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Vision Care Plan Benefit Description
Wappingers Congress of Teachers Welfare Trust Fund is very pleased
to provide this information about your vision care plan administered
by Davis Vision, Inc., a leading national administrator of routine
vision care programs. Eligibility for vision care benefits is
determined by the same rules that apply to your other health
How do I receive services from a provider in the network?
Call the network provider of your choice and schedule
Identify yourself as a member or covered dependent of
the Wappingers Congress of Teachers Welfare Trust Fund.
Provide the offce with the member's Identification number
and the date of birth of any covered children needing services,
Its that easy! The provider's office will verify your eligibility
for services, and no claim forms or ID cards are required!
Who are the network providers?
They are licensed providers who are extensively reviewed and
credentialed to ensure that stringent standards for quality service
are maintained. Please call 1-800-999-543 I to access the Interactive
Voice Response (IVR) Unit, which will supply you with the names
and addresses of the network providers nearest you, or you may
access our website at www.davisvision.com
and utilize our "Find a Doctor" feature.
What are the plan benefits, frequencies and costs?
EYE EXAMINATIONS..Every 12 months, including dilation as professionally
indicated. In Network Copayment..None Out-of-Network..Reimbursement
up to $30.00
SPECTACLE LENSES..Every 12 months In-Network Copayment..None.
You may select a frame from the Premier selection in the exclusive
"Tower Collection" available in most network provider
offices. A $56.19 credit will be applied toward a network providers
own frame. Out-of-Network..Reimbursement up to $30.00 for frames,
up to $25.00 for single vision lenses. $35.00 for bifocals, $45.00
for trifocals, $45.00 for- lenticular (post-cataract) lenses
CONTACT LENSES..Every 12 months In-Network Copayment..None. Standard,
soft, daily-wear, disposable. or planned replacement contact
lenses may be selected in lieu of eyeglasses. A $100.00 credit
will be applied toward contact lenses from the provider's own
supply (which may or may not apply toward fittinglfollow-up care
fees). Medically necessary contact lenses for the correction
of Keratoconus are covered up to $500.00 with prior approval.
Out-of-Network..Reimbursement up to $75.00 for cosmetic contact
lenses, up to $225.00 for medically necessary contact lenses
for the correction of Keratoconus with prior approval.
Please note contact lenses can be worn by most people. Once the
contort lens option is selected and the lenses are fitted, they
may not be exchanged for eyeglasses Routine eye examinations
may ar may not include professional fees for contact lens evaluations.Any
applicable fees are the responsibility of the patient
* Disposable contact lens wearers will receive four multi-packs
of lenses. Planned replacement contact lens wearers will receive
two multi-packs of lenses.
What lenses/coatings are included?
Plastic or glass single vision, bifocal or trifocal lenses,
in any prescription range.
Glass grey #3 prescription lenses,
Fashion, sun or gradient tinted plastic lenses.
Photogrey Extra@ (photosensitive) glass lenses.
Blended invisible bifocals.
Ultraviolet (UV) coating.
Polycarbonate (impact resistant) lenses.
Standard and premium anti-reflective coating (ARC).
Plastic photosensitive lenses.
High-index (thinner and lighter) lenses.
Intermediate vision lenses.
Progressive addition multifocals.**
**Progressive addition multifocals can be worn by most people
Conventional bifocals will be supplied at no additional cost
for .anyone who is unable to adapt to progressive addition lenses
When will I receive my eyewear?
Your eyewear will be sent to your provider from the laboratory
generally within two to five business days. More delivery time
may be needed when out-of-stock frames, anti-reflective coating
(ARC), specialized prescriptions or non "Tower Collection"
frames are selected.
What about out-of-network provider benefits?
You may receive services from an out-of-network provider, although
you will receive the greatest value and maximize your benefit
dollars if you select a provider who participates in the network.
If you choose an out-of-network provider, you must pay the provider
directly for all charges and then submit a claim for reimbursement
Vision Care Processing Unit
PO. Box 1525
Latham, NY 12110
To request claim forms, please visit the Davis Vision website
or call 1-800-999-5431.
May I use the benefit at different times?
To maintain continuity of care, we recommend that all services
be obtained at one time from either a network or an out-of-network
Information about Low Vision Services:
You and your covered dependents are entitled to a comprehensive
low vision evaluation once every five years and low vision aids
up to the plan maximum. Up to four follow-up care visits will
be covered during the five year period.
Information about LaserVision Correction Services:
Davis Vision is pleased to provide you and your eligible family
members with the opportunity to receive LaserVision Correction
Services at significant discounts through a network of experienced,
credentialed surgeons (please note that some providers have flat
fees equivalent to these discounts). For more information, please
visit our website at www.davisvision.com
or call 1-800-999-5431.
More special features:
Free membership and access to a mail order replacement
contact lens service, Lens 123, providing a fast and convenient
way to purchase replacement contact lenses at significant savings.
For more information, please call 1-800-LENS-123 ( I-800-536-7123)
or visit the Lens 123 website at www.Lens123.com.
A one year unconditional breakage warranty is provided
for all eyeglasses completely supplied by Davis Vision.
Are there any exclusions?
The following items are not covered by this vision program:
Medical treatment of eye disease or injury.
Special lens designs or coatings, other than those previously
Replacement of lost eyewear.
Non-prescription (plano) lenses.
Services not performed by licensed personnel.
For more information, please visit Davis Vision's website at
or call DavisVision at I-800-999-5431 to:
Learn about the DavisVision company.
Access the Interactive Voice Response Unit which will
provide network providers nearest you.
Verify eligibility for yourself or your dependents.
Request an out-of-network provider reimbursement form.
Understand emergency care.
Speak with a Member Service Representative.
Ask any questions about yourVision Care benefits.
Member Service Representatives are available:
Monday through Friday, 8:00 AM to 8:00 PM, Eastern Time,
Saturday, 9:00 AM to 4:00 PM Eastern Time.
Participants who use a TTY (Teletypewriter) because of a hearing
or speech disability may access TTY services by calling 1-800-523-2847.
Your rights as a patient:
Davis Vision recognizes that all patients have specific rights,
including, but not limited to:
The right to complete information about their healthcare
options and consequences.
The right to participate in all treatment decisions.
The right to dignity, privacy, confidentiality and non-discrimination.
The right to complain or appeal any decision.
Patients also have the responsibility:
To provide complete and accurate information.
To follow care instructions.
For a complete copy of Your Rights and Responsibilities As a
Patient, please visit our website at: www.davisvision.com
or call 1-800-999-5431.