Page 43 - Amerihealth New Jersey - 59-99 - 2021 Benefits at a Glance

Vision
adds value to your benefits package
Access to a a a a a a free hearing hearing exam and exclusive discounts on
hearing hearing aids supplies and more from Your Hearing Network through Davis Vision
Members can get discounts on
on
on
on
contact lens replacement and laser vision correction
If you you choose DPOS or POS POS medical plans routine eye exams are included and you you can choose to enhance your benefit with a a a a a a plan that includes frames and lenses If you you offer PPO medical plans plans you can choose any one of our vision plans plans for complete coverage 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 24 months/24 months
months
12 months/24 months
months
12 12 months/12 months
months
12 12 months/12 months
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 to $100 or up to to $150 at Visionworks
plus 20% off on
any overage9
Up to to $100 or up to to $150 at Visionworks
plus 20% off on
any overage9
Up to to $100 or up to to $150 at Visionworks
plus 20% off on
any overage9
Up to to $100 or up to 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 and specialty lens types
15% discount 15% discount 15% discount 15% discount 2021 Large Group Plans 41
Please see footnotes on
page 46