Davis Vision Copay



Two rewards you can earn:

Who does not carry the Davis Vision Collection (such as Vistar or a retailer like Visionworks ®, etc.), you will pay a $15 copay for the contact lens evaluation. Copay Eye Examination $10 $10 Contact Lens Evaluation, Fitting & Follow up Care $20 $20 Spectacle Lenses $20 $20 Frames Any frame in the provider’s office $130 allowance 20% discount on balance /1 $130 allowance 20% discount on balance Davis Vision’s Frame Collection/2 (in lieu of Allowance) Fashion frame $0 Designer frame $0 Premier frame. Davis Vision EyeMed MetLife; Conventional. $0 copay up to $150, then 85% of balance over $150; or, four boxes from Collection lenses ($105) $0 copay up to $150, then 85% of balance over $150 ($150).

What Does Davis Vision Plan Cover

  1. Free PCP visits:
    • To earn free PCP visits, select a PCP, and
    • Complete the RealAge® test (an online health assessment that helps you determine the physical age of your body compared to your calendar age.)
  2. $5 reduction to your specialist copay:
    • To receive a $5 reduction in your specialist copay, complete one of the recommended screenings listed in the State of Maryland Wellness Plan Activities (PDF).

The $5 reduction to your specialist copay will be activated after CareFirst receives a verified paid claim. The claim must meet certain requirements including having gone through the CareFirst claims review process and have been paid. CareFirst will update the member's account to show the $5 copay reduction has been granted. The entire process may take up to 45 days.

To access the above activities, simply log in to your Sharecare account, click Achieve, then Rewards. Next, click State of Maryland Wellness Program 2021. The sooner you complete your wellness plan activities, the sooner you start saving. If you require assistance with the wellness program or completing any activity, call Sharecare at 877-260-3253.

VisionDavis Vision Copay

*Sharecare, Inc. is an independent company that provides health improvement management services to CareFirst members. Sharecare, Inc. does not provide CareFirst BlueCross BlueShield products or services and is solely responsible for the health improvement management services it provides.

(state and higher education employees | retirees if enrolled in the state’s retiree group health plan and receiving a monthly pension from TCRS based on own service or participating in a higher education optional retirement plan | local education and local government employees contact agency to see if agency participates)

The state offers two voluntary vision options through Davis Vision. Members pay the full monthly premium.

How Much Does Davis Vision Cover

Click here to see the 2021 vision premium rates.

Davis Vision Copay

Davis Vision
800.208.6404
Monday - Friday, 7-10; Saturday, 8-3; Sunday, 11-3 CT
Basic Client Code: 8155
Expanded Client Code: 8156
davisvision.com/stateoftn

Cover

Members can request additional ID cards by contacting the carrier or by using the carrier’s mobile app. Employees new to coverage, or who change or transfer plans, will receive new ID cards.

You can choose from two vision options

Basic Plan

  • Pays for your eye exam and various “allowances” (dollar amounts) for materials such as eyeglass frames, lenses, contact lenses, etc.

Expanded Plan

  • Includes greater “allowances” (dollar amounts) and additional materials versus the Basic Plan.

In both plans you pay copays and coinsurance on materials or other services when the cost exceeds the allowed dollar amount.

The Basic and Expanded plans are both managed by Davis Vision. In-network and out-of-network benefits are available. You will receive the maximum benefit when visiting a provider in Davis Vision’s network.

It is important to check the network for your provider and other providers in your area. You can look for your provider by going to davisvision.com/stateoftn.

Both plans offer the same services, including:

  • Routine eye exam once every calendar year
  • Frames once every two calendar years
  • Choice of eyeglass lenses or contact lenses once every calendar year
  • Discount on LASIK/refractive surgery
  • Discount on Hearing Aids (includes Free Hearing Exam) through Your Hearing Network (YHN)

Additional benefits, based on the plan you choose, include:

  • Zero ($0.00) copay for single vision, bifocal, trifocal or lenticular lenses purchased at an in-network location.
  • Free pair of eyeglass frames from any Davis Vision’s “The Exclusive Collection”, which includes “Fashion, Designer and Premier” Selections under the in-network Expanded Plan.
  • Free pair of “Fashion Selection” eyeglass frames from Davis Vision’s “The Exclusive Collection” under the in-network Basic Plan. “Designer” and “Premier” Selections have $15 and $40 copays respectively.
  • Free pair of frames at Visionworks retail locations.
  • 40% discount off retail under the in-network Expanded Plan and 30% discount off retail under the in-network Basic Plan for an additional pair of eyeglasses, except at Walmart, Sam’s Club or Costco locations.
  • 20% discount off retail cost of an additional pair of conventional or disposable contact lenses under the in-network Expanded Plan.
  • One-year warranty for breakage of most eyeglasses.

Additional lens and coating benefits

Davis Vision CopayDavis
  • High Index Lenses -- 1.74
  • Progressive Lenses -- Ultimate Tier
  • Anti-reflective Coating -- Ultimate Tier
  • Premium Scratch-resistant Coating
  • Digital Single Vision Lenses
  • Trivex Lenses
  • Blue Light Filtering (Coatings & Lens Options)
  • Scratch Protection Plan
For questions about Vision Insurance you can go to davisvision.com/stateoftn. To review benefits for the plans, use these plan codes.

You can also call Davis Vision at 800.208.6404, Mon – Fri, 7 a.m. -10 p.m.; Sat, 8 a.m. - 3 p.m.; Sun, 11 a.m. - 3 p.m., Central time.

General limitations and exclusions that are not covered under the vision plan:

  • Treatment of injury or illness covered by workers' compensation or employer's liability laws
  • Cosmetic surgery and procedures
  • Services received without cost from any federal, state or local agency
  • Charges by any hospital or other surgical or treatment facility and any additional fees charged for treatment in any such facility
  • Services by a vision provider beyond the scope of his or her license
  • Vision services for which the patient incurs no charge
  • Vision services where charges exceed the amount that would be collected if no vision coverage existed

Note: If you receive vision services and materials that exceed the covered benefit, you will be responsible for paying the difference for the actual services and materials you receive.

Davis Vision Copay

NOTE: A complete description of the benefits, provisions, conditions, limitations, and exclusions for the Davis Vision Basic and Expanded plans will be included in their respective Certificate of Insurance. If any discrepancies exist between the information listed above and the legal plan documents, the legal plan documents will govern. We recommend you review these documents. The documents are available at https://www.tn.gov/partnersforhealth/publications/publications.html.