Optical Plan

The Optical Plan is provided through Davis Vision

How does the Optical plan work?

• Call the network provider of your choice and schedule an appointment
  network provider list

• Identify yourself as a Davis Vision Plan Participant and NAGE/SEIU Local 5000 Trial Court of Massachusetts Health and Welfare Fund member or covered dependent

• Provide the office with the member’s Identification number and the name and date of birth of any covered children needing services.

• You can call Davis Vision directly at 1-800-999-5431 or you can go to the Davis Vision web site www.davisvision.com

What are the Plan Benefits?
download brochure

In-Network Benefit

• Eye Examination – Every 12 months - Co-payment $12.00
• Eyeglasses – Every 24 months
• Lenses - Co-payment $10.00
• Frames - Co-payment $ 5.00
• Contact Lenses – Every 24 months - Co-payment $45.00

Out-of-Network Benefit

• Eye Examination – Every 12 months - Reimbursed up to $25.00
• Eyeglasses/Contact Lenses – Every 24 Months
• Frames – Reimbursed up to $25.00
• Single Vision Lenses - Reimburse up to $20.00
• Bifocal Lenses - Reimbursed up to $40.00
• Trifocal Lenses - Reimbursed up to $55.00
• Contact Lenses – Reimbursed up to $100.00