or contacts. | Out-of-Network Benefits are provided once every calendar year for exams and either lenses and frames or contacts. |
Benefits Eye Examination | In-Network Coverage Plan pays 100% after $10 member copayment. | Out-of-Network Plan pays up to $30. |
Frames
Benefits | In-Network Coverage | Out-of-Network |
|---|---|---|
Benefits Retail Frame Allowance (for frames outside the Davis Frame Collection) | In-Network Coverage Plan pays 100% up to $180 at Visionworks locations or $130 at non-Visionworks locations. | Out-of-Network Plan pays up to $30. |
Benefits | In-Network Coverage | Out-of-Network |
|---|---|---|
Benefits Fashion Collection | In-Network Coverage Plan pays 100%. | Out-of-Network No benefit available. |
Benefits Designer Collection | In-Network Coverage Plan pays 100%. | Out-of-Network No benefit available. |
Benefits Premier Collection | In-Network Coverage Plan pays 100% after $25 copayment. | Out-of-Network No benefit available. |
Spectacle Lenses
Benefits | In-Network Coverage | Out-of-Network |
|---|---|---|
Benefits Single Vision | In-Network Coverage Plan pays 100% after $25 copayment. | Out-of-Network Plan pays up to $25. |
Benefits Bifocal | In-Network Coverage Plan pays 100% after $25 copayment. | Out-of-Network Plan pays up to $35. |
Benefits Trifocal | In-Network Coverage Plan pays 100% after $25 copayment. | Out-of-Network Plan pays up to $45. |
Benefits Lenticular | In-Network Coverage Plan pays 100% after $25 copayment. | Out-of-Network Plan pays up to $60. |
Specialty Lens Options
Benefits | In-Network Coverage | Out-of-Network |
|---|---|---|
Benefits Fashion and Gradient Tinting of Plastic Lenses, Oversized Lenses and Standard Scratch-Resistant Coating | In-Network Coverage Plan pays 100%. | Out-of-Network Member pays full cost for out-of-network lens options. |
Benefits Other Specialty Lens Options | In-Network Coverage Member copayments vary. Refer to the Summary Plan Description for benefit details and options. | Out-of-Network Member pays full cost for out-of-network lens options. |
Benefits Scratch Protection Plan Option | In-Network Coverage Member pays $20 for single vision lens plan. Member pays $40 for multifocal lens plan. | Out-of-Network No benefit available. |
Benefits | In-Network Coverage | Out-of-Network |
|---|---|---|
Benefits Contact Lens Evaluation and Fitting | In-Network Coverage Plan pays 100% with in-network provider and purchase of Exclusive Collection lenses. For non-Davis Collection lenses: Plan pays up to $130 and member may also receive a 15% discount on charges above $130 at most in network providers. | Out-of-Network No benefit available. |
Benefits Contact Lens Material Allowance | In-Network Coverage For Davis Collection lenses: Plan pays 100% after $25 copayment and member receives one pair of standard daily wear lenses or up to four boxes/ multipacks of disposable lenses or up to two boxes/multipacks of planned replacement lenses. For non-Davis Collection lenses: Plan pays up to $130 and member receives a 15% discount on charges above $130. | Out-of-Network Plan reimburses up to $75. |
Benefits Medically Necessary Contact Lenses | In-Network Coverage Plan pays 100%, with prior approval. | Out-of-Network Plan pays up to $225, with prior approval. |