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Finding In-Network Vision
Providers

Remember to visit in-network We partner with NVA to offer you and your family members vision
provider to receive the deepest insurance. Visit www.e-nva.com to ind in-network providers and
level of discount on your services . access to a variety of online tools and programs.
To find a participating in- In-Network Out-of-Network
network dentist in your area Copay
go to www.e-nva.com or call Exam Covered 100% Up to $35
800.672.7723. Materials $10 Copay
Lenses
Single Covered 100% after Up to $20
Bifocal $10 copay Up to $30
Trifocal Up to $55
Lenticular Up to $75
Standard Scratch Covered 100% Up to $8
Coating
Frames
Up to $110 (20% Up to $40
discount off balance)
Contacts
Elective $110 allowance, plus Up to $100
10-15% discount over
allowance
Medically Necesasary Covered 100% Up to $200
Contact Lense Fit/Follow-Up
Standard Daily Wear Covered 100% after Up to $20
$20 copay
Standard Extended Covered 100% after Up to $30
Wear Specialty Wear $30 copay
Specialty Wear Covered 100% after Up to $50
$50 copay
Frequency
Exam 12 months
Lenses 12 months
Contacts (in lieu of 12 months
glasses)
Frames 24 months

This is a high level summary of your benefit coverage . Full coverage details are
available in your summary plan description (SPD) . In the event there is a discrepancy
between what is reflected in this guide and what is communicated in your SPD, the
terms of your SPD will prevail .

20 2019 Benefits Guide