The PBA Health and Welfare Fund Vision Plan (Plan) provides coverage for periodic eye examinations and prescription eyewear through a contract with Davis Vision, a leading national administrator of vision care benefits.
In-Network Benefits Provided
The Plan provides one (1) comprehensive eye examination per twelve (12) month period and one (1) set of prescription eyewear per twelve (12) month period to members and their eligible dependents when obtained using a Davis Vision Network Provider.
Annual Eye Examination
Each member and dependent is eligible, at no out-of-pocket cost, for one (1) comprehensive eye examination every twelve (12) months. When visiting a Visionworks location, contact lens evaluation, fitting, and follow-up visit will be included as a part of the comprehensive eye examination at no additional cost. If a member or dependent uses a participating provider other than Visionworks, contact lens evaluation, fitting, and follow-up visit will be included as a part of the comprehensive eye examination only if the member or dependent:
- Chooses to be evaluated and fit with formulary contact lenses in lieu of eyeglasses; and
- Is deemed a suitable candidate for contact lenses; and
- Is able, in consultation with the Participating Provider, to be fitted with Formulary contact lenses.
If any of the three (3) conditions described above are not met, the member or dependent is responsible for the costs associated with the contact lens evaluation, fitting, and follow-up.
Each member and dependent is eligible to receive, at no out-of-pocket cost, one (1) set of prescription eyewear every twelve (12) months. A set of prescription eyewear includes one (1) of the following:
- Eyeglasses, consisting of frames from Davis Vision’s Fashion, Designer, or Premier level, fitted with prescription lenses provided by Davis Vision. When Visiting a VisionWorks location, members may choose from an expanded selection of frames up to a retail value of $149.95. The lenses and coatings that are available at no cost are described later in this section.
- Prescription lenses provided by Davis Vision and fitted into member/dependent supplied frames.
- Contact lenses selected from Davis Vision’s formulary contact lens list (in lieu of eyeglasses).
No-Cost Lens Options
The following lenses/coatings are available at no out-of-pocket cost:
- Plastic or glass single vision, bifocal or trifocal lenses, in any prescription range
- Polycarbonate spectacle lenses for
- Active New York City Police Officers (Members)
- Dependent children
- Monocular patients
- Patients with prescriptions of +/- 6 diopters or greater
- Glass grey #3 prescription lenses
- Post-cataract lenses
- Fashion, sun or gradient tinted plastic lenses
- Mirror coating
Other lens and coating options are available with co-payments. Information about lens coatings and co-payments can be found online at www.davisvision.com.
How to Use Your In-Network Vision Benefit
Follow these steps to get the most out of your Vision Plan by using in-network vision providers:
- First, find a participating provider on Davis Vision’s website at davisvision.com or call Davis Vision at 1-800-999-5431. Davis Vision’s network includes Visionworks locations as well as licensed vision care providers in private practice and at retail locations throughout the United States.
- Once you have chosen an in-network provider, call to make an appointment for an eye examination, and identify yourself as a PBA Health and Welfare Fund Member and a Davis Vision customer.
- If you are interested in using your eyewear benefit for contact lenses in lieu of eyeglasses, be sure to notify the provider so that your contact lens evaluation may be included as part of your comprehensive eye examination.
- If you require prescription eyewear, select your frames from Davis Vision’s Fashion, Designer, or Premier frame collections. Most participating providers have the latest frames at their locations. If you cannot find a suitable frame, you may view Davis Vision’s entire frame collection online at davisvison.com and provide the frame identification number to your provider. When visiting a VisionWorks location, members may choose from an expanded selection of frames up to a retail value of $149.95.
- If you choose to receive contact lenses in lieu of eyeglasses, your provider will be able to explain your options and help you choose a supply of contact lenses from Davis Vision’s formulary list.
Although it is recommended that you select a participating provider in Davis Vision’s network, the Plan provides the following out-of-network benefits:
- Eye Examination: Reimbursement of up to $15.00
- Eyeglasses: Reimbursement of up to $25.00
If you choose to obtain services from an out-of-network provider, you must pay the provider directly and then submit a claim for reimbursement to:
Vision Care Processing Unit
P.O. Box 1525
Latham, NY 12110
Warranty on Eyewear
There is a one (1) year warranty on Plan material breakage, including but not limited to, spectacle lens and Davis Vision collection frame defects, at no additional cost. All plan eyeglasses come with a breakage warranty for repair or replacement of the frame and/or lenses for a period of one (1) year from the date of delivery. The warranty applies to all plan covered eyeglasses, i.e., spectacle lenses and Davis Vision Collection frames. There is a ninety (90) day warranty on prescription changes for eyeglasses (thirty (30) days for contact lenses). Progressive lenses may be returned in the case of non-adaptation within sixty (60) days and replaced with conventional lenses.