The Optical Plan is provided through Davis Vision
How does the Optical plan work?
Download Davis Vision Open Plan Reimbursement Claim Form
Call Davis Vision for a list of providers.
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?
- 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
- 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