Page 41 - Amerihealth New Jersey - 59-99 - 2021 Benefits at a Glance

VISION CARE 100
Frequencies
24 months
24/24/24
12 months
12/12/24
12 months
12/12/12
12 months
12/12/12
Eye Exam10
Spectacle lenses/frames
24 months/24 months
12 months/24 months
12 months/12 months
12 months/12 months
Contact Lenses
24 months
12 months
12 months
12 months
Copays
Eye exam/spectacle lenses
Non-collection frame allowance (retail)
$10/$25
$10/$25
$10/$25
$0/$0
Frame
Up to $100 or up to $150 at Visionworks, plus 20% off on
any overage9
Up to $100 or up to $150 at Visionworks, plus 20% off on
any overage9
Up to $100 or up to $150 at Visionworks, plus 20% off on
any overage9
Up to $100 or up to $150 at Visionworks, plus 20% off on
any overage9
Davis Vision Frame Collection in lieu of allowance; fashion/designer/premier
$0/$15/$40
$0/$15/$40
$0/$15/$40
$0/$15/$40
Contact Lenses
Collection contact lenses (in lieu of allowance)
Not covered
Not covered
Not covered
Not covered
Collection Evaluation, fitting, follow-up care
Non-collection contact lenses: materials allowance8
Not Covered
Up to $100 plus a 15% discount on any overage
Not Covered
Not Covered
Not Covered
Up to $100 plus a 15% discount on any overage
Up to $100 plus a 15% discount on any overage
Up to $100 plus a 15% discount on any overage
Non-collection evaluation, fitting and follow-up care; standard and specialty lens types
15% discount
15% discount
15% discount
15% discount
Vision adds value to your benefits package
Access to a free hearing exam and exclusive discounts on hearing aids, supplies, and more from Your Hearing Network through Davis Vision
Members can get discounts on contact lens replacement and laser vision correction
If you choose DPOS or POS medical plans, routine eye exams are included, and you can choose to enhance your benefit with a plan that includes frames and lenses. If you offer PPO medical plans, you can choose any one of our vision plans for complete coverage.
Please see footnotes on page 44
2021 Large Group Plans 39